January 1, 2023 Update: Congress passed the Consolidated Appropriations Act for Fiscal Year 2023, which includes a one-year delay to reimbursement cuts and reporting resulting from PAMA.
Without congressional action, the fourth round of Medicare reimbursement reductions mandated by the Protecting Access to Medicare Act (PAMA) will affect laboratories across the country in January 2023. The American Clinical Laboratory Association (ACLA) is urging Congress to pass the Saving Access to Laboratory Services Act to postpone further implementation of PAMA.
According to ACLA, under PAMA, clinical laboratories have already experienced three years of compounding cuts to the most popular tests, including the top 25 tests most frequently used by seniors. ACLA emphasized that reimbursement for more than 800 lab tests would be reduced by up to 15 percent under the upcoming round of Medicare reductions. ACLA attributes these cuts to an inadequate data reporting system. As part of PAMA, the U.S. Department of Health and Human Services (HHS) was tasked with establishing market-based rates for clinical laboratories with one national fee schedule. According to ACLA, HHS gathered private market rate information from an unrepresentative sample of less than 1 percent of laboratories nationwide.
“By ignoring the payment data from more than 99 percent of the nation’s laboratories, HHS’ actions have already had an adverse impact on patient care and market stability,” ACLA states.
ACLA notes that Congress is “poised to permanently improve implementation of the PAMA reimbursement model and protect the more than 50 million seniors and all patients who rely on screening and diagnostic tests to manage their health through the Saving Access to Laboratory Services Act.” The bill would permanently ease Medicare cuts and address the issues of PAMA by collecting representative market data “to achieve accurate and sustainable rates for laboratory services,” ACLA writes in a statement.
ACLA adds: “Rather than weaken the health care system with further PAMA cuts, the nation’s clinical laboratory infrastructure should be strengthened, ensuring laboratories have the tools and resources necessary to continue serving patients, innovate, and prepare for and respond to future public health challenges.”
Sources:
https://www.acla.com/wp-content/uploads/2021/05/ACLA_PAMA-Backgrounder_5.20.2021.pdf
