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Quality Clinical Laboratory Services Are the Foundation of Medical Care—and They Are at Risk

Monday, April 15, 2024   |   Category: Media Coverage

Quality clinical laboratory services are the foundation of medical care – and they are at risk

At least 70 percent of medical decisions depend upon laboratory test results, making it critical for patients to have access to timely, accurate, and reliable laboratory testing, for both routine and critical health care needs.

In 2014, Congress passed The Protecting Access to Medicare Act (PAMA), establishing a new system for the Centers for Medicare & Medicaid Services (CMS) to determine laboratory payment based on commercial market rates. CMS based its clinical laboratory payment rates on data collected from less than one percent of the nation’s laboratories. This payment determination is not representative of the vital services provided by the laboratory industry across the nation.

Since the implementation of PAMA, Medicare payments for clinical laboratory services have been cut on three separate occasions, totaling $3.8 billion, with additional cuts scheduled for the end of this year.  Significant cuts can have detrimental impacts on the laboratory infrastructure and patient care.

PAMA is a flawed law with lasting implications

Unfortunately, hundreds of existing laboratory tests used for diagnosing, monitoring, and screening health conditions have been set on an unsustainable path of multi-year Medicare cuts—up to 15%— through PAMA. These cuts are scheduled to be repeated in 2025.

Age is a major social determinant of health, making our seniors one of the most vulnerable populations to bear the inequity of PAMA cuts. Our seniors are most at risk of losing access to essential, timely, and comprehensive testing for a wide range of conditions that affect an aging population, including diabetes, heart, liver and kidney diseases, prostate and colon cancers, HIV, hepatitis, and more. These cuts have also impacted health care settings, including a reduction of services in skilled nursing facilities. Prior to PAMA, there were 25 clinical laboratories that specialized in providing care to patients in skilled nursing facilities. By 2022, there were only six remaining.

There are serious concerns with PAMA, resulting in the limited collection of representative data and the repeated cuts to Medicare reimbursement. Congress has acknowledged the importance of preventing continued implementation of PAMA given these concerns with multi-year bipartisan delays to the law. In December, Congress passed the fourth delay to PAMA’s clinical laboratory payment cuts that would have taken effect in January 2024. This is a direct result of laboratories from across the nation working together with the American Clinical Laboratory Association and other health care stakeholders to urge Congress to address these payment cuts.

One-year delays are helpful, but SALSA provides a long-term solution

The Saving Access to Laboratory Services Act (SALSA) is bipartisan legislation to ensure appropriate and representative data collection from laboratories to inform clinical laboratory payment rates in the Medicare program. The legislation also helps simplify the reporting process by providing CMS with the authority to collect data samplings from all major types of laboratories that provide services to seniors, achieving accurate, sustainable Medicare rates for those services.

SALSA would protect patient access to laboratory services, bolster clinical laboratory infrastructure, and foster innovation for the next generation of laboratory services. Ultimately, this bill would help ensure that America’s seniors have access to lifesaving laboratory tests and services. Enacting this legislation also supports investment in the next generation of diagnostics and infrastructure in global health emergencies.

Help ensure sustainability and access to laboratory services

We must ensure that the data collected to determine Medicare payments for clinical laboratory services is representative of the entire laboratory industry and its patients. This helps protect our nation’s testing capacity and infrastructure for health emergencies and day-to-day care, which are essential to meet the growing health care needs of our country, including seniors and medically underserved communities.

So, what can you do to ensure you, your family, and your community have access to the quality testing needed to live long, happy, healthy lives? Get informed and take action! Tell Arizona’s representatives in Congress to stop Medicare cuts to clinical laboratory testing. Visit StopLabCuts.org to stay up to date on the latest developments on SALSA and to send an email to your local congressperson.

David A. Dexter is president & CEO for Sonora Quest Laboratories, Arizona’s leading diagnostic laboratory system.