Clinical laboratories, which have faced significant Medicare reimbursement cuts in recent years, are likely to face additional payment threats this year, according to speakers at the annual meeting of the American Clinical Laboratory Association (ACLA), held April 3-4 in Washington, D.C. “We are clearly in an era of fiscal austerity, and everyone is being affected,” said Norman Ornstein, resident scholar at the American Enterprise Institute. As lawmakers look for a way to reform the sustainable growth rate and Medicare, they also will be looking for offsets to help pay for these changes. Such changes could include a lab copay or additional cuts, said speakers. To help prevent such cuts, it’s critically important that lab representatives make personal connections with lawmakers, said Dave King, ACLA chairman of the board and chairman and chief executive officer of Laboratory Corporation of America. “I challenge you to get a member of Congress into your lab. It’s very important to put a face on the industry.” These types of personal connections are crucial when it comes time for senators and congressmen to vote on legislation that affects labs, he noted. Labs already were hit this year with an almost 5 percent cut in Medicare payment […]
Clinical laboratories, which have faced significant Medicare reimbursement cuts in recent years, are likely to face additional payment threats this year, according to speakers at the annual meeting of the American Clinical Laboratory Association (ACLA), held April 3-4 in Washington, D.C.
“We are clearly in an era of fiscal austerity, and everyone is being affected,” said Norman Ornstein, resident scholar at the American Enterprise Institute. As lawmakers look for a way to reform the sustainable growth rate and Medicare, they also will be looking for offsets to help pay for these changes. Such changes could include a lab copay or additional cuts, said speakers.
To help prevent such cuts, it’s critically important that lab representatives make personal connections with lawmakers, said Dave King, ACLA chairman of the board and chairman and chief executive officer of Laboratory Corporation of America. “I challenge you to get a member of Congress into your lab. It’s very important to put a face on the industry.”
These types of personal connections are crucial when it comes time for senators and congressmen to vote on legislation that affects labs, he noted. Labs already were hit this year with an almost 5 percent cut in Medicare payment in addition to substantial reductions in Medicare reimbursement for molecular diagnostic tests. The industry cannot absorb any more cuts, said King.
Negotiated Rulemaking Redux?
In a separate exchange with Marc Hartstein, director of the Hospital and Ambulatory Policy Group at the Centers for Medicare and Medicaid Services (CMS), King called for a more constructive relationship with CMS, noting that there has been little transparency in the process used by Medicare contractors to set new payment rates for more than 100 new molecular pathology (MoPath) codes. He suggested that industry representatives sit down with CMS officials and Medicare contractors to discuss code pricing, much as they did during the negotiated rulemaking in 2001 that established national coverage and administrative policies for clinical laboratory services under Medicare Part B.
In response, Hartstein said that there already is a process in place by which Medicare contractors are gathering information from labs that they need to set the MoPath prices. Meeting participants responded that many contractors have rebuffed attempts to provide additional information or to engage them in conversation.
According to Hartstein, contractors are supposed to determine pricing based on a number of factors: charges for the test and discounts to charges, resources required to perform the tests, payment amounts determined by other payers, and charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant.
Contractors were to have submitted their draft prices to CMS by April 1. CMS will post these contractor-specific amounts on the agency Web site by April 30, and the industry and public will have 60 days to comment. Contractor prices may be adjusted based on comments and will be finalized by Sept. 30, with a 30-day reconsideration period. According to Hartstein, contractors are required to provide a rationale for their final pricing amounts.
