Lab Reimbursement Looks for a Lifeline with a New ACLA Campaign

In a decisive move, the American Clinical Laboratory Association (ACLA) is attempting to rally the lab community and stakeholders across the nation while taking on Congress by creating a new campaign called the “Stop Lab Cuts campaign.” The campaign is an effort to safeguard patient access to laboratory services through an advocacy effort to pass the Saving Access to Laboratory Services Act (S. 4449/H.R. 8188) by the end of the year. With proposed policies over the years aiming to strike and weaken reimbursement, staffing levels impacted by the great resignation, and the general financial turmoil created by a global pandemic, the value of protecting dwindling reimbursement is imperative.

A Looming Threat

As you may know, Medicare payment cuts are likely coming at the start of next year. By cutting reimbursement, access to diagnostic tests could be put at risk. However, according to the ACLA, there are even more consequences at stake stating “After three prior rounds of 10 percent cuts, additional reductions to payments may result in a weakened clinical lab infrastructure, making it more difficult to deliver routine health care and respond to the next public health crisis. Without strong clinical laboratories, the nation’s response to COVID-19 would have been severely hampered.”

According to the ACLA, over 800 tests across the nation are slated to experience an up to 15 percent reimbursement cut at the start of the next year. However, this is the shadow of “previous rounds of cuts between 2017 and 2022 that resulted in payment for tests used to screen and diagnose diabetes, heart disease, and other chronic conditions to be cut by 27 percent. Some tests could see a cumulative cut of up to 41 percent.”

Furthermore, reimbursement cuts stifle investment in future generations of diagnostic tests.

The Promise of Potential Legislation

The bipartisan and bicameral legislation plans to adjust the existing 2014 Protecting Access to Medicare Act (PAMA). As many may know the PAMA Act, has resulted in “significant cuts to Medicare payments for routine laboratory tests that guide clinical decision-making.” By building a robust clinical laboratory infrastructure, healthcare will be able to reinforce the execution of everyday patient care. This structure, if properly maintained, can provide protection against the inevitable future public health crisis. The Saving Access to Laboratory Service Act would support existing needs while creating innovation for future generations of clinical diagnostics.

In an online press release, Susan Van Meter, ACLA President, commented that “Without congressional intervention this year, laboratories across the country will face a fourth round of Medicare reimbursement cuts, which could threaten the delivery of routine care, undermine the clinical laboratory infrastructure needed to manage multiple public health challenges, and reduce investment in innovation, Congress has acted three times to delay these harmful reimbursement cuts, but long-term reform is needed to safeguard access to the essential tests that patients need.”

The act was put forward early this summer in June by senators Sherrod Brown (D-OH) and Richard Burr (R-NC), along with Reps. Bill Pascrell (D-NJ), Scott Peters (D-CA), Richard Hudson (R-NC), Gus Bilirakis (R-FL), and Kurt Schrader (D-OR). The act would break down the data reporting and offer a simplified process. Policies within the act guide the Centers for Medicare & Medicaid Services (CMS) to gather data from a statistical sampling of not just a few types of labs but all significant types of labs including hospital, independent, and physician office laboratories.

The ACLA praised the potential policy, stating “Targeted sampling, as designed by the Saving Access to Laboratory Services Act, is a straightforward solution to collecting representative private market data to achieve accurate and sustainable Medicare rates for laboratory services. In the long-term, sustainability for lab reimbursement will support strong clinical laboratory infrastructure to protect public health and innovation in tomorrow’s diagnostics while providing robust access to improve patient health.”

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