STOP LAB CUTS
Screening and diagnostic tests performed by clinical laboratories inform life’s most important health care decisions.
Scheduled reimbursement cuts under the Protecting Access to Medicare Act (PAMA) could jeopardize access to many of the clinical laboratory tests that are used to diagnose, monitor, and manage common diseases for more than 65 million seniors.
But the threat doesn’t stop there. After three prior rounds of up to 10 percent cuts, planned payment reductions of up to an additional 15 percent in 2025 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. Strong clinical laboratories are foundational to the U.S. health care system.
Medicare reimbursement cuts also weaken investment in the next generation of diagnostic tests, including those that enable personalized care for diseases like cancer.
IMPACT ON PATIENTS
Routine tests play a critical role in health care. Without congressional action, about 800 tests will face payment cuts. Learn more about how these tests are used and the potential impact of Medicare cuts on patients:
Skilled Nursing Facilities
Diabetes
Heart
Disease
Kidney, Heart and Liver Conditions
Cancers
Chronic Kidney Disease
Viral
Hepatitis
HIV
THE PROBLEM
Congress passed the Protecting Access to Medicare Act (PAMA) in 2014. The legislation was designed to align Medicare payment for clinical labs with prevailing market rates across the country. Unfortunately, the first round of market data was collected from less than one percent of the nation’s laboratories – far from representative of market rates. Congress’s scorekeeper, the Congressional Budget Office, originally projected $2.5 billion in cuts to reimbursement rates over 10 years if PAMA was implemented as Congress intended; however, the last three rounds of cuts have already reached $4 billion with a pending round of further cuts scheduled for January 2025.
Without congressional intervention this year, laboratories across the country will face tough decisions potentially reducing services offered to patients and curbing investment in the next generation of diagnostic tests. Physician offices may stop offering essential laboratory tests, and independent laboratories could be forced to close. These cuts will impact the most common laboratory tests in health care, including those used for the management of heart disease, diabetes, cancer, and many other common and complex health conditions. In short, these scheduled Medicare cuts will undermine laboratory infrastructure essential for day-to-day care and critical to public health emergencies, while also stifling investment to advance innovative new screening and diagnostic tests.
Congress has acted on a bipartisan basis four times to “press the brakes” on harm caused by PAMA, and now is the time to put lab payment policy on the right trajectory for the long-term, with congressional action before the next round of cuts go into effect in January 2025. The outcome of these cuts is predictable: Delayed and disrupted care could lead to the worsening of health care status for at-risk and vulnerable seniors, ultimately resulting in higher costs for everyone, and undermining any potential cost-savings from uniform reimbursement.
THE SOLUTION
The Solution Is Simple: Enact H.R. 2377 / S. 1000, the Saving Access to Laboratory Services Act (SALSA)
SALSA would simplify the data reporting process by providing the Centers for Medicare & Medicaid Services (CMS) with the authority to collect data from a statistical sampling of all major types of laboratories that provide services to seniors, including independent, hospital, and physician office laboratories. Targeted sampling, as designed by SALSA, is a straightforward solution to collecting complete 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.
SALSA SUPPORTERS
TAKE ACTION
Tell Congress to stop Medicare cuts to clinical laboratory testing.