STOP LAB

CUTS

Medicare payment cuts threaten access to clinical lab services and undermine our nation’s laboratory infrastructure. Tell Congress to protect patients and enact the Saving Access to Laboratory Services Act (S. 4449/H.R. 8188).

Screening and diagnostic tests performed by clinical laboratories inform life’s most important health care decisions

Medicare reimbursement cuts, scheduled for January 2023, could jeopardize access to many of the clinical laboratory tests that are used to diagnose, monitor, prevent, and manage common diseases for more than 50 million seniors.

But the threat doesn’t stop there. After three prior rounds of 10% 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.

Medicare reimbursement cuts also weaken investment in the next generation of diagnostic tests, including those that serve as the foundation for personalized care for diseases like cancer.

IMPACT ON PATIENTS

Routine tests play a critical role in health care and most cost between $5 and $12. Without congressional action, reimbursement for clinical laboratory tests will be cut by up to 15 percent in 2023. This is on top of three previous rounds of cuts over the past five years for tests used to screen and diagnose diabetes, heart disease, cancer, and other chronic conditions. If SALSA is not enacted this year, somecommonly used tests will see a cumulative cut of up to 38 percent. Cutting reimbursement for laboratory services could mean cutting access for America’s seniors and all patients.

PAMA cuts could impact access to laboratory tests, including at:

Skilled Nursing Facilities

Most skilled nursing facilities are served six days per week by clinical laboratories that often provide same-day results to inform treatment options for patients.
Prior to the PAMA cuts, there were 25 clinical laboratories that specialized in providing care to skilled nursing facility patients. Today, only seven remain.
Without congressional action, the most medically complex, frail, and vulnerable patients in skilled nursing facilities may experience compromised access to timely and comprehensive clinical laboratory testing essential to treating medically complex conditions.

PAMA cuts could impact clinical laboratory tests for many serious conditions including:

Diabetes

The Centers for Disease Control and Prevention estimates that 37.3 million adults in the United States have diabetes and one in five of them do not know they have it.
A1C is a routine blood test, typically ordered by a primary care provider, to assess if a patient has or might be at risk of developing diabetes, and it helps health care providers monitor diabetic patients’ average glucose levels over time.
In 2020, more than 17 million Medicare beneficiaries had a hemoglobin A1C test. Without congressional action, payment for this test will be cut an additional 13 percent in January 2023, making it potentially more difficult for seniors to access.

PAMA cuts could impact clinical laboratory tests for many serious conditions, including:

Cardiovascular Disease

Heart disease is the leading cause of death for Americans aged 65 and older.
In 2020, more than 28 million tests were ordered to diagnose and monitor heart disease, including tests to measure cholesterol and triglycerides.
Despite the enormous human health and economic burden of this disease, a number of commonly ordered tests, collectively face an additional 14 percent reimbursement cut in 2023.

PAMA cuts could impact clinical laboratory tests for many serious conditions, including:

Heart, Liver, and Kidney Conditions

Comprehensive metabolic panel is a widely used routine blood test that helps providers diagnose, screen for, and monitor certain health conditions.
In 2020, comprehensive metabolic panel tests were ordered for about 40 million Medicare beneficiaries to assess blood sugar and electrolyte levels, and for indications of how the kidneys, liver, and heart are functioning – including after a COVID-19 infection.
Reimbursement for the comprehensive metabolic panel will be cut by an additional 14 percent in 2023.

PAMA cuts could impact clinical laboratory tests for many serious conditions, including:

Cancers

Nearly 90,000 Medicare beneficiaries had testing commonly ordered to diagnose leukemia and hereditary breast and colon cancer in 2020.
Tests for hereditary colon cancer and leukemia are scheduled for an additional 15 percent rate reduction in 2023.
Tests for hereditary breast cancer will be cut by an additional 12 percent in 2023.

PAMA cuts could impact clinical laboratory tests for many serious conditions, including:

Chronic Kidney Disease

Laboratory tests that allow early diagnosis of chronic kidney disease are key to preventing kidney failure.
These critical laboratory tests were performed for more than 1.5 million Medicare beneficiaries in 2020. Unless Congress steps in, Medicare reimbursement for these renal function panels will be cut by an additional 14 percent in January 2023.

THE PROBLEM

In 2014, Congress passed the Protecting Access to Medicare Act (PAMA). PAMA was designed to align Medicare payment for clinical laboratories 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 2023.

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 three times to “press the brakes” on harm caused by PAMA, and now is the time to ease the cuts for the long-term, with congressional action before the next round of cuts go into effect in January 2023. 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 the Saving Access to Laboratory Services Act (SALSA)

The Saving Access to Laboratory Services Act (S. 4449/H.R. 8188) would simplify the data reporting process by directing the Centers for Medicare & Medicaid Services (CMS) through new 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 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.

SALSA SUPPORTERS

TAKE ACTION

Tell Congress to stop Medicare cuts to clinical laboratory testing.

Sponsored by the American Clinical Laboratory Association