AdvaMedDx Statement on CMS Clinical Laboratory Fee Schedule Update

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AdvaMedDx Statement on CMS Clinical Laboratory Fee Schedule Update

September 25, 2017

WASHINGTON, D.C. – AdvaMedDx released the following statement from Executive Director Andy Fish on CMS's recently issued preliminary lab payment amounts for 2018:

"Diagnostic tests provide incredible value to the U.S health care system. These tests are a cornerstone of modern medicine, accounting for a small percentage of health care expenditures but guiding much of the medical decision making underlying patient care. Until passage of the Protecting Access to Medicare Act (PAMA), Medicare’s system for paying for diagnostic tests had not been updated for almost 30 years and was a source of repeated, arbitrary cuts to offset other areas of health care spending.
 
"AdvaMedDx and other laboratory stakeholders supported PAMA because it would put in place a more objective basis for determining reimbursement rates for diagnostic tests –aligning Medicare payments with private payer rates.
 
"However, as we have expressed previously, PAMA implementation has been flawed. A fundamental premise of PAMA was that it would align Medicare diagnostic payment rates with the private payer marketplace; but the lab-reported data that Medicare has used to calculate the new payment rates does not accurately reflect the private market, due to both challenges related to the reporting system itself and to the lack of hospital and physician office lab data. For many tests, the Medicare reimbursement cuts now projected to take place under PAMA are dramatically deeper than Congress originally envisioned when it passed PAMA and it is imperative to ensure that PAMA rates are calculated correctly and that new PAMA rates will not lead to diminished access to advanced diagnostic tests.
 
"We are reviewing the data posted by CMS and will continue working with Congress, the Administration and other stakeholders to ensure that PAMA is implemented correctly.  CMS should delay implementation of new rates under PAMA until it can assure all stakeholders that they fairly reflect the full diagnostics marketplace.”