115 Members of Congress Urge Medicare Officials to Drop Proposal to Cut Medicare Payments for Pathology Services

in Press Releases

Washington, D.C.—The American Clinical Laboratory Association (ACLA) applauds efforts by U.S. Congressmen Jim Gerlach (R-PA),Bill Pascrell Jr. (D-NJ) and 113 of their colleagues in the House who sent a letter yesterday to Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner requesting a withdrawal of a recommendation in the CY 2014Medicare Physician Fee Schedule Proposed Rule to cut Medicare payments for pathology services that diagnose breast, colon, prostate, skin, ovarian, leukemia and other cancers.

The cuts outlined in the proposed rule amount to as much as 80% for some of the mostcommon anatomic pathology services. Medicare payments to independent laboratories would be capped to levels that hospitals are paid for the sameservice under the hospital outpatient prospective payment system (OPPS). 

In some cases, payment rates may be below the cost of providing these tests despite the fact that independent laboratory services account for less than 2% of Medicare spending and guide 70% of clinical decisions.

The bipartisan letter described the proposal to use OPPS data to determine payment for clinical laboratories as a “flawed approach” that could jeopardize Medicare beneficiaries’ access to these important diagnostic services. 

“True lab costs for providing anatomical pathology services are not reflected in dataprovided by hospitals,” said members of Congress in the letter. “In light of the importance of beneficiary access to these tests, the CMS proposal is penny wise and pound foolish.” 

The letter also argued that clinical lab services help patients and physicians choose the most appropriate care and avoid unnecessary, ineffective treatments that drive up Medicare spending.

CMS is expected to finalize its proposed rule – which would take effect in 2014 – by November 1st.

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