AAFP Joins Effort to Postpone PAMA Laboratory Reporting

Faulty Data Collection Practices Endanger Patients' Access to Critical Tests

July 24, 2019 06:28 pm News Staff

As part of its ongoing advocacy on behalf of patients, the AAFP recently joined 25 other physician, medical and patient organizations to ask congressional leaders to protect access to clinical laboratory services for Medicare beneficiaries.

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In a July 17 letter(2 page PDF) sent to the Democratic and Republican chairs and ranking members of the Senate Finance Committee, the House Ways and Means Committee, and the House Energy and Finance Committee, the groups urged a delay of the upcoming data reporting period associated with the Protecting Access to Medicare Act.

As required by the 2014 PAMA law,(www.cms.gov) Congress directed CMS to create a market-based fee schedule for clinical laboratory services. Unfortunately, that process created unintended consequences for labs.

"Over the past two years, more than 53 million seniors who depend on clinical diagnostics for early prevention and effective treatment of chronic diseases have faced significant cuts to these laboratory tests," said the letter.

The organizations noted that millions of seniors rely on access to lab tests "to avoid painful and costly complications" and that labs serving vulnerable patients in nursing homes and rural communities often provide "rapid test results on a daily basis in order to triage health conditions and inform clinicians of any necessary changes to treatment regimens."

Unfortunately, continued the letter, "The agency continues to rely on a faulty, incomplete data collection that has led to an erosion of seniors' lab benefits."

The organizations pointed to the crux of the problem -- CMS' decision to base lab payment on data collected from less than 1% of labs nationwide.

"CMS has imposed severe cuts -- which for some tests will exceed 30% when fully implemented," said the letter. Furthermore, the cuts "far exceed initial estimates from the Office of Management and Budget as well as the Congressional Budget Office."

CMS has failed to follow Congressional intent and the consequences have been severe, the organizations charged.

The letter noted that a survey of laboratories undertaken by the Infectious Diseases Society of America found that

  • 79% of survey respondents said they would be unable to provide the full range of testing needed to rapidly diagnose infectious diseases,
  • more than 32% changed their test menu and
  • nearly 40% refer more tests to other labs.

Referring testing out to other laboratories "can cause life-threatening delays in diagnosis and care," said the letter.

The organizations called on Congress to "take immediate action to protect seniors" by considering recently introduced bipartisan legislation known as the Laboratory Access for Beneficiaries Act(www.govinfo.gov) (H.R. 3584).

Enactment of the so-called LAB Act would delay the next round of data reporting by one year and ensure that all applicable labs that are required to report private payer data have sufficient time to do so.

In addition, the legislation would commission the National Academy of Medicine to study how implementation of PAMA could be improved to better realize Congress' intent to establish a market-based fee schedule.

In closing, the letter noted that a suspension of data reporting in 2020 would allow a more representative share of labs to report data and would give stakeholders and policymakers additional time to achieve a better solution.

Related AAFP News Coverage
AAFP Letter Cites Concerns With CMS' Proposed Lab Rule
(4/9/2019)