It is fascinating to think that just a few years ago if someone wanted to take a family trip to Miami from Seattle; it would take around a 49-hour car ride and a lot of “are-we-there-yets.”
In 2014, Congress passed the Protecting Access to Medicare Act (PAMA) to direct the Centers for Medicare and Medicaid Services (CMS) to develop a market-based methodology for determining the future rates Medicare will pay for tests under the Clinical Laboratory Fee Schedule (CLFS). The centerpiece of the methodology is for CMS to gather data from laboratories nationwide on the payments they receive from the private insurance market.
A deeper analysis shows that the current data collection and evaluative pricing methodology, if fully implemented, will jeopardize patient access to laboratory testing in clinics and small community independent laboratories. The cuts in Medicare rates for the common tests that clinicians use every day to treat patients will be to a level that providers may simply stop performing laboratory services.