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.” We now live in an advanced transportation age, where the same trip by plane would only take you under six hours and a flight to Australia under a day. But with the ease and timeliness of travel, also comes devastating consequences like outbreaks.
With air travel linking people together like never before, it is easy to see the world, but also easy to spread diseases from around the globe. For example, when the Ebola virus came to the United States in 2014, it arrived on the content after a traveler returned from Africa. If it wasn’t for the expeditiousness of healthcare providers, laboratorians and public health experts this could have resulted in a nation-wide pandemic.
Physicians practicing in communities across the country see diseases when they first emerge, because when people are feeling ill they often first see their doctor or go to the local hospital. Physicians who are able to rely upon rapid, accurate testing when the patient is in their office can quickly recognize when a patient may be at risk of having an exotic disease based on their symptoms, initial laboratory results and recent travel. When an individual needs further evaluation after initial test results, physicians promptly send the ill patient’s specimen to a reference laboratory or public health laboratory. The quicker these diseases are identified, the faster the patient can be treated. Importantly, early identification prevents further spread of contagion.
Compromising the ability to perform near patient testing could prolong diagnoses and leave communities vulnerable to pandemics. In 2014, Congress passed the Protecting Access to Medicare Act (PAMA) to direct the Centers for Medicare and Medicaid Services (CMS) to develop payments that reflected the rates that private insurance companies were paying for tests. While the stated goal has merit, the way it is being implemented is causing serious concern.
The current implementation approach does not reflect private payer pricing for clinical testing in the places of care where patients are tested and there are questions about the accuracy of the data. Experts are predicting that there is a high probability that the data is incorrect because the “reporting period” was defined prior to CMS providing those required to report with the what, when and how they would be required to report. This can be likened to the IRS informing you of a new requirement to track miles you traveled for business for a retrospective six-month period of time that you didn’t know you needed to track.
In short, because CMS defined the reporting period to occur prior to having published the final requirements publicly, everyone required to report were faced with the difficult task of attempting to report for a period retrospectively when the guidance was not available.
At least one national billing clearinghouse has analyzed claims data and if the estimated cuts are accurate, they will have a devastating impact on patient access to clinical testing as many laboratories, especially physician clinics and small community independent laboratories will no longer be able to offer testing. Many practices and small independent community laboratories now operate at a profit margin of only 3 to 6 percent and the potential cuts are well-beyond this margin. If these Medicare reductions are implemented, many of the very labs that are on the front line of preventing the next pandemic will not be able to operate. This will result in delayed diagnoses and, in the case of infectious disease, it could have the consequence advanced contagion and delays in treatment.
Because we live in an interconnected society, it is more crucial than ever for health professionals to get real-time diagnostics. The faster the identification, the faster the treatment. Visit www.NearPatientTestingMatters.org for more information.