Introduction
The currently proposed Medicare Clinical Laboratory Fee Schedule (CLFS) rates have the potential to cause harm to the laboratory industry and to the Medicare beneficiaries that require lab testing.
By informing and organizing the medical professionals whose work will be affected by the new CLFS rates, our hospital can work to prevent their implementation by sending approved sample letters to the members of Congress.
Background
The new Medicare CLFS is intended to implement provisions of the Protecting Access to Medicare Act (PAMA). They are scheduled to become effective on January 1, 2018. However, the rates are based on an unsubstantiated market survey and cannot support the lab work that is required on a daily basis. In previous years the rates were set according to credible information, but the new survey is not credible and strays from reality.
Problem
Laboratory work is one of the most commonly used benefits of Medicare. It may involve a variety of procedures, but all are necessary to the Medicare beneficiaries. The work provided by the laboratories is considered “life-saving” due to its importance for the positive patient outcomes. However, it is an expensive service that is likely to become unavailable to the majority of patients if the new Medicare CLFS rates will be implemented.
The published rates are based on a market survey that excluded key components of the lab market. The majority of physician offices and almost all hospitals were excluded in the survey. On the other hand, the private market data of the most efficient laboratories was prioritized. The nature of these oversights is unclear, but the rates that were produced based on the faulty information are below market value. This could lead to severe impacts on the availability of lab work to Medicare beneficiaries.
These issues can be prevented, however. If the U.S. employees of our hospital are mobilized to send approved sample letters to the Centers for Medicare and Medicaid Services (CMS), as well as to contact the members of Congress that represent our area, the PAMA may be amended until the rates are corrected.
Solution
The current political climate is responsive to the issues present in medical legislation. This is why a coordinated effort from a large number of medical professionals should have a significant effect on the proposed rates. If the efforts of our hospital will prove to be insufficient, other hospitals and clinics will be informed about this issue.
The medical professionals will have to fill out an online form provided by the American Clinical Laboratory Association. It will submit all the required information to the appropriate channels and will inform the participants of any developments on this issue. It is a one-time procedure and can be done both in work and home environments. Therefore, its implementation should not be problematic.
Conclusion
The negative impact that these rates may bring will affect millions of patients in the United States and thousands that visit our hospital. This issue can bring dire straits to the hospital environment, but it can be avoided through simple engagement on the part of the medical staff.