ARUP Statement Regarding PAMA

September 29, 2017

Last Friday, Sept 22, 2017, Centers for Medicare & Medicaid Services (CMS) released the proposed CY 2018 Medicare payment rates for laboratory tests on the Part B Clinical Laboratory Fee Schedule (CLFS). 

ARUP will be conducting a careful assessment, but upon first review, CMS outlines drastic cuts to many high volume routine test rates currently performed by numerous hospitals, small community and critical access hospital labs, physician office labs (POL), and nursing homes that will be significantly affected. 

ARUP does not believe these rates represent market-based reimbursement levels for these tests in the laboratory industry. It appears that less than five percent of labs provided private payer data used to calculate the new Medicare payment rates under Protecting Access to Medicare Act (PAMA).

“We worry that the incomplete data driving these rates may adversely impact the ability of many laboratories to survive and may adversely impact patient care,” says Kathy Carlson, VP, University of Utah Health Services.

ARUP continues to advocate and coordinate with laboratory industry professionals and associations and ask that hospital and physician stakeholders join us in asking that the Congress and the current Administration delay and make needed changes to the PAMA process to ensure that any revisions to the CLFS are market-based as required under statute and to address major data integrity concerns. ARUP will continue to push Congress and the Administration to delay implementation of the revised Part B fee schedule until the identified problems are fixed.

“The impact of this on labs and the effect this could have on patient care concerns us. How will this impact our clients? Our healthcare system?  Will this degree of cuts jeopardize patient care? These are all questions we have and we are carefully reviewing what this proposal means with other laboratory leaders in the industry,” says Sherrie Perkins, CEO, ARUP Laboratories.

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