A few months ago, Matt Sause, president and CEO of Roche Diagnostics North America, and William Morice II, M.D., Ph.D., president and CEO of Mayo Clinic Laboratories, shared in a Real Clear Policy column how Medicare cuts could force labs to reduce or eliminate services. This could potentially harm some of the most vulnerable patients and communities in the U.S.
Congress recently began considering new bipartisan legislation to keep this from happening. Here are three key things to know about this bill – and how you can take action to ensure access to life-changing diagnostic solutions.
In 2014, Congress passed a law called the Protecting Access to Medicare Act (PAMA) to provide a uniform protocol for setting reimbursement rates for clinical lab tests. Unfortunately, the first round of market data for PAMA was collected from less than 1% of the nation’s laboratories — far from representative of market rates. Congress has delayed PAMA’s implementation three times since the bill’s passage, citing the harm the law could have on more than 800 clinical tests.
Medicare reimbursement cuts through PAMA, scheduled for January 2023, risk jeopardizing patient access to tests used to diagnose, monitor, prevent and manage common diseases for more than 50 million seniors. Without PAMA reform, labs could face drastically reduced reimbursement for commonly performed lab tests for a host of diseases, including diabetes, heart disease and cancer.
Diagnostic tests are critical in communities with limited access to health services because of preexisting socioeconomic and racial disparities. According to the American Clinical Laboratory Association, if these cuts to reimbursement rates are implemented, it could be laboratories serving the most vulnerable and homebound that are affected.
Congress recently introduced a bipartisan bill called the Saving Access to Laboratories Act (SALSA), which would require accurate and representative data from all laboratory market segments that serve Medicare beneficiaries to support a common-sense Medicare fee representing the market.
This would help ensure access to vital laboratory services (as PAMA originally intended) while setting a sustainable path forward that allows labs to adapt and innovate in how they serve their patients by decreasing economic pressures.
Roche is committed to helping reform PAMA and pass SALSA to ensure that patients and healthcare providers continue to have access to the testing they need. We know that diagnostics guide treatment decisions, meaning people get better care faster and benefit from better health outcomes.
Disclaimer: This content is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician. Always seek the advice of your doctor or another qualified health provider regarding a medical condition.
Hong Hong is vice president of access and government affairs at Roche Diagnostics Corporation