For years, Dr. John Cullen has prided himself on offering same-day diagnostic testing and results for his patients. He oversees a small family practice in Valdez, Alaska, and some of his patients travel as far as 120 miles for care.
CMS cuts threaten access to critical diagnostic tests
Providers and smaller labs will have to determine if they can still afford to provide certain testing services.
Some of Cullen's patients don't have the option of returning in a few days for results. He offers this service even though Medicare does not fully reimburse the cost of administering the tests. Starting next year, the CMS will cut millions from what it pays for laboratory tests offered in outpatient settings, and Cullen finds himself facing a difficult choice."We plan to continue offering the tests, but it really comes down to if we would be able to maintain clinical operations," Cullen said. "At some point we're just going to stop offering them." Cullen isn't alone in his dilemma. Practices in rural areas that offer clinical testing or small laboratories that service these communities are going to have to evaluate if it's feasible to continue offering these services. Shutting off the testing could mean ailments go undiagnosed longer, possibly leading to worse prognoses. Clinical labs will lose up to $670 million as part of a CMS effort to pay the same rate for tests as private payers. Medicare's fee schedule for lab tests has been largely unchanged since being established in 1984. Each lab determines its own rates based on market prices. Medicare has historically paid 18% to 30% more than other insurers for some tests, HHS' Office of Inspector General found. The program shells out about $7 billion a year for clinical diagnostic laboratory tests. The change in reimbursement was mandated by the Protecting Access to Medicare Act of 2014. The switch was made final in a rule released last year and is effective Jan. 1. The CMS estimated the change will save nearly $4 billion over 10 years. Medicare-enrolled laboratories are a mix of national chains that perform a large menu of tests and small regional ones that concentrate on a specific population, such as nursing home residents. Physician offices also perform some tests reimbursed by Medicare. Some clinicians are most concerned that the cuts appear to have a disproportionate impact on the emerging field of genetic testing for cancer. Tests that evaluate the likelihood of breast cancer took the hardest hits in terms of cuts. For instance, reimbursement for a test offering a risk score for breast cancer will be cut 73%, or $933, by 2020 once the cuts are fully implemented, according to CMS data. The second- and third-biggest losers are ones that determine if the BRCA gene has mutated, which is an indicator of increased risk of breast cancer.
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