At G2 Intelligence's 2017 Laboratory Institute last week, the hot topic was PAMA; in multiple conference sessions, experts from the largest laboratory-related associations unanimously concurred with XIFIN's position that Medicare reimbursement rates for clinical laboratory testing under the Protecting Access to Medicare Act (PAMA) is a top industry priority.
Experts identified the methodology used to determine the rates as "flawed." A delay in implementation for reform of the methods and dataset used to calculate reimbursement rates is in order. Not only are the rates not "market-based," they also do not reflect the true cost or value of the clinical lab services. If the draft 2018 PAMA reimbursement rates are implemented in January, laboratories will be hit with destructive consequences, including acceleration of the already consolidating laboratory industry.
In September, XIFIN issued a press release sharing the initial findings of a study conducted on this topic, which are in line with the views of the G2 panel of experts. Because the Medicare Clinical Laboratory Fee Schedule (CLFS) significantly influences private payor pricing and contracting, the impact of the proposed rate structure will be far-reaching and have significant ramifications for many laboratories.
XIFIN supports the American Clinical Laboratory Association (ACLA)'s position that implementation of these rates be delayed until the government and relevant stakeholders can move toward a market-based payment solution. XIFIN will continue to evaluate the data and advocate for an unbiased market-based policy.
Also at G2 Lab Institute 2017, we were pleased that Kyle Fetter, VP & General Manager of Diagnostic Services, XIFIN, Inc. went into depth and presented on "Laboratory Oversight and Enforcement." This main general session discussed the regulatory and compliance issues that regulatory and oversight entities are focusing on in the laboratory and pathology context including the latest developments concerning laboratory developed tests, direct to consumer diagnostics, genetic testing and laboratory quality and patient safety. His slide presentation is available here.
At XIFIN, we stand by our position that the laboratory industry cannot be made to cost-cut its way out of a revenue deficit created by PAMA. Laboratories and diagnostic providers need ways to maximize revenue, reimbursements, and cash flow. Learn more about how leading labs are optimizing reimbursement revenue in a continuing battle against margin compression.