October 2011 Clinical Laboratory News: Advocates Warn Labs to Prepare for Copays

AM 2011

The educational offerings at the AACC 2011 Annual Meeting were as diverse as the attendees. Symposia, workshops, brown bag sessions, and more gave attendees the latest information, as well as practical advice, on a myriad of clinical lab topics. Below is a brief on one of the sessions.

Advocates Warn Labs to Prepare for Copays

By Bill Malone

In the aftermath of the debt-ceiling negotiations, the new mandate for Congress to make deep budget cuts will almost certainly mean a Medicare copay for lab tests, warned experts at the 2011 AACC/ASCLS Healthcare Forum. Over the past 30 years, a lab copay has been considered and rejected over and over by Congress after fierce lobbying from lab advocates and other organizations, most recently in the negotiations leading up the healthcare reform law.

However, the debt-ceiling deal signed into law by President Obama on August 2 tasks a 12-person joint congressional committee to come up with $1.2 to $1.5 trillion in cuts by November 23. With their backs against the wall, congressional leaders will have to make painful, across-the-board cuts with little flexibility, according to ASCLS Executive Vice President Elissa Passiment, who spoke at the symposium. “This time, they aren’t listening to us,” she said. Even before the debt-ceiling deal was reached, a lab copay was on the table—either as 20% coinsurance or a flat copayment per test.

Annual Meeting
Speakers at the 9th Annual POC Coordinators Forum 
gave presentations on preventing cross contamination 
and infectious disease transmission to an 
attentive audience of point-of-care coordinators.

As bad as it sounds, surviving a lab copay may actually be better than further cuts to Medicare’s lab fee schedule, Passiment said. Reimbursement already is scheduled to decline by almost 20% over the next 10 years due to changes made by healthcare reform. “At least with a copay, labs have a chance to get the money if they handle it right,” she said. “But without a copay, what we’ll get in exchange from Congress would be draconian cuts to the lab fee schedule, which could hurt labs even worse.” Analysts expect around $200 billion in cuts to Medicare over the next ten years out of the final debt deal. From this, Congress will look to labs for between $8–16 billion, Passiment said.

In the past, lab advocates have defeated a copay by successfully arguing that the cost of collecting a lab copay could outweigh the copay itself for lower-cost tests, and that without the face-to-face contact with patients that other medical disciplines have, labs would face unique difficulties. However, as some private insurers have instituted copays for lab tests, it’s become more difficult to argue this case. “Congress will expect Medicare to be treated like all other insurers who have copays,” Passiment observed.

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