Despite the United States healthcare system being one of the best in the world, we’ve also taken on the reputation of being the most expensive. Instead of prioritizing investing in the well-being of Americans, especially our seniors, we’ve developed a costly, sick care system. One of the most obvious ways to prevent people from becoming ill with a chronic condition, however, is by encouraging regular early screening and diagnosis. Unfortunately, the Medicare system, as one of the primary sources of healthcare among our country’s seniors, is failing in its mission to provide access to these innovative diagnostic tests and treatments. Unless addressed, millions of Medicare beneficiaries will have delayed and disrupted care, further perpetuating the sick care conundrum.
Since it was created over 50 decades, the Centers for Medicare and Medicaid (CMS) has provided older Americans and disabled people with timely access to innovative and effective treatments, medicines, and therapies that otherwise would have no access to healthcare. The health program prides itself on improving health outcomes among beneficiaries by covering preventative services, such as early diagnostics and lab tests. A bill passed by Congress in 2014, however, was built on a misguided design, ultimately leading to severe cuts to laboratories that are foundational to quality clinical care.
While intended to ensure private insurers and Medicare’s clinical laboratory fee schedule (CLFS) were aligned, the Protecting Access to Medicare Act (PAMA) implemented a flawed data reporting and rate-setting methodology that led to reductions in laboratory reimbursement. These cuts weren’t just a one-time mistake but have compounded, with community and regional laboratories facing 10 percent cuts for three consecutive years. What’s worse, laboratories have already struggled to cover increasing expenses since the COVID-19 pandemic, so PAMA’s cuts only doubled down on their cost concerns.
Unless addressed, further cuts to laboratory services will go into effect this January, jeopardizing the availability of an estimated 800 tests.
What does this mean for Medicare beneficiaries?
Reductions in the number of services available to them through Medicare and with less access to this care comes the possibility that a health condition goes untreated or unnoticed. These threats are even more apparent among rural and regional community health centers that provide services to underserved populations that already face significant barriers to care and experience higher rates of illness. With nearly 40 percent of North Carolinians living in one of the state’s 80 rural counties, these facilities are critical in providing our residents with healthcare, and any further access restrictions would only further isolate patients.
Seeing that access to these critical care measures has been compromised for beneficiaries over the years, Senators Tom Tillis (R-NC) and Sherrod Brown (D-OH) introduced the Saving Access to Laboratory Services Act (SALSA). This bill would take critical steps to update Medicare’s payment system for lab services to ensure the proper guardrails are in place to prevent excessive payment cuts, increases in test rates, and reduce reporting burdens.
We should be prioritizing making tests and treatments as accessible through Medicare as possible, considering the most common laboratory tests include those for the management of conditions like diabetes, cancer, and heart disease, which disproportionately impact older Americans. In fact, two out of three Medicare beneficiaries have two or more chronic conditions, but studies show that early detection often makes them easier and less costly to treat. These screenings aren’t just imperative to individual care plans but for our entire healthcare system. Uptake of early diagnosis care could lead to astounding cost-savings, with one study estimating it would lead to $26 billion in savings for the healthcare system per year.
It’s imperative that Congress pass SALSA so we can realign our healthcare system to invest in the well-being of consumers. This bill would not only give doctors back their autonomy in providing the most appropriate early detection and screening services for their patients but also would ensure Medicare’s payment cuts can no longer undermine our nation’s healthcare infrastructure.
— Robert Mims, Morven