As medical laboratory scientists, we are at the forefront of diagnostics. We take great pride in our role in patient care by ensuring accurate and timely results. As you know, the legislative landscape significantly impacts our profession, influencing everything from reimbursement rates, to standards of practice. Out of the many facets and legislative complexities that are massively relevant to our profession, I would like to focus on just one: H.R. 2377/S1000 or the Saving Access to Laboratory Services Act (SALSA). This bill sets the Medicare payment for the Clinical Laboratory Fee Schedule (CLFS) in a sustainable way. To understand SALSA however, it is vital to discuss the Protecting Access to Medicare Act.
The Protecting Access to Medicare Act of 2014 (PAMA) was an attempt to make sure millions of seniors had access to critical health services, including laboratory testing. While the bill had good intentions, it fundamentally changed how the Medicare payment rates are established. In order to set the payment rates, the first round of data collection started in 2017. It was supposed to collect data from independent, hospital outreach, and physician office laboratories. This data however turned out to be highly flawed, leaving out almost all hospital and physician office laboratories. For example, of the 1,942 labs that reported data in 2017, just 21 were hospital laboratories. For context, there are roughly 200,000 labs in the United States, and roughly 10,000 of them are hospital labs.
This statistically flawed data led to 3 years of 10% cuts, affecting 75% of laboratory tests. Due to the inaccuracy of the data sample, $4 Billion in cuts were enacted on those labs who performed the most common laboratory tests ordered for the 56 million seniors who rely on them. That number is even more striking when you learn that the total CLFS budget for 2020 was $8 billion. These cuts impact the most common and vital laboratory tests for those with conditions such as kidney and liver disease, diabetes, cancer, anemia, and infections.
The Saving Access to Laboratory Services Act is a bipartisan and bicameral bill aimed at fixing the flaws of PAMA and cementing patient’s access to laboratory testing. It was introduced in the House on March 3rd, 2023 by Representative Richard Hudson (R-NC), and now has 62 cosponsors. SALSA would give the CMS the authority to recollect data from a truly representative population of labs that would give them a valid and statistical data set with which to set the Medicare payment rates. The tests that are reported would be those performed at more than 100 labs, and whose reimbursement rate is under $1,000. SALSA would alter the payment cuts for widely available tests, cutting 0% in 2025, no more than 2.5% in 2026, and no more than 5% in 2027 thereafter. For the payment increases, SALSA would implement increases of no more than 2.5% for 2025, no more than 3.75% in 2026, and no more than 5% after 2027.
SALSA is supported by a myriad of organizations, including American Society for Clinical Laboratory Science (ASCLS), American Clinical Laboratory Association, American Medical Technologists (AMT), American Hospital Association (AHA), College of American Pathologists (CAP), Association of Pathology Chairs (APC), American Society for Clinical Pathology (ASCP), and the Alliance for Woman’s Health and Prevention among many others. With your help, we can get this bill through congress, and fix the broken parts of PAMA that will greatly impact our patients that we work so hard every day to take care of.
Now, what can you do? First, learn who your Representatives and Senators are. Next, I recommend sending them a personalized email, phone call, or letter expressing your support for H.R. 2377. Tell them who you are, what you do, and why this issue matters to you. Tell them how this directly affects you, and your fellow labratorians. If this seems like a daunting prospect, don’t fear. Just visit https://stoplabcuts.org/. This is a website ran by the American Clinical Laboratory Association which has a section that you can fill out, and with one click, email your representatives a message of support for SALSA. Another way to get involved, is to attend the ASCLS Labvocate Symposium, scheduled for September 30th through October 1st, 2024 at the Hilton Alexandria Old Town in Alexandria, Virginia. This is a fantastic opportunity for networking, fun, education, and a great way to go right to the source and represent laboratorians nationwide in Washington D.C. If you have never been, you are missing out on the experience of a lifetime. The ASCLS, ACLA, ASCP, CAP, and others also have great resources on their websites if you would like to learn more or how to get involved.
Damien F. Garza MLT(ASCP)
Government Affairs Chair
ASCLS-WI