Jane Hermansen, Network Manager at Mayo Medical Laboratories in Rochester, Minnesota, recently authored an article featured in MedicalLab Management on the 2014 Protecting Access to Medicare Act (PAMA), which went into effect January 1, 2018.
The act affects nearly every laboratory in the country that performs testing for Medicare beneficiaries. Laboratories will realize a decrease in reimbursement, regardless of laboratory size or type (hospital, independent, or physician office-based). Further, in most states, Medicaid fee schedules are based upon Medicare rates, thus Medicaid reimbursement is likely to also decrease.
In the article, Hermansen notes that though the act is far from ideal, the sky is not falling. All laboratories must face the future with PAMA in place and establish a framework for moving ahead in the industry’s new reality. "It is time to look past the sensational messaging and place perspective on the true impact of PAMA in order to create a positive action plan for laboratory survival into the future," she says.
When reviewing all possible avenues in light of PAMA (as well as other operational factors), Hermansen discusses certain considerations and actions a facility must take into account:
According to Hermansen, it is necessary to have a thorough understanding of the true impact that PAMA will have on your laboratory and demonstrate the value that outreach test volumes will continue to bring, even with reduced reimbursement. However, she notes, "The sky is not completely falling! Remain steadfast in the knowledge that the laboratory impacts nearly every patient within the health care system, and take the measures necessary to ensure that value is recognized and appreciated by every stakeholder within the health care system."