Tuesday, November 7, 2017

Labs Could Get More Money Under PAMA Law Than They Lose !!

This is a sexier title for the prior article.   In famous scene from the movie and musical "The Producers," the accountant says, "Under the right circumstances, you can make more from a flop than a hit."

Labs lose several hundred million dollars under PAMA price cuts. But ACLA has argued that PAMA overrides a panel pricing policy for clinical chemistry tests.   These panels are a big deal, logging $710M in payments in CY2016.   The arcane panel price rules cost industry about $45M in CY2016 relative to a la carte analyte prices, and they would recover this money immediately under PAMA if panel prices rules stop in 2018.

But wait, there's more.  If there was any rise in the delivery and billing of the newly and colossally profitable N-1 panels paid at a la carte prices, CMS could pay out another $70M, or even more, depending on the popularity this approach - or the bravery of labs in submitting this type of a la carte analyte code stack.   Why bill a ten-analyte, $15 panel if you can bill a 9-analyte, $40 panel?  And, oh, say, 30 million of them?

See the prior article for charts and details, here.