The PAMA Section 216 lab payment reform of 2014 requires the OIG to issue an annual report on lab test spending in Medicare Part B as well as hospital outpatient CLFS lab spending. Typically, these reports have come out in late fall following the calendar year being reported (e.g. Fall 2019 for CY2018).
Now, in August 2020, OIG has issued the report we've been looking for since last winter, on CY2018 CLFS spending.
- Find the 26 page PDF report on the OIG website here.
"Although payment rates for 75 percent of tests decreased in 2018 under the new payment system, savings that resulted from lower rates were overtaken by increased spending on other tests, including genetic tests and certain chemistry tests. Spending on genetic tests increased from $473 million in 2017 to $969 million in 2018 because of new and expensive tests entering the Clinical Laboratory Fee Schedule (CLFS), as well as an increase in the volume of existing genetic tests."Spending on certain chemistry tests also increased by $82 million in 2018 following the end of a discount on these tests [meaning: the old clin chem panel pricing system also known as "ATP" price codes.] Finally, a one-time spending increase on some tests occurred in cases in which the national rate was higher than the local payment rates that it replaced."
|click to enlarge|