A brief heads-up blog. ACLA and other lab stakeholders support, and Congress has introduced, a legislative fix for PAMA called "SALSA" - Saving Access to Laboratory Services Act.
- Open coverage at 360Dx here.
- News at XIFIN, here.
- Press release from NILA, here.
- Press release ("two pager") from ACLA, here. Advocacy page from ACLA, June 30, here.
- News from Congr. Pascrell (NJ) here. (Wednesday, June 22, 2022).
The most complete analysis is at the ACLA two-pager, linked above. It's now also posted at CONGRESS.GOV, as S. 4449, here.
From ACLA's two pager, key bullets are:
- Use statistical sampling instead of reporting billions of transactions.
- Guardrails against too-rapid payment reduction.
- Exclude Medicaid managed-care rates.
- By law, Medicaid rates can't exceed Medicare rates, so these could only pull downward. Manually-processed claims would also be excluded from PAMA.
- Report every 4 years (not every 3).
PAMA sometimes yielded crazy rates especially on more recent codes. For example, in 2017, CMS paid about $2500 for BRCA testing (81162) and $931 for 81432 (BRCA and related genes panel.) But 81432 priced at $136 via PAMA, a crazy price unrelated to costs. 81435, Lynch colon cancer panel, was being paid at $802 on the CLFS, but got a $37 price under PAMA - even crazier. The impact of these lunatic PAMA results was tempered by the guardrails on the speed of annual price reductions. Oops: SALSA limits rate decreases to 5% or less, but also, caps rate increases to 5%. This means the Lynch gene code priced at $37 would never normalize to the $500 range (rising at 5% a year from $37; 54 years to reach $500).