AACC addresses challenges facing clinical labs due to Medicare changes

July 31, 2017
By Diana Trinh, MLS(ASCP)CM
Clinical Analyst, MD Buyline

Scientists, professors, laboratory professionals, and vendors from a wide array of diagnostic specialties are gathering at the 69th American Association of Clinical Chemistry Annual Scientific Meeting & Clinical Lab Expo in San Diego this week.

They’ll be presenting topics relating to ways of tackling current issues and showcasing innovations in laboratory automation, data analytics, and diagnostics. Diana Trinh and Dennis Matricardi, clinical analysts from MD Buyline, will be filing reports exclusive to HCB News from the meetings and expo.

The Centers for Medicare and Medicaid Services (CMS) will begin its new Medicare reimbursement payouts for laboratory testing starting on January 1, 2018. This will bring about a sweeping change in the laboratory industry, because the current reimbursement policies have remained relatively unchanged since 1984.

Current policies have allowed laboratories to determine their own reimbursement rates based on the local fee for a geographic area or the national limit. The new reimbursement rates will be based on private payor rates collected from applicable Medicare-enrolled labs defined by CMS.

The data will be collected and updated every three years (or every year for molecular diagnostic testing) from a mixed bag of nationally known reference laboratories like Quest Diagnostics, along with smaller regional hospital laboratories, physician office laboratories, and independent laboratories whose total Medicare revenue makes up more than 50 percent of total, and exceeds $12,500 from lab services.

No longer will the rates be determined by geographical location and analytic costs. It will now be largely driven by the private payor rates of reference laboratories that can provide cheaper rates due to their massive testing volume.

It is expected that these new regulations will cause the reimbursement for laboratory testing to decrease by $390 million in the first year and by nearly $4 billion by the year 2025.

Clinical laboratories and vendors alike are now left with the challenges of what the future may hold. How will U.S. laboratories operate under heavy financial pressures and significant staffing shortage, but keep up with the quality and standards of modern health care? How can the industry prevent itself from becoming stagnant in clinical diagnostic innovations? What diagnostic tests will remain in-house and what tests will now have to be sent out to reference laboratories due to financial burdens? How can efficiency be improved to prevent waste and achieve better return on investments?

These will be the hot topics of discussion on the expo floor and lectures at the San Diego Convention Center this week.

Diana Trinh
Diana Trinh joined MD Buyline in April 2017 as a clinical analyst specializing in laboratory and pharmacy. She brought more than eight years of experience in medical laboratory science in several multi-disciplines, including microbiology, bone marrow biopsies, special coagulation, and flow cytometry at Parkland Health and Hospital System in Dallas. In addition, she served as a histocompatibility technologist in the ASHI-accredited Immunogenomics and Transplantation laboratory at Baylor University Medical Center in Dallas, North Texas’s largest transplant center. She also brings with her research laboratory experience in molecular and structural biology from UT Health San Antonio.

Trinh received her Bachelor of Science degree in Clinical Laboratory Science from UT Health San Antonio, and previously studied biology at Trinity University and at UT in San Antonio. She is a member of the American Society of Clinical Pathology and obtained her MLS(ASCP)CM certification in 2009.