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How Medicare’s New Payment System for Laboratory Services Is Changing the Industry’s Competitive Dynamics
The webinar will cover PAMA mandates, CMS regulatory requirements on implementing a new Medicare market-based Part B fee schedule for lab services, competitive implications for the industry based on the fallout from PAMA rates and the outlook for changes in PAMA which could affect future rate changes that contain the following key elements:
. Overview of Medicare’s new lab payment system required by PAMA
. Projected Medicare savings under PAMA
. Definition of Applicable lab required to report data to CMS
. Defining Advanced Diagnostic Laboratory Tests (ADLTs)
. Why most hospitals labs were excluded from providing data.
. How hospital lab data could result in higher reductions or all labs
. How new market-based rates are calculated
. Phase-in of future payment reductions
. Analysis of 2018 lab pricing changes
. Why PAMA payment changes will impact both Medicaid & commercial lab rates
. How the PAMA changes are causing competitive changes in the industry including some new dynamics for hospital outreach programs & local, regional & national labs
. The status of a federal lawsuit and possible administrative action expanding the pool of labs required to give CMS private payor data that could result in fairer rates in the future.
Overview of the webinar
This webinar details the methodology and related requirements adopted by CMS for developing a revised Medicare Clinical Laboratory Fee Schedule using rates paid by private health insurance companies, Medicaid Managed Care Organizations and Medicare Advantage plans. Key changes covered include the market-based data approach that Medicare uses to set payment rates; the switchover to a national fee schedule creating a single payment rate nationwide for each test without local variation; and the creation of a new category of tests, Advanced Diagnostic Laboratory Tests (ADLTs.) An analysis will be presented of 2018 lab pricing changes under the new based system along with hows its impacting Medicaid and commercial rates and the competitive implications all this is having on the lab industry. Finally, a court case and/or administrative action may require future changes regarding which labs have to report private payor data to the government that could favorably impact future payment changes.
Who should attend?
- Laboratory Presidents
- CEOs
- COO
- CIOs
- Medical and Administrative Laboratory Directors
- Senior Managers
- Head of Reimbursement
- Billing and Finance
- Legal & Compliance Executives
Why should you attend?
As the largest single purchaser of clinical lab services in the U.S., Medicare now pays over $7 billion annually under Medicare Part B for testing provided in a wide variety of provider settings including hospitals, independent labs and physician offices & clinics. Medicare’s new market-based payment system for lab services became effective in 2018 with many diagnostic tests cut 10% this year and due for further deep cuts in future years with mainly only certain proprietary tests doing well under the revised reimbursement scheme. The fallout from the new market-based system, which is also affecting Medicaid payment as well as commercial payor rates that have historically set their lab payments at a percentage of Medicare allowable rates, has created a changing competitive dynamics for the lab sector. Meantime, a pending federal lawsuit as well as a CMS proposal could result in a more representative pool of labs (including hospital outreach labs) turning private payor data over to the government that could produce fairer payment rates in future years
Faculty - Mr.Dennis Weissman
Dennis Weissman, A nationally recognized, independent analyst and thought leader in the diagnostic field for over three decades, Dennis is President of Dennis Weissman & Associates, LLC, Falls Church, VA, a consultancy which provides market intelligence, M&A advisory services, business leadership and public policy advice to diagnostic and life science companies and organizations. He has expertise in Medicare and health care reform policies and trends; clinical lab and pathology payment & compliance policies as well as business trends affecting the diagnostic sector. Dennis founded and served as publisher of Washington G-2 Reports (now G2 Intelligence) through 1999, an information company that reports on and analyzes the U.S. clinical laboratory industry via newsletters, research reports and conferences. Prior to G2, he served as the Director of the Washington Office of the American Society for Medical Technology (now ASCLS) and before that, Special Assistant to the Deputy Assistant Secretary for Health, Department of Health, Education & Welfare (now HHS).