Medicare Cuts for Diagnostic Tests Would Show the Government Has Taken the Wrong Lessons from COVID-19
COVID-19 has had a profound impact on the world and taught all of us critical lessons. Chief among these is the importance of ensuring everyone has access to affordable, reliable testing when they need it most. For a highly contagious disease like COVID-19, testing wasn’t simply important for individual health. It was essential to minimize community spread, especially while treatments and vaccines were limited or not yet available.
Even after the federal government’s response to the pandemic, chronic illnesses, cardiovascular diseases, cancers, neurodegenerative diseases, and a host of other complex and challenging health conditions will remain with us. For many of these illnesses, testing and diagnostics are equally important pieces of our arsenal as we fight for a healthier life for everyone.
The importance of these types of diagnostic tests as part of our health infrastructure is well established. As leaders at the nation’s leading diagnostic company and one of America’s premier medical centers, respectively, we continue to increase the collaboration between Roche Diagnostics and Mayo Clinic to co-develop and advance diagnostic technologies to address current and future gaps in clinical care. Years of data have shown us that diagnostics guide treatment decisions, meaning people get better care faster and benefit from better health outcomes. When this happens, not only do we save lives, but we also reduce overall health care costs across the board because testing matters in everything — from prenatal care to the management of chronic illnesses.
For example, testing for human papillomavirus helps identify the patients who are at the greatest risk for cervical cancer. Early screening and diagnosis can help prevent the undertreatment and overtreatment of the disease, leading to improved quality of care for patients and reduced health care costs.
Challenges in testing access are even more of a concern among our most vulnerable communities. When we look at conditions where reliable, affordable testing access matters, we can see this plainly. According to the Centers for Disease Control and Prevention, the five-year survival rate for cervical cancer is about 67% for white women and 58% for Black women. A significant contributing factor to this disparity is that white women tend to be diagnosed at an earlier stage because they are more likely to get tested in the first place.
Unfortunately, the Protecting Access to Medicare Act of 2014 — a well-intended bill designed to ensure that America’s seniors have access to critical health services — is scheduled to be implemented in ways that put access to these critical tests at risk. And without PAMA reform, labs could face drastically reduced reimbursement for commonly performed lab tests for a host of diseases, including diabetes, heart disease, and cancer.
These cuts would come from changes to the Clinical Laboratory Fee Schedule, which sets the rates Medicare will pay for diagnostic tests and other laboratory services. For the past two years, Congress delayed these scheduled cuts, which would have significantly lowered the amount that laboratories could be reimbursed for many diagnostic tests, making that critical work unsustainable. These delays show that Congress understands the threat that these cuts pose to health in the United States. But the delay is simply a delay, and the threat of these significant reductions still looms large, with cuts set to take effect early next year.
If the proposed cuts to reimbursements for diagnostic tests are allowed to take effect, disparities caused by challenges with accessing diagnostic tests will likely grow even further.
Looking at the COVID-19 experience, studies have shown that the public health response to the pandemic was less effective in areas that have less access to health services because of pre-existing socioeconomic and racial disparities. And there is no small overlap between the communities that had the greatest challenges in accessing COVID-19 testing services and those that show higher rates of chronic conditions like diabetes, heart disease, kidney disease, and more. Simply put, making medical diagnostic tests harder to get hurts communities that are already vulnerable. And with Medicare specifically focused on the elderly — who are more likely to be on fixed incomes and facing chronic and costly health conditions — it’s easy to see how potential rate cuts can translate directly into worse health for those with the most risk.
But something else came out of COVID-19 that we can learn from. We saw policymakers, diagnostics companies, and clinical laboratories working in close concert to meet the acute need of a generationally defining public health challenge. Collaboration became a necessity because we had a shared, common problem and it was clear that testing access was critical.
While not every health condition is highly contagious like COVID-19, these conditions should still warrant our focus and attention. Our ability to address the chronic diseases that affect millions of Americans relies on testing. For many of these conditions, early detection can mean less severe and more treatable diseases. And when testing is unavailable, it negatively impacts people’s lives and places untold stress on our health system. In short, the need for close collaboration between the government and diagnostics providers should be no less important than it was during the height of the pandemic.
The costs of refusing to act will be borne by those with the most to lose. According to the American Clinical Laboratory Association, if these cuts to reimbursement rates are implemented, it will be the laboratories serving the most vulnerable and homebound who will be forced to either shut down operations, reduce services, eliminate tests, or lay off employees. And these changes will not only affect Medicare patients but everyone who relies on these labs and the tests they offer. If the PAMA cuts go through, laboratories across the country may be forced to reevaluate what tests they offer and at what cost in order to compensate for the loss of funding.
The good news is that bipartisan legislation that was just introduced, the Saving Access to Laboratory Services Act, would help everyone — and especially America’s seniors — have real, reliable access to testing and diagnostic services. The bill would reform PAMA to require accurate and representative data from all laboratory market segments that serve Medicare beneficiaries to be collected to support a commonsense Medicare fee schedule that truly represents the market. This would help ensure access to vital laboratory services, as PAMA originally intended while setting a sustainable path forward that supports future innovation.
To emerge from nearly three years of a pandemic by sending the signal that austerity is our nation’s health policy when it comes to testing and diagnostics would be a significant mistake. It would threaten the health of some of our most vulnerable citizens and turn a blind eye to an epidemic of treatable — and often preventable — chronic conditions that exact a toll on all of us. Let’s work together to make sure that doesn’t happen.
Matt Sause is President and CEO of Roche Diagnostics North America. William Morice II, MD, PhD, is President of Mayo Clinic Laboratories.
