Are Labs To Be Punished for Vitamin D Testing?

HERE’S AN INTERESTING QUESTION: Are labs to be punished because patients want to know if their Vitamin D levels are sufficient? Consider this: THE DARK REPORT predicted last year that labs might suffer a backlash from payers as a result of increased demand for Vitamin D testing.

In a briefing titled: “Vitamin D Test Volumes Double in Past Year,” published on July 28, 2008, we said, “Across the nation, labs report a near doubling in the volume of Vitamin D tests they are performing. Will Medicare and private payers recognize that, per evidence-based medicine guidelines, this testing is justified and labs should not be punished for increased utilization?”

Now comes news that National Government Services (NGS), one of the nation’s largest Medicare contractors, is taking steps to make that prediction become reality by its proposal to stop paying for routine testing for Vitamin D insufficiency. In its proposed local coverage determination (LCD), NGS said it would cover Vitamin D testing only for patients with chronic kidney disease, osteomalacia, hypercalcemia, and rickets. Other testing for Vitamin D would be denied. Is this short-sighted bureaucratic thinking? Or is it part of a shrewd, long-term strategy to reshape utilization of laboratory testing in this country? (See pages 7-8)

After all, if Medicare patients must pay out of pocket for Vitamin D testing, then many will forego these tests, putting themselves at risk for long- term chronic conditions. Eventually, Medicare will need to pay to treat patients who have these chronic and costly conditions. For that reason, NGS’ proposal to deny coverage for routine Vitamin D sufficiency testing puts Medicare squarely at odds with its stated goal of supporting early detection and preventive medicine. So much for a $40 Vitamin D test once every year or two and its potential to save the healthcare system tens of thousands of dollars per patient in downstream costs.

More importantly for the laboratory industry, this ill-conceived proposal to deny coverage for a test that is relatively non-controversial should be viewed for what it is: less an effort to guide clinicians via appropriately coverage guidelines and more a deliberate step to constrain increases in the cost of care by shifting the burden away from Medicare and onto both patients and the laboratories that provide their physicians with these tests.