Threat of Medicare 20% Co-pay for Lab Looms Again

BY NOW MOST OF YOU KNOW THAT THE LATEST ATTEMPT TO REINSTITUTE the 20% patient co-payment for Medicare Part B laboratory testing services was waved off in the Senate last week. But don’t relax, because similar proposals are expected to be put forward in Congress in coming months.

It was a close call for the laboratory industry last week. An economic stimulus bill in the Senate included a provision that would have imposed the application of beneficiary co-insurance and Part B deductible for clinical laboratory services. The stated justification for this provision was that it would create budget savings to offset increased Medicare payments to rural providers. Lab industry insiders close to the Washington legislative action tell THE DARK REPORT that lawmakers decided an economic stimulus bill was not the place to try and insert provisions to increase Medicare funding to rural providers. So that language was dropped from the bill that eventually passed the Senate.

Since the 20% co-payment requirement was eliminated in the late 1980s (as part of a deal to offset other Medicare cuts in reimbursement for Part B laboratory testing services), initiatives to reinstitute the 20% co-payment surface regularly. For this to happen, it means that one or more individuals within Congress and/or the Centers for Medicare and Medicaid Services (CMS) are convinced this is a way to reduce Medicare costs, regardless of its economic impact on the clinical laboratory industry.

Who are these individuals? Are they known to the lab industry lobbyists in Washington, DC? Over the years, I’ve never read an analysis or commentary about proposals to reinstitute the 20% co-payment which identify specific CMS officials and legislative aides to Senators and Representatives who are the prime movers behind such proposals.

I suggest that it is timely for the collective laboratory industry to adopt a different lobbying strategy. Let’s publicly identify those individuals committed to reinstituting Part B co-payments. Let’s invite them to lab industry meetings to explain, from a public podium, why the 20% co-pay is such a good idea. Let them circulate and network at these meetings and hear, first-hand, the problems resulting from a reinstituted co-pay. Have them tour real labs to directly experience the challenges of billing charges less than $10 and $20. I think it’s time to effectively educate the root source of these unceasing efforts to reinstitute the Medicare Part B laboratory services co-pay.