Midyear Update to OIG Work Plan Targets Laboratory Testing

Each year, the U.S. Department of Health and Human Services' Office of Inspector General's (OIG's) Work Plan highlights the projects and reviews it will pursue in the coming year. At the end of May, the OIG released an update adding new activities to that agenda. This latest updated added one item directly addressing clinical laboratories.

That new item "Annual analysis of Medicare clinical laboratory payments" indicates the OIG plans to focus on Medicare payments for lab tests, "including the top 25 clinical diagnostic laboratory tests by Medicare expenditures in 2014" because its prior reviews revealed Medicare pays more than other payers "for certain high-volume and high-expenditure laboratory tests." Citing the Protecting Access to Medicare Act of 2014 (PAMA), the OIG says it will annually review and "monitor Medicare expenditures and the new payment system for laboratory tests."

Also of interest to laboratories is an item discussing electronic health records and coordination of care in Accountable Care Organizations (ACOs). The OIG says it will review ACO participants' use of electronic health records to share information while coordinating care and "identify best practices and possible challenges" as providers move toward interoperability. G2 Intelligence's report Laboratory Services in Accountable Care Organizations explains that achieving the "seamless" access to data of interoperability and "[t]o be able to collaborate and discuss diagnosis and treatment options, laboratories need to have easy access to clinical data stored in an EHR and clinicians need access to laboratory data stored in the LIS." The report cites interoperability as "one of the top two most significant challenges ACOs face in the deployment of HIT." G2 Intelligence surveys summarized in the report indicate ACO laboratories are taking action to improve data sharing and achieve interoperability.

Finally, the OIG also plans to take a close look at the "number and nature of financial interests" reported under the Open Payments Program. The OIG will be checking up on how the Centers for Medicare and Medicaid Services oversees the reporting of this data and whether the data is displayed in public databases.

Takeaway: Laboratories continue to attract scrutiny from the OIG and data continues to be a trending topic—both for the sake of transparency and compliance as well as for purposes of transforming health care delivery.