News at a Glance
HHS Reports Medicare Spending Declined. After announcing that the goal of linking 30 percent of Medicare payments to quality was reached months earlier than anticipated, the U.S. Department of Health and Human Services (HHS) reported that Medicare spending between 2009 and 2014 was $473.1 billion lower than it would have been if average growth in […]
HHS Reports Medicare Spending Declined. After announcing that the goal of linking 30 percent of Medicare payments to quality was reached months earlier than anticipated, the U.S. Department of Health and Human Services (HHS) reported that Medicare spending between 2009 and 2014 was $473.1 billion lower than it would have been if average growth in the eight years prior to that period had continued. HHS also estimates that Medicare spending could be $648.6 billion less between 2009 and 2015 than it would have if 2000-2008 average growth rate had continued. “To put this in context, this reduction in spending is greater than all of Medicare’s spending for personal health care expenditures in 2015,” according to HHS’ report. The prediction relies on per enrollee spending growth remaining as low as 1.1 percent. Crediting the Affordable Care Act for the success, the HHS press release announcing the release of the Medicare spending report said “[t]he health care law gives HHS new tools to pay providers for what works, better coordinate and integrate care, and make information more readily available to those who can use it to improve health. Initiatives to limit avoidable hospital readmissions and to promote new payment models that focus on value are contributing to the moderation in overall health spending, and particularly for Medicare.” Despite the slowed growth in spending, the report does reveal that 2014 expenditures for national personal health care increased by 4.3 percent per person. Still even this increase is considered “modest” by HHS, compared to growth in prior years, and is attributed to the increase in health care insurance coverage under the ACA.
ACLA Seeks Better Medicare Coverage for Vitamin D Testing. The American Clinical Laboratory Association (ACLA) has asked regional fiscal intermediary Novitas—and by extension, much of the Medicare program—to reconsider its austere position on testing for some vitamin deficiencies. In particular, the ACLA has asked Novitas to reconsider its position regarding testing for vitamin D. Currently, Medicare does not reimburse for many forms of vitamin or micronutrient testing, considering such tests to be medically unnecessary. It makes a few exceptions for patients with specific diseases or medical conditions, but they are generally narrow. Although the draft LCD currently provides testing coverage for Medicare enrollees diagnosed with rickets, osteomalacia, osteoporosis, chronic kidney disease and some digestive disorders such as irritable bowel syndrome and Crohn’s disease, the ACLA wants coverage to include other patients as well. The organization is asking for coverage of patients who have been diagnosed with cystic fibrosis, undergone bariatric surgery or suffered from radiation enteritis—an inflammation of the digestive system due to radiation treatments for cancer. It is also asking for coverage for patients diagnosed with several forms of lymphoma and histoplasmosis.
U.S. Lab Sector Globalizes with Foreign Deals. The U.S. lab industry has in recent decades begun to go global. Large multinational corporations that own laboratories in other nations are buying American companies and acquiring either their labs or opening new domestic facilities. Some examples of globalization are straightforward: Sonic Healthcare Laboratories, an affiliate of an Australian firm, has had significant operations in the U.S. for years, although it keeps testing within U.S. borders. Other deals involve foreign labs entering the U.S. market and publicly traded U.S. labs beginning commercialization initiatives outside the U.S. The Centers for Medicare & Medicaid Services (CMS) has also created an “International Laboratory CLIA Certification Process” that provides a blueprint for labs operating outside of the United States to legally accept and process samples from the U.S. The March 17, 2016 issue of Laboratory Industry Report provides an in-depth look at foreign lab deals and off shore CLIA certifications.
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