2/25/2023 0 Comments Clinical pathology labs austin![]() ![]() The Move from FFS (Fee for Service) to VBP (Value-Based Pricing) Formaspace built five laboratory facilities within this new 29,800 sq ft medical device research facility located in Danvers, Massachusetts. Nonetheless, given the ongoing trend toward falling reimbursement rates (the CMS intends to set new reimbursement rates again in 2021 that are expected to be even lower), quite a few hospital administrators are considering their options before reimbursements go any lower, including spinning off their internal clinical laboratory operations as separate businesses, or selling their lab operations outright to private lab companies, and taking the money to fill shortfall gaps in their own hospital budgets. the federal CMS, insurance companies, hospital administrators, etc.) have taken notice.īut, rather than congratulating laboratories for their efforts, they have interpreted this progress as evidence that labs tests, taken as a whole, have become a commodity item - a commodity that can be bid out to the lowest bidder.Īcting under the auspices of PAMA (the Protecting Access to Medicare Act), the CMS made deep cuts (as much as 30% percent) on to the Clinical Laboratory Fee Schedule (CLFS), which sets the all-important reimbursement amounts paid to clinical pathology laboratories by the government.īecause insurance companies also use CMS rates as guidance for their own non-CMS reimbursement rates, the effect of these cuts was widespread - despite bitter opposition from groups, such as the AMA, who argued that the process for determining reimbursement rates was inherently flawed. As labs have striven to provide more accurate (and repeatable) results, those paying for the tests (e.g. The last bullet item above is the most critical.
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