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The Case for Updating the Medicare Specimen Collection Fee

The Case for Updating the Medicare Specimen Collection Fee. Legislative Symposium March 15, 2010 Michael N. McCarty Brickfield Burchette Ritts & Stone, PC AMT Legal Counsel. What is the Medicare Specimen Collection Fee?.

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The Case for Updating the Medicare Specimen Collection Fee

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  1. The Case for Updating the Medicare Specimen Collection Fee Legislative SymposiumMarch 15, 2010 Michael N. McCartyBrickfield Burchette Ritts & Stone, PCAMT Legal Counsel

  2. What is the Medicare Specimen Collection Fee? • In 1984, Section 1833(h) of the Social Security Act established: "a nominal fee to cover the appropriate costs in collecting the sample on which a clinical diagnostic laboratory test was performed and for which payment is made under this part ….” • The fee was initially set at $3.00 per draw

  3. Why the Need for an Update? • Since its inception 24 years ago, the fee has never been adjusted – even for inflation. It is still $3.00. • If the fee had been adjusted just to keep up with the CPI-U, the fee would be over$6.00 today. • But inflation is only part of the story ….

  4. Why the Need for an Update? • The cost of obtaining quality specimens has increased dramatically since 1984, regardless of inflation • In 2001, OSHA revised its Bloodborne Pathogen Standards after Congress passed the Needlestick Safety and Prevention Act • Although important, the new standards imposed an “unfunded mandate” by requiring costly new health care worker safety provisions.

  5. 2001 OSHA Bloodborne Pathogen Standards Require clinical laboratories to: • Identify and provide safer sharps systems (including needles and blades) • Maintain sharps injury logs • Discard blood tube holders after a single use (previously laboratories were able to reuse these devices), and • Involve health care workers in the selection of safer technologies

  6. Other Phlebotomy Cost Increases Since 1984 • Latex gloves and other protective wear • Phlebotomy staffing costs have risen, as the demand for more highly skilled phlebotomists has increased (with CA and LA requiring licensure or certification) • Labor cost to obtain ABNs from patients

  7. Other Reasons to Support Draw Fee Update • Proper sample collection and handling is an integral part of obtaining a valid and timely laboratory test result. • Specimens must be obtained using proper phlebotomy techniques, collected in the proper container, correctly labeled, and promptly transported to the laboratory. • Lots can go wrong during the sample collection process • Failure to label a specimen correctly and to provide all pertinent information required on the test request form. • Insufficient quantity of specimen to run test or QNS (quantity not sufficient). • Failure to use the correct container/tube for appropriate specimen preservation. • Inaccurate and incomplete patient instructions prior to collection. • Failure to tighten specimen container lids, resulting in leakage and/or contamination of specimens. • Hemolyzed blood specimens, etc. ….. • Significant quality and liability implications of improper draws: • Contaminated samples that have to be redrawn; false positive results; incorrect medication doses; nerve damage, fractures from patient passing out, etc. • Better reimbursement improves labs’ ability to hire qualified phlebotomists and pre-analytic personnel

  8. Past Initiatives to Adjust Draw Fee • Bills were introduced in each of the past four Congresses by former Rep. Phil English (R-Pa.) and various cosponsors • 2001: H.R. 3388 (107th Cong.) • 2003: H.R. 883 (108th Cong.) • 2005: H.R. 2218 (109th Cong.) • 2007: H.R. 1501 (110th Cong.) • Each bill would have adjusted the draw fee to reflect the current CPI-U, and would have provided an annual inflation adjustment going forward. • None of the bills got a hearing as stand-alone legislation

  9. Current Initiative (111th Cong.) • H.R. 1452 – The Medicare Clinical Diagnostic Laboratory Fee Schedule Modernization Act of 2009 (intro’d by Rep. Stupak last spring) • Title II contains a Specimen Collection Fee update similar to the English bills in the prior four Congresses. • Initial adjustment (in 2010) is to $6.04 • Automatic annual CPI-U adjustments thereafter • The Challenge: Title II “scores” with CBO, while Title I is budget-neutral. • While supporting H.R. 1452, fight to keep Title II in the bill • If Title II is stripped, continue to advocate for an update

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