Laboratory Services for Nursing Homes

Several members have contacted LeadingAge NY regarding letters they have received from their laboratory provider stating that they will no longer be providing laboratory services or will be providing only limited services.

The issue stems from the recent decrease in reimbursement as a result of the Protecting Access to Medicare Act of 2014 (PAMA). PAMA significantly revises the Medicare payment methodology for certain clinical diagnostic laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS). PAMA establishes that the Medicare payment amount for a test on the CLFS generally will be equal to the weighted median of the private payor rates determined for the test, based on the data that is collected during a data collection period and is reported to the Centers for Medicare and Medicaid Services (CMS) during a data reporting period. The statute also provides for a phase-in of payment rate reductions for the first six years of the revised payment system.

The Department of Health (DOH) has reached out to LeadingAge NY and other associations to discuss the potential impact that the changes to laboratory services will have on nursing home providers. DOH sought input on the following topics:

• Are you experiencing challenges finding a laboratory to provide clinical laboratory testing and phlebotomy services for your facilities?
• What are the challenges? Cost? Availability of phlebotomy services? Proximity of a lab?
• What is the magnitude and scope of the clinical lab testing and phlebotomy services that your facilities require?
• Do you rely on a single laboratory to provide these services? Do you have a back-up laboratory or other back-up plans if a laboratory determines that it will no longer offer services?
• Are there STAT tests that are required more often than others?
• Is your client population privately insured or are they predominately Medicaid recipients? If Medicaid, has this impacted your ability to obtain laboratory services?
• Do you have in house phlebotomy capability?
• Do you have any in house testing capacity? Covered under a limited lab license? Could you increase this capacity?
• Have you considered using a point-of-care instrument to provide some services? If not, what are the challenges?
• What is the cost differential of using a point-of-care lab testing versus traditional lab testing?
• If your facility began using point-of-care lab testing, how would your staffing needs be affected?
• If your facility began point-of-care testing, would you still need a traditional lab? If yes, for which tests?

Within the next few weeks, DOH plans to ask providers to complete an online survey to better assess the extent to which nursing homes are experiencing issues with laboratory services and what actions they are taking in response to the service disruptions. Members should also review their emergency plans to determine if current measures outlined in their plans continue to be viable.

Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832 or Mary Wassel, mwassel@leadingageny.org, 518-867-8383