FOR IMMEDIATE RELEASE
May 11, 2006
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ADVAMED HAILS BIPARTISAN LEGISLATION TO ENSURE MEDICARE PATIENT ACCESS TO NEW ADVANCED DIAGNOSTIC LABORATORY TESTS |
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WASHINGTON, D.C. – AdvaMed praised the introduction of legislation in the U.S. House of Representatives today designed to knock down the barriers patients and their physicians face accessing new diagnostic laboratory tests needed to make informed health care decisions.
The bipartisan Advanced Laboratory Diagnostics Act of 2006 is sponsored by Rep. Michael Ferguson (R-NJ), Rep. Phil English (R-PA), Rep. Mike Thompson (D-IL), and Rep. Bobby Rush (D-IL).
“This important legislation will begin to bring the 22-year-old Medicare payment system in line with 21st Century medical science,” said AdvaMed President and CEO Stephen J. Ubl. “With breakthroughs in molecular diagnostic testing increasing our ability to preempt and more precisely treat disease, our society cannot afford to have outdated Medicare payment policies standing in the way of these advances.”
According to Ubl, the time is right for Congress to consider and pass this legislation. The Institute of Medicine, The Lewin Group, and the HHS Secretary’s Advisory Committee on Genetics, Health, and Society have all concluded that the current system is flawed, complex, and does not efficiently incorporate new technologies.
“The stakes are high because Medicare poses significant barriers to patient access to new clinical diagnostic lab tests, reaching far beyond its 42 million beneficiaries because Medicaid and private health insurers often follow Medicare’s lead when setting new test payment levels,” Ubl said.
By failing to recognize new tests may offer greater benefits to patients and physicians, the current Medicare Clinical Laboratory Fee Schedule provides few incentives for laboratories and health care providers to adopt new tests, according to Ubl.
Medicare reimbursement for an advanced viral load test for Hepatitis C illustrates the problem with this flawed system, according to Ubl. Medicare reimburses laboratories that offer the Hepatitis C viral load test less than the cost of performing the test and only half the amount of performing an HIV viral load test, which requires an identical series of complex steps and resources. Hepatitis C viral load testing measures the amount of virus in the patient’s blood and helps the physician determine the effectiveness of drugs used to treat the disease, which affects nearly 4 million people in the United States.
Ubl stated that Medicare’s outdated system does not consider the technological sophistication of a new test, the resources required to run it and the value of the test to patient care. Current policies also do not allow for the correction of payment errors.
The bill will reform Medicare policies that discourage the development and adoption of new clinical diagnostic laboratory tests. Its provisions aim to:
- Establish a demonstration project to evaluate a new Medicare payment system for molecular diagnostic tests designed to more appropriately reflect the value of these important technologies to patient care management, potential to reduce long-term health care costs, and ability to improve overall health care efficiencies;
- Improve current processes for obtaining adequate reimbursement for new clinical diagnostic lab tests;
- Provide more transparency with respect to Medicare reimbursement decisions; and
- Afford timely correction of historic payment errors that often lead to inadequate payment.
“Advances in diagnostic lab testing are propelling our ability to personalize medical care to a level unforeseen in 1984, when the current Clinical Laboratory Fee Schedule was created,” said Ubl. “As medical science evolves, so must the Medicare program, and this legislation will allow the program to test a way to better account for the technological sophistication and increasing value of diagnostic lab testing to patient care.”
Additional information on bill’s introduction
AdvaMed member companies produce the medical devices, diagnostic products and health information systems that are transforming health care through earlier disease detection, less invasive procedures and more effective treatments. Our members produce nearly 90 percent of the health care technology purchased annually in the United States and more than 50 percent purchased annually around the world. AdvaMed members range from the largest to the smallest medical technology innovators and companies.
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