New Paradigm, New Opportunities: Laboratory Stewardship

Abstract

AbstractOver the years, there has been a dramatic and unsustainable increase in health care (HC) expenditures in the United States. By the year 2024, an estimated $4 trillion will be spent for HC. So, what role do laboratories play in increasing HC costs? Some 4 to 5 billion laboratory tests are performed annually, but 30% have been deemed unnecessary. Medicare has been reimbursing for tests based on fee for service without regard to clinical necessity. To address this high rate of reimbursement and waste, in 2014, the Protecting Access to Medicare Act (PAMA) became law. Under PAMA, a lower fee for tests ordered under the Part B Clinical Laboratory Fee Schedule will be phased in. Laboratories covered under alternative insurance plans are no longer compensated for each test performed. Instead, value-based reimbursement will be progressively introduced, eliminating waste and ensuring the right tests are ordered to improve patient care. As a result, laboratories are responding to these changes by developing laboratory stewardship programs.