Transcript ACLA`s Membership

Spotlight on Washington - The Impact of
Health Reform Legislation and Politics
on Your Lab
Presentation to Delaware Valley Chapter
CLMA
October 6, 2010
David Mongillo
VP Policy and Medical Affairs
American Clinical Laboratory Association
ACLA
• Not-for-profit organization created in 1971 which offers
the benefits of representation, education, information
and research.
• Advocate laws and regulations that benefit the laboratory
industry and patients
• Promote public awareness about the value of laboratory
services in preventing illness, diagnosing disease, and
monitoring medical treatment.
ACLA’s Membership
• ACLA Membership – 44 members that represent
diversity of laboratory industry
– Independent Laboratories
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Esoteric/Biotech/Gen.-Mol.
Regional Full Service
ESRD
National Full Service
Pathology
– Hospital Laboratories
• ACLA Associate Members (11)
State of the Union or What’s going on in DC?
The Best of Times
The Worst of Times
Spotlight on Health Reform
Rising health costs in the U.S…
GDP: Gross Domestic Product
NHE: National Health Expenditures
NHE
Projected NHE
GDP Share
Projected GDP Share
$4,500
25%
$4,000
20%
$3,500
15%
$2,500
$2,000
10%
$1,500
$1,000
5%
$500
$0
0%
1980 1990 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Calendar Year
Source: CMS, CDC
GDP Share
Billions
$3,000
Major Spending, Taxing, Savings
Provisions
• $938 Billion In Subsidies & Medicaid Expansion for
Coverage (2010-2019)
– 15-18 Million More Eligible for Medicaid
– 15 Million Eligible for New Subsidies & Access to “Network
Exchange”
• $1.089 Trillion in New Taxes & Medicare Cuts to
Finance
– $523 Billion in Medicare Cuts
– $569 Billion in New Taxes
HCR Provisions Impacting Labs
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Productivity Adjustment
Additional 1.75% Adjustment (2011-2015)
Prevention & Wellness
TC Grandfather Clause Extension
Date of Service Demonstration
Others
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Device Tax
Cost Control & Quality
How Productivity Adjustment (PA)
Works
• Basis: DOL Annual Productivity Index (1.11.4%)
• Most Part B Services Reduced 2011 & Beyond
By PA
• Applied to CLFS Only (Not PFS)
• Protecting Labs from Negative Update from PA
• Existing .5% Reduction in CLFS Repealed for
2011-2013
• Total Cut From Labs $5 Billion (2010-2019)
Additional Adjustment - CLFS
• -1.75% in each of 2011-2015
• Taken from CPI Adjusted CLFS, But Can
Reduce CLFS Below Zero
• Replaced Proposal For New Federal Fee/Tax
on All Lab Revenue
• Total Over 2010-2011 Is $5 Billion
HCR Is Beginning of Process
• Lack of “Conference Report” Has Left Many Questions
About Intent, Implementation
• Already Talk of “Correction Bills”
• 2700 Page HCR Law Will Require Complex
Interpretation & Implementation
– Thousands of Pages of Regulations
– Interpretation by HHS, Treasury
– Multiple Lawsuits Challenging Provisions
HCR Enactment Is Beginning
of Process
• Medicare Has Been Evolving Program Over 45 Years
• HCR – Major Programs Implemented
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2010
2011
2012
2013
2014
39
20
8
12
25
Cost Control and Quality
Buzz Words and Key Terms
• PCORI
• ACO
• IPAB
• CMI
Health Care Reform – Prevention Services
• Reimburse for more preventive services
• Remove barriers – no co-pay
• Promote community wellness and strengthen public
health
• Teach prevention to health care providers
• Encourage workplace wellness programs
• Create Federal level prevention and wellness strategies
• Incentives for healthy lifestyles – HBP, high cholesterol,
tobacco use, obesity, diabetes for Medicare
• CBO should develop better scoring for prevention
services
Chronic disease is key driver of health
costs…
GDP: Gross Domestic Product
NHE: National Health Expenditures
NHE
Projected NHE
GDP Share
Projected GDP Share
$4,500
25%
$4,000
20%
$3,500
15%
$2,500
$2,000
10%
$1,500
$1,000
Chronic Disease
5%
$500
$0
0%
1980 1990 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Calendar Year
Source: CMS, CDC, Radiology, 2004
GDP Share
Billions
$3,000
Why does this matter?
1.6% of Medicare
2.3% Total Healthcare
60%-70% of health care decisions
Lab Interest - Prevention Component
• Current Medicare lab screening tests
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PSA
Glucose
FOBT
Lipids
Pap smear
Lab Interest – Positive Prevention Provisions
• Annual Wellness and Personalized Prevention Plan – beginning in
2011 Medicare will pay for comprehensive health risk assessment
and personalized prevention plan by primary care provider.
• USPSTF Expansion - Recognized need to expand the criteria the
USPSTF uses beyond A and B recommendations to consider
professional medical societies, patient groups and relevant
agencies.
Selected Examples of USPSTF
Recommendations
Inconsistencies with Professional Societies
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Fasting plasma glucose or oral glucose tolerance testing: diabetes
– USPSTF - All adults with blood pressure > 135/80
– American Diabetic Association - All adults with BMI > 25 and one or
more risk factors for diabetes. All adults without risk factors age > 45.
Lipid profile: coronary heart disease
– USPSTF - Fasting lipid profile every 5 years for men age > 35 yrs and
women 45 yrs, and patients > 20 yrs with risk factors for coronary
heart disease
– National Cholesterol Education Program – Fasting lipid profile at least
every 5 years for patient’s age > 20 yrs
PSA (prostate specific antigen)
– USPSTF – Evidence insufficient for recommendation in men <75 yrs
– American Cancer Society and American Urological Association Offered to men > 50 yrs with a life expectancy of at least 10 yrs
Looking Ahead
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Paralysis in Congress For Remainder of 2010
Impact of the 2010 Elections Next Year
Physician Fee Schedule Must be Extended in 2010
Drive Toward Cost Control Will Intensify
– Deficit & Debt, Medicare Solvency
– Deficit Commission Reports 2010
• Hope for Personalized Medicine Advanced Diagnostics?
– FDA Oversight of LDTs
– NIH Genetic Test Registry
– Legislative Solution?
Thank You!