The following HTML text is provided to enhance online
readability. Many aspects of typography translate only awkwardly to HTML.
Please use the page image
as the authoritative form to ensure accuracy.
Medicare Laboratory Payment Policy: Now and in the Future
ing policy and making decisions about fees and clearer communications for presenting them. Changes are also needed in administrative procedures, particularly for the incorporation of new tests, to streamline procedures and make them more efficient. The committee was concerned with the lack of data on which to base a judgment of whether HCFA’s fees for individual services were set at an appropriate level and the lack of data on the frequency of inappropriate use.
The committee believes that the shortcomings discussed in this chapter can and should be addressed. Time tends to exacerbate such problems because laboratory practice and the larger health care system continue to change, thus putting further stress on an already cumbersome and inefficient system. By taking action promptly, HCFA and the Congress can revise the payment system to better accommodate the technological advances expected in the decades ahead. In the next chapter the committee discusses alternatives for change. In Chapter 7 the committee presents its recommendations for changes in payment methodology.
Axt-Adam, P., J.C.van der Wouden, and E.van der Does. 1993. Influencing behavior of physicians ordering laboratory tests: A literature study. Med Care 31, No. 9:784– 794.
Dyckman, Z., and B.B.Cassidy. 2000. Recent developments and trends in the clinical laboratory industry (unpublished). Columbia, MD: CHPS Consulting.
Executive Office of the President of the United States. 2000. Proposed Budget of the United States Government, Fiscal Year 2001. Washington, DC: U.S. Government Printing Office.
General Accounting Office (GAO). 2000. Medicare Payments: Use of Revised “Inherent Reasonableness” Process Generally Appropriate. HEHS-00–79. Washington, DC: GAO.
Health Care Financing Administration (HCFA). 1998. 1998 Data Compendium, 030407. Baltimore, MD.: U.S. Government Printing Office.
Hindmarsh, J.T., and A.W.Lyon. 1996. Strategies to promote rational clinical chemistry test utilization [see comments]. Clin Biochem 29, No. 4:291–299. Comment in Clin Biochem 1997; 30, No. 4: 361, 363.
Medicare Payment Advisory Commission (MedPAC). March 1999. Report to the Congress: Medicare Payment Policy. Washington, DC: MedPAC.
Office of the Inspector General (OIG). June 1995. OEI-05–94–00130. CLIA’s Impact on the Availability of Laboratory Services. Washington, DC: OIG.
van Walraven, C., and C.D.Naylor. 1998. Do we know what inappropriate laboratory utilization is? A systematic review of laboratory clinical audits [see comments]. JAMA 280, No. 6:550–558. Comment in JAMA 1998; 280, No. 6:565–566.