Medicare Compliance & Reimbursement

As CMS's demonstration project ramps up, every lab should be calling Washington

Medicare is hoping that some old-fashioned competition will revamp the laboratory market, forcing labs to adopt new, time-efficient techniques. Is your lab in danger of being left behind? Here's help.

What To Do

Your lab can help define the terms of the demonstration project (see box, page 6) by contacting your local representatives, recommends David Mongillo, director of professional and regulatory affairs for the College of American Pathologists in Northfield, IL. "Labs should be working with their representatives in Washington to make sure that any demonstration project that moves forward will not have a detrimental effect on the critical aspect of quality and access to care."

If CMS officials seek to extrapolate broader conclusions about the laboratory market from this demonstration project, small and moderate-sized labs can preserve their business by insisting that variables other than price be included. Examples include access to services, turn-around times and quality of care. "There are a whole list of things that we think have to be evaluated to make sure that in the end they don't just choose someone based on dollars and cents," says Vince Stine, director of the Government Affairs Program at the American Association of Clinical Chemistry in Washington, DC.

This input is especially important because, as Robin Stombler of Auburn Health Strategies in Arlington, VA points out, "CMS is looking at competitive bidding as a way to obtain what it believes will be the best value for its dollar."

Labs interested in sharing their opinions about the parameters of the demonstration project should inquire into an information session that CMS stated on October 6, 2004, would occur "later this fall." Otherwise, you can send comments or questions to Linda Lebovic.
 
Southeastern U.S., Look Out

One possible inference we can make from CMS' decision to work with Palmetto GBO, a carrier largely based in the Southeastern U.S., is that they plan to conduct at least part of the demonstration project in that part of the country.

"If you are going to choose someone's area, you really want to have access to their data," Stine explains. "One of the reasons they may have subcontracted with Palmetto may be that they want to use one of the areas under Palmetto's jurisdiction as a demonstration site."

Time Frame

Even though CMS' first deadline is closing in, don't expect the actual project to begin for a while. "This is going to be a lengthy process," Stine says. "What they are probably working on right now is putting together their technical advisory panel."

These panels will supply the project directors with experts to evaluate the collected data. "It's really supposed to be a panel that is focused at the local area, not a national panel," Stine says. "They're looking for people with expertise in different areas."

The first deadline might just be an opportunity for the researchers to present the project design and/or some initial findings. "I suspect that the December 31, 2005 report will be an interim report," says Stine. "It will be multiple years before they actually complete the demonstration project."