FROM THE EDITOR By Linda Wilson, Managing Edi tor
Passing the test on the importance of testing
T
esting plays a central – and often unsung – role in treating acute and chronic diseases. Without data to determine a diagnosis, providers cannot treat a disease. But because
of the COVID-19 pandemic, the public is getting a rare look at how important testing is in the fi elds of medicine and public health.
At a virtual conference hosted by the American Society
for Clinical Laboratory Science (ASCLS) and the Association of Genetic Technologists (AGT) in late June, attendees ex- pressed frustration about the perceived lack of respect and fi nancial support for lab operations among other healthcare
professionals, politicians, and the public. But despite their exasperation, they also voiced optimism. They noted how important it is for lab professionals to turn the public’s focus on testing for SARS-CoV-2 into a teachable moment. As one attendee noted, “We need to seize this opportunity to get the attention
of regulators, legislative offi cials (state and local) and the general public about the woeful state of clinical laboratory funding. Time for training dollars and reim- bursement relief – not to mention RESPECT.” In hospitals, labs garner a small chunk of the total budget – roughly 2.5 percent, by some estimates. The fi nancial pressures on laboratory services has become even greater in recent years. The Protecting Access to Medicare Act of 2014 (PAMA), which bases Medi- care pricing for lab tests on rates that private insurers pay, has impacted budgets. Since the new payment system became effective on January 1, 2018, labs have seen as much as a 20 percent reduction in Medicare payments, according to COLA estimates in 2019. Value-based care, which bases payment on patient outcomes and resource uti- lization, is also a factor, as some value-based programs, such as bundling, lump costs for lab tests with other medical services necessary to treat patients for an episode of care.
Meanwhile, at public health labs, budgets have been shrinking as part of the cutbacks in overall funding for public health. Spending on public health is less than 3 percent of all healthcare expenditures, and its share of total funds has been declining since 2000, according to the Trust for America’s Health. Given those dwindling budgets, the public health workforce has lost 56,000 positions over the last decade, the trust also said. The demand for testing created by SARS-CoV-2 has only intensifi ed the fi nan-
cial pressure on laboratories. Breaking even on molecular testing for SARS-CoV-2 is challenging. The Centers for Medicare & Medicaid Services (CMS) reimburses labs $100 per test run on high-throughput analyzers and $51 per test run on other equipment. However, lab managers told me that those rates do not cover their costs, which include capital expenditures, testing supplies and kits, personal pro- tective equipment (PPE), staff salaries, and more. To offer testing in their communities, lab managers also have had to combat continuing shortages of PPE, test kits, reagents, and swabs. In a survey of 100 of its members in June, for example, Premier found that 40 percent of them do not have enough testing swabs and test kits. At the ASCLS-AGT virtual conference, attendees also talked about not having access to enough basic materials to make transport media in-house. But they persevere because they know testing is key in the fi ght against SARS-
CoV-2. They are not the only ones who understand this. The public recognizes it, too.
That is the why this is an opportunity for lab professionals to talk about the important role their fi eld plays in keeping the public safe and healthy and why adequate funding is necessary. I encourage you to talk about it everywhere – from the halls in the hospitals to the socially distanced chats in the neighborhoods – un- til these conversations produce viable, actionable solutions for everyone. I welcome your comments, questions, and opinions — please send them to me at
lwilson@mlo-online.com.
4 CLR 2020-2021 • MLO •
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MEDICAL LABORATORY OBSERVER Vol.52, No.13 &
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MLO EDITORIAL ADVISORY BOARD
John Brunstein, PhD, Biochemistry (Molecular Virology) President & CSO PathoID, Inc., British Columbia, Canada
John A. Gerlach, PhD, D(ABHI) Laboratory Director Michigan State University, East Lansing, MI
Barbara Strain, MA, SM(ASCP), CVAHP Principal, Barbara Strain Consulting LLC Formerly Director, Value Management University of Virginia Health System, Charlottesville, VA
Jeffrey D. Klausner, MD, MPH Professor of Medicine and Public Health Division of Infectious Diseases: Global Health, Dept. of Epidemiology, David Geffen School of Medicine, Karen and Jonathon Fielding School of Public Health, University of California Los Angeles, CA
Susan McQuiston, JD, MT(ASCP), SCy(ASCP) Instructor, Biomedical Laboratory Diagnostics Program Michigan State University, East Lansing, MI
Donna Beasley, DLM(ASCP) Director Huron Healthcare, Chicago, IL
Anthony Kurec, MS, H(ASCP)DLM Clinical Associate Professor, Emeritus SUNY Upstate Medical University, Syracuse, NY
Suzanne Butch, MLS(ASCP)CM Freelance Consultant, Ann Arbor, MI
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Paul R. Eden, Jr., MT(ASCP), PhD Lt. Col., USAF (ret.) (formerly) Chief, Laboratory Services 88th Diagnostics/Therapeutics Squadron Wright-Patterson AFB, OH
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