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Institute of Medicine - Medicare Laboratory Payment Policy: Now and in the Future

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Institute of Medicine Medicare Laboratory Payment Policy: Now and in the Future
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Medicare Laboratory Payment Policy

Now and in the Future

Dianne Miller Wolman, Andrea L. Kalfoglou, and Lauren LeRoy, Editors

Committee on Medicare Payment Methodology for Clinical Laboratory Services

Division of Health Care Services

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS

Washington, D.C.

NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W.
Washington, D.C.20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Support for this study was provided by the Health Care Financing Administration (Contract No. 500-99-0023).

ISBN 0-309-18361-8 e-pub ISBN

International Standard Book No.0-309-07266-2

Medicare Laboratory Payment Policy: Now and in the Future is available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055. Call 8006246242 or 2023343938 (in the Washington metropolitan area), or visit the NAP online bookstore at
www.nap.edu.

The full text of Medicare Laboratory Payment Policy: Now and in the Future is available on-line at www.nap.edu.

Copyright 2000 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Knowing is not enough; we must apply. Willing is not enough; we must do.

Goethe

INSTITUTE OF MEDICINE Shaping the Future for Health THE NATIONAL ACADEMIES - photo 1

INSTITUTE OF MEDICINE

Shaping the Future for Health

THE NATIONAL ACADEMIES

National Academy of Sciences

National Academy of Engineering

Institute of Medicine

National Research Council

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M.Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A.Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I.Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academys purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M.Alberts and Dr. William A.Wulf are chairman and vice chairman, respectively, of the National Research Council.

COMMITTEE ON MEDICARE PAYMENT METHODOLOGY FOR CLINICAL LABORATORY SERVICES

LAUREN LEROY(Chair), President and Chief Executive Officer,

Grantmakers In Health

HOWARD BAILIT, Professor,

University of Connecticut Heath Center

CHRISTOPHER BLADEN, Independent Consultant

WILLIAM HSIAO, K.T.Li Professor of Economics,

Harvard School of Public Health

WILLIAM KERR, Senior Vice President,

The Hunter Group

J.STEPHEN KROGER, Chief Executive Officer,

COLA

JOHN MATSEN, Professor Emeritus,

University of Utah

STEPHEN T.MENNEMEYER, Professor,

Health Care Organizations and Policy, University of Alabama at Birmingham

DAVID SMALLEY, Professor,

College of Medicine, University of Tennessee-Memphis

EARL P.STEINBERG, Senior Vice President,

Resolution Health Strategies, Inc.

BRUCE STEINWALD, Independent Consultant,

Washington, D.C.

ELEANOR TRAVERS, National Clinical Advisor,

Medical Cost Effectiveness, Department of Veterans Affairs Headquarters

Study Staff

DIANNE MILLER WOLMAN, Study Director

ANDREA L.KALFOGLOU, Program Officer

NICCI T.DOWD, Senior Project Assistant

KRYSTAL JONES-FOY, Senior Project Assistant

Auxiliary Staff

JANET M.CORRIGAN, Director,

Division of Health Care Services

MIKE EDINGTON, Managing Editor

JENNIFER CANGCO, Financial Advisor

Consultants

KATIE MERRELL,

University of Chicago

ZACHARY DYCKMAN,

CHPS Consulting (Center for Health Policy Studies)

HENRY MILLER,

CHPS Consulting (Center for Health Policy Studies)

Copy Editor

FLORENCE POILLON

REVIEWERS

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Councils Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the Institute of Medicine in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and the draft manuscript remain confidential to protect the integrity of the deliberative process. The committee wishes to thank the following individuals for their participation in the review of this report:

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