CLINICAL LABORATORY IMPROVEMENT PROGRAM
CLINICAL LABORATORIES CONTINUE TO EXPERIENCE HARSH ECONOMIC REALITIES
Prostatic Specific Antigen (PSA) Medicare FFS payment cap:
2017 national limitation amount (NLA) = $25.23
2018 payment w/ cap = $22.71
2019 payment w/ cap = $20.44
2020 payment w/ cap = $18.39
Through 2020, Medicare average payment rates are declining 15% – 28% from 2017
Average cost per test = $15.12
Average Medicare reimbursement = $14.67 (2018)
3rd party pays more, Medicaid pays ~ 10% less.
Study of productive hours per billed test comparing 325 hospital clinical laboratories (FYE 2016/2017):
Median = 0.165
10th percentile = 0.101
25th percentile = 0.130
35th percentile = 0.146
Minimum staffing concerns occur at less than 125,000 lab tests per year.
Unless the hospital clinical laboratory adjusts to the new reality, it will go from a revenue center to a cost center.