U.S. Senators Pat Roberts (R-KS) and Robert Menendez (D-NJ) recently sent a bipartisan letter signed by 32 other Senators regarding a Medicare Physician Fee Schedule rule requiring that all laboratory requests forms be signed by the ordering physician. The letter sent to Dr. Donald Berwick, administrator Centers for Medicare & Medicaid Services, calls for an additional delay of up to nine months until CMS can work with labs and providers to improve this process for all involved.

Senator Roberts has heard from laboratories and physicians about the difficulties the rule will cause in their everyday practices, including extra administrative and paperwork burdens, special hardships for rural patients, confusion at laboratories and additional cost and delay for patients and providers. The initial implementation date proved to be unworkable and the Centers for Medicare and Medicaid (CMS) agreed to postpone enforcement by three additional months.

"Under this new policy, laboratories will face a difficult decision when they receive a patient specimen with an unsigned requisition," the letter states. "Laboratories will have to decide not to provide their needed services and therefore be unable to provide a physician the information necessary to make health care decisions - or - provide the services without a guarantee of payment and then work to obtain signatures in order to submit claims to Medicare. As you can imagine, in the former situation, care may be significantly delayed; in the latter scenario the laboratories who serve a high percentage of Medicare beneficiaries could spend a large amount of time contacting providers to gather the required signatures and could see their payments delayed or face the possibility of being unable to receive payment."

Various scenarios were mentioned in the letter that might have negative impact. They include delayed care for patients reporting to in-patient service centers without the requisite signature form and the difficulty of tracking down the physicians on call for skilled nursing facilities in order to obtain signatures and the subsequent and more costly use of emergency rooms for patients needing immediate lab tests

While the proliferation of electronic medical records in the coming years has the potential to transform the process and documentation of orders and requisitions, offering CMS access to standardized documentation of the physicians orders, the letter noted that challenges currently exist in the electronic ordering systems for lab tests, particularly as some physician systems do not interface with lab computer systems. Therefore, the senators encourage CMS to consider using the additional time requested to ensure that efforts to provide consistency in documentation are aligned with its goals for adoption of health information technology systems, which will benefit patients, providers and payers alike.

The letter was signed by Senators Roberts, Menendez, John Kerry (D-MA), Tim Johnson (D-SD), John Ensign (R-NV), Richard Burr (R-NC), John Barrasso (R-WY), Jerry Moran (R-KS), Mike Crapo (R-ID), Chuck Grassley (R-IA), James Risch (R-ID), Chuck Schumer (D-NY), Frank Lautenberg (D-NJ), Ron Wyden (R-OR), Roberts Casey (D-PA), Ben Nelson (D-NE), Sherrod Brown (D-OH), Debbie Stabenow (D-MI), Mark Udall (D-CO), Carl Levin (D-MI), Kay Bailey Hutchison (R-TX), Roy Blunt (R-MO), Mike Johanns (R-NE), Kay Hagan (D-NC), Scott Brown (R-MA), Mark Kirk (R-IL), John Cornyn (R-TX), Al Franken (D-MN), Daniel Akaka (D-HI), Bill Nelson (D-FL), Kristen Gillibrand (D-NY), Richard Durbin (R-Il), Chris Coons (D-DE) and John Thune (R-SD).

Roberts is a member of the Senate Health, Education, Labor and Pensions Committee, a member of the Senate Finance Committee which has jurisdiction of Medicare and is co-chairman of the Senate Rural Health Caucus.

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