RESULTS Act aims to avert Medicare lab fee cuts that could hit physician office testing

Medical groups’ in-office labs are a workhorse for same-day testing in primary care and many specialties, and they are back in the crosshairs of Medicare payment policy as Congress weighs a bipartisan proposal known as the RESULTS Act.

The bill, formally titled the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025, would change how Medicare sets rates on the Clinical Laboratory Fee Schedule by revising how private payer data is collected and used. In the House, the legislation is H.R. 5269; in the Senate, it is S. 2761. The text of H.R. 5269 says the goal is to improve “the accuracy of, and feasibility of data collection” used to set Medicare lab payment rates.

For physician practices, the stakes are immediate. If payment resets move forward without congressional action, many office-based labs and other providers could face cuts that ripple into what services are offered on site and how quickly patients can get answers.

“Cuts would occur in the range of 15% for our members who have these physician owned labs,” Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, said in an interview with Physicians Practice. “It’s important that we don’t obviously cut physician laboratory services at 15% …”

What the RESULTS Act would do

Supporters describe the RESULTS Act as a long-term fix to problems tied to PAMA, the 2014 law that required Medicare to reset lab prices based on commercial market rates. Critics of the current approach argue the private payer data Medicare relies on is not representative and that the reporting structure has produced repeated payment cliffs that Congress has had to delay.

MGMA and other stakeholders have urged lawmakers to move the proposal as part of a broader push to stabilize lab payments while Congress debates a permanent fix. In a Jan. 8 MGMA letter supporting the bill, the group argued that physician office labs support same-day testing and faster clinical decision-making, particularly for older adults and rural patients.

Gilberg said the RESULTS Act is both a payment and process change.

“Also, there’s a new bill that we support using another acronym called the Results Act, which would not only create a more sustainable payment system for laboratories, but also reform the data collection methodology that caused the cuts in the first place,” he said.

Where things stand in Congress

The RESULTS Act has gained visibility as Congress considers multiple Medicare payment and access proposals.

The House Energy and Commerce Subcommittee on Health included the bill in a legislative hearing on Medicare payment policies for seniors, according to a Jan. 8 recap from the American Hospital Association. In his interview, Gilberg pointed to that committee activity as a sign the measure is getting traction.

“The Energy and Commerce Committee in the House of Representatives was looking at a number of health care bills, and that is one of them,” he said. “So hopefully there was some help on the horizon, and they moved that bill.”

At the same time, lawmakers have been pursuing a shorter-term patch. The College of American Pathologists reported that House action on a broader funding package would delay pending lab cuts and keep current rates in place into 2027, buying time for longer-term reforms. The group outlined the timeline and implications in its Jan. 23 update.

Why practice managers care

In-office labs are a workflow and patient-access lever for practices, not just a revenue line item, because they can reduce follow-up visits, avoid outside lab trips and speed clinical decisions.

“For a physician practice, what we want to is to be able to provide a full range of services for our patients,” Gilberg said. “To have it if you have an elderly patient who needs a lab test, so they don’t have to go home, get transportation, back to the practice or to another lab.”

Gilberg also argued physician-owned labs do not have the scale of large reference laboratories, making sudden reductions harder to manage.

“We don’t have the same economies of scale,” he said. “We’re not doing 1000s and 1000s and 1000s of these services, like a big reference laboratory would do.”

What to watch next

For practice managers tracking the issue, three near-term checkpoints matter.

One is whether the Senate advances the House-backed spending package described by CAP that would delay the next round of cuts. Another is whether H.R. 5269 moves beyond hearings and into markup or becomes part of a larger Medicare package. The third is whether negotiators attach RESULTS Act language to must-pass legislation, a common pathway for payment policies on a tight calendar.

If Congress opts for another short-term delay without passing a longer-term fix, practice leaders could find themselves back in the same place later this year, preparing contingency plans for lab services and reworking workflows around test turnaround times and patient convenience.