Competitive bidding for Medicare Part B clinical laboratory services



The traditional Medicare fee-for-service program may be able to purchase clinical laboratory test services at a lower cost through competitive bidding. Demonstrations of competitive bidding for clinical laboratory tests have been twice mandated or authorized by Congress but never implemented. This article provides a summary and review of the final design of the laboratory competitive bidding demonstration mandated by the Medicare Modernization Act of 2003. The design was analogous to a sealed bid (first price), clearing price auction. Design elements presented include covered laboratory tests and beneficiaries, laboratory bidding and payment status under the demonstration, composite bids, determining bidding winners and the demonstration fee schedule, and quality under the demonstration. Expanded use of competitive bidding in Medicare, including specifically for clinical laboratory tests, has been recommended in some proposals for Medicare reform. The presented design may be a useful point of departure if Medicare clinical laboratory competitive bidding is revived in the future.


Clinical laboratory Competitive bidding Auction Medicare Part B CLIA Reimbursement 

JEL Classification

D44 H51 I11 I18 L88 



This study was funded by the Centers for Medicare and Medicaid Services. The views expressed are those of the authors and are not necessarily those of the Centers for Medicare & Medicaid Services.


  1. Antos, J., Pauly, M., & Wilensky, G. (2012). Bending the cost curve through market-based incentives. New England Journal of Medicine, 367(10), 954–958.PubMedCrossRefGoogle Scholar
  2. Center for American Progress (2012). Senior protection plan. Retrieved April 20, 2013, from
  3. Centers for Medicare & Medicaid Services (2012). Competitive bidding update-one year update, April 17, 2012. Retrieved April 20, 2013, from
  4. CMS (Centers for Medicare and Medicaid Services) (2010). Data compendium. Retrieved April 20, 2013, from
  5. Coulam, R., Feldman, R., & Dowd, B. (2011). Competitive pricing and the challenge of cost control in medicare. Journal of Health Politics Policy and Law, 36(4), 649–689.CrossRefGoogle Scholar
  6. Cramton, P., Ellermeyer, S., & Katzman, B. E. (2012). Designed to fail: The Medicare auction for durable medical equipment. Working Paper: University of Maryland, Supported by National Science Foundation.Google Scholar
  7. Emanuel, E., Tanden, N., Altman, S., et al. (2012). A systemic approach to containing health care spending. New England Journal of Medicine, 367(10), 949–954.PubMedCrossRefGoogle Scholar
  8. Feldman, R., Coulam, R., Dowd, B. (2012). Competitive bidding can help solve Medicare’s Fiscal Crisis. American Enterprise Institute for Public Policy Research, Health Policy, Outlook, No. 2, February 2012.Google Scholar
  9. Guterman, S., Davis, K., Schoen, C., Stremikis, K. (2009). Reforming provider payment: Essential building block for health reform. New York: The Commonwealth Fund. Retrieved April 20, 2013, from
  10. Hoerger, T., Lindrooth, R., & Eggleston, J. (1998). Medicare’s demonstration of competitive bidding for clinical laboratory services: What it means for clinical laboratories. Clinical Chemistry, 44(8), 1728–1734.PubMedGoogle Scholar
  11. Institute of Medicine (IOM). (2000). Medicare laboratory payment policy: Now and in the future. Washington, DC: The National Academies Press.Google Scholar
  12. Kandilov, A. M. G., Pope, G. C., Kautter, J., & Healy, D. (2012). The national market for Medicare clinical laboratory testing: Implications for payment reform. Medicare and Medicaid Research Review, 2(2), E1–E21.Google Scholar
  13. Mennemeyer, S.T. (1989). Competitive bidding for Medicare outpatient laboratory tests. Advances in health economics and health services research (Vol. 10, pp. 313–333). Greenwich, Connecticut: JAI Press Inc.Google Scholar
  14. Merlob, B., Plott, C. R., & Zhang, Y. (2012). The CMS auction: Experimental studies of a median-bid procurement auction with nonbinding bids. Quarterly Journal of Economics, 127(2), 793–827.CrossRefGoogle Scholar
  15. Milgrom, P. (1989). Auctions and bidder: A primer. Journal of Economic Perspectives, 3(3), 3–22.CrossRefGoogle Scholar
  16. Myerson, Roger. (1981). Optimal auction design. Mathematics of Operations Research, 6, 58–73.CrossRefGoogle Scholar
  17. Office of Inspector General, United States Department of Health and Human Services (2009). Variation in the clinical laboratory fee schedule. OIG report no. OEI-05-08-00400. Retrieved April 20, 2013, from
  18. Riley, John, & Samuelson, William. (1981). Optimal auction. American Economic Review, 71, 381–392.Google Scholar
  19. Varian, H. (1992). Microeconomic analysis (3rd ed.). New York: W. W. Norton & Company.Google Scholar
  20. Vickrey, William. (1961). Counterspeculation, auctions and competitive sealed tenders. Journal of Finance, 16, 8–39.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.RTI InternationalWalthamUSA

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