This white paper was developed in collaboration with Mayo Clinic and is based on a panel discussion from the 2019 Dark Report Executive War College benefactor session featuring speakers from Change Healthcare and Mayo Clinic. As significant as the PAMA cuts are, their financial impact extends beyond Medicare payments. Many commercial payers and state Medicaid programs base their reimbursement on Medicare rates. That means most lab revenues will be driven lower over time. PAMA’s financial impact comes at a time when hospital laboratories are already under intense margin pressure.