Read the Latest Issue of STATLINE

April 11, 2017

In This Issue:

Tom Daschle

The CAP is excited to announce that former Senate Majority Leader Tom Daschle will be the lunch Keynote Speaker on Monday, April 24 during the CAP Policy Meeting, which will be held April 24-26, 2017 in Washington, DC.

As the architect of the Affordable Care Act, Senator Daschle will discuss healthcare reform and provide a predictive analysis of the political and economic factors likely to influence policy and shape legislation. During his time in the Senate, Senator Daschle established himself as a leading authority on health care reform, climate change, renewable energy policy, financial services reform, and international trade and tax developments.

With health care reform still unsure and the pending release of potential legislation impacting the practice of pathology and laboratory medicine, the 2017 CAP Policy Meeting will be an essential event for pathologists to advocate on behalf of their specialty and patients.

It's not too late to register for the 2017 CAP Policy Meeting where attendees earn 5.25 CME credits and will receive the latest information and analysis on the implementation of new Medicare and laboratory regulations.

The CAP is actively engaged in the legislative and regulatory arenas on the critical issues facing pathology and laboratory medicine, including physician payment reform, reducing regulatory burdens, and improving health care quality.

The CAP Policy Meeting will also include meetings with members of Congress and their staff during the CAP's Annual Hill Day on April 26, which is the specialty's opportunity to focus on the federal issues most important to pathologists now and in the future.

The CAP Policy Meeting is a benefit of CAP membership and there is no fee to register.

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On April 6, Rep. Jackie Speier (D-CA) reintroduced legislation that would remove anatomic pathology and other designated health services from the in-office ancillary services exception (IOASE) in the self-referral statute known as the Stark Law.

The Promoting Integrity in Medicare Act (PIMA) or HR 2066, which Rep. Speier has sponsored in previous years, faces major opposition from other medical specialities, members of Congress and the influential Republican Doctors Caucus, which has urged the Congress to oppose the bill. Health and Human Services Secretary Tom Price, a former member of Doctors Caucus, also opposes the legislation. Rep. Speier's legislation previously garnered little support in Congress and the bill did not receive a hearing. There is no companion bill in the Senate. The CAP continues to strongly support the need for the Speier bill but believes enactment of the legislation is highly unlikely given the level of opposition in Congress and the Administration.

The PIMA bill would restore the original intent of the self-referral law by prohibiting self-referral for advanced imaging, anatomic pathology, radiation therapy and physical therapy, which are not typically performed at the time of the patient's initial office visit. The legislation also would strengthen provisions in the law to maintain access to care for rural Medicare patients.

Stay tuned to STATLINE for further updates.

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The Oregon Pathologist Association (OPA) and the CAP are continuing to fight legislation that would, in part, link the state's out-of-network (OON) physician payment formula to Medicare.

House Bill 2339, designed to prohibit health care providers or participating health care facilities from balance billing patients for services provided at a participating facility, was passed out of the House Health Care Committee on April 5. Prior to approving, the committee adopted an amendment that would link the OON payment to 175 percent of Medicare for non-emergency services.

OPA and the CAP have said repeatedly that while they support efforts to keep the patient out of the middle of reimbursement issues, they do not support the approach contained in the amended bill.

"Our primary concern regarding the amendment to House Bill 2339 is that it limits what a health plan can pay to an out-of-network physician, including pathologists, based upon the Medicare fee schedule, thereby devaluating certain physician services and encouraging the rollback of private insurance coverage and contracting," wrote OPA President Mohiedean Ghofrani, MD, MBA, FCAP, in an April 5 letter to members of the Oregon House of Representatives.

Dr. Ghofrani explains that the Medicare fee schedule was designed only for medical services rendered to persons over the age of 65. Some medical services, including some pathology and some genetic screening services, are not covered by Medicare. Further, the fee schedule is created in the context of a government program, not to service the private insurance market, he says.

"In some instances, Medicare rates, which are driven by federal budgetary requirements and not by the cost of providing care, are so low that they do not even cover the cost of treatment provided," writes Dr. Ghofrani. "Thus, there is no incentive for health insurance plans to contract with physicians for their services."

The OPA and the CAP support payment to OON physicians based on usual and customary rates that reflect the market value of physician services, at not less than the 80th percentile of an independent database of charges that are determined by geography. They note that other states, such as Florida, Minnesota and New York, have adopted such a market-based formula for payment.

Dr. Ghofrani is urging lawmakers either to vote no on the bill as amended or send the bill back to committee so that the payment formula to physicians can be amended to reflect the market value of physician services. "We believe there are other formulas that can be implemented that would be fair compensation and maintain the integrity of Oregon’s strong network of system providers," he writes.

Specifically, the OPA and the CAP support adoption of a separate amendment that would use the 80th percentile of the FAIR Health Inc. database for determining "usual and customary" rates.

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The CAP is fielding the 2017 Practice Characteristics Survey to gather data from individual pathology practices regarding their economics, demographics, and market trends.

On or around April 10, pathologists received an email from with a link that is unique to the pathologist receiving the invitation. Respondents will be eligible for a drawing for one of four $150 Amazon gift cards. If you have not received your invitation, please contact us at This survey will be available to board-certified pathologists who are currently practicing in the US. The survey excludes full-time retirees, pathologists practicing in different countries, and junior members of the CAP.

The survey should take 15 minutes to complete. The CAP will share the survey findings with its members in a full report and provide early access to the data to those who finish the survey.

All responses are kept strictly confidential.

Responses will be reported in aggregate form only. No individual practice information will be uniquely identified or shared.

The CAP will use the data in its advocacy efforts with policy influencers, healthcare leaders, and other stakeholders to increase understanding of the significant role and value of the pathologist in the delivery of patient care.

Survey participants are helping the CAP to better serve its members. The survey will capture:

  • Vital practice member characteristic data
  • Information on the concerns and challenges of the CAP member
  • Compensation data, including salary and benefits
  • Practice-related data

Complete your survey soon as it closes on May 12.

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On April 4, the Centers for Medicare and Medicaid (CMS) announced that groups planning to use its Group Web Interface or administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) must register to report 2017 performance data for the Merit-based Incentive Payment System (MIPS) by June 30, 2017.

This announcement clarifies what is required of groups of eligible clinicians using the CMS Web Interface or administering CAHPS as part of MIPS reporting. While these eligible clinicians are required to register in accordance with MIPS, all other eligible clinicians are exempt. The registration period is open from April 1, 2017 through June 30, 2017.

Eligible clinicians participating as a group will receive one payment adjustment for their performance. For 2017, only groups of 25 or more eligible clinicians that have registered can report by using the CMS Web Interface.

Groups that participate in MIPS through a qualified registry, qualified clinical data registry, or electronic health record data submission mechanisms do not need to register. For 2017, only groups of 2 or more eligible clinicians that have registered can participate in the CAHPS for MIPS survey.

In addition, the CMS clarified that groups participating in a Shared Savings Program Accountable Care Organization (ACO) do not need to register or report MIPS data as they qualified as part of an Advanced Alternative Payment Model (APM).

Given that the CMS has cited 2017 as a transition year for providers adjusting to the new payment system, the CMS would like to help providers in adapting to MIPS and Advance APMs as part of the Quality Payment Program as smoothly as possible.

As a courtesy, the CMS will automatically register groups for the CMS Web Interface for the 2017 performance period that previously registered for group reporting under the Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO) Web Interface.

If your group qualifies, visit the Quality Payment Program website to register.

How to Register

To register, visit the Quality Payment Program website. You will need a valid Enterprise Identity Management (EIDM) account with a Physician Value–Physician Quality Reporting System (PV-PQRS) role in order to register.

EIDM Account Information
  • Open a New Account: To create or modify an EIDM account, review the Guide for Obtaining a New EIDM Account.
  • Reactivate an Account: To reactivate or confirm the status of an account, contact the Quality Payment Program at 1-866-288-8292 (TTY:1-877-715-6222) or, Monday–Friday 8:00AM–8:00PM Eastern Time and provide the group name and TIN.
  • Use a Current Account: To request a role to access the 'Physician Quality and Value Programs' application in the CMS Enterprise Portal, review the Guide for Obtaining a 'Physician Quality and Value Programs' Role for an Existing EIDM User.

STATLINE will continue to provide updates from CMS.

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Whether you are a seasoned Policy Meeting veteran or a first timer thinking about going to the 2017 Policy Meeting, then you should watch the Essential Tools for Pathologists Engaging in Grassroots Advocacy webinar.

The Essential Tools for Pathologists Engaging in Grassroots Advocacy webinar provides a foundational training for CAP members who are attending the 2017 Policy Meeting by covering the basics of how Congress works, why grassroots advocacy matters, and the tools and resources the CAP provides for members. This webinar provides a general understanding of grassroots advocacy before you arrive in Washington.

During the webinar you hear from experienced advocates Joe Saad, MD, FCAP, Federal and State Affairs Committee chair; Al Campbell, MD, FCAP, Grassroots Subcommittee chair of the Federal and State Affairs Committee; and moderator Michael Giuliani, advocacy senior director of the CAP.

Watch the webinar.

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As part of the organization's ongoing efforts to educate policy influencers—members of Congress, congressional staff, regulatory agency officials, and health policy experts—the CAP is running advertisements in the Washington area during April and through the 2017 CAP Policy Meeting April 24-26.

The advertisements are intended to bring greater attention to the role of pathologists in patient diagnosis. The CAP's digital ads are appearing in several national and local media outlets based in Washington.

A core function of the CAP's overall messaging is that policy influencers, among others, recognize the value of pathologists in bettering patient care. One advertisement reads, "Pathologists unlock the mysteries of cancer." Another message reads "Pathologists are physicians whose diagnoses drive care decisions made by patients, primary care physicians, and surgeons."

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