Advocacy Update

• Increased Funds for CDC in White House Budget Proposal; Adds New Health Care Agency
• CAP Leaders Emphasize Critical Graduate Workforce Training in New Article
• Physicians Faced Burdens from Prior Authorization During Pandemic: AMA Survey
• Have You Taken the Advocacy News Quiz?

President Joe Biden’s 2021 budget recommendation to Congress released on April 9 called for an additional $8.7 billion for the Centers for Disease Control (CDC) and Prevention and a 23% boost to the Department of Health and Human Services (HHS). The proposed budget also asked Congress for $6.5 billion to create a new federal agency under the National Institutes of Health, called the Advanced Research Projects Agency for Health, which would focus on cancer, diabetes, and Alzheimer’s disease research.

The request is President Biden’s first discretionary spending proposal, a predecessor to the full annual budget, will address Medicare and Medicaid programs, to be released later in the year. Even though the president proposes the federal government's budget, Congress controls spending and must pass appropriations funding legislation.

Other areas that the proposed budget asks for include $10.7 billion in funding for the campaign to Help End the Opioid Epidemic. The amount for the program would represent an increase of $3.9 billion over the 2021 enacted level, to support research, prevention, treatment, and recovery support services. Additionally, the administration asked for $8.7 billion for the CDC, which would represent the largest budget authority increase in nearly two decades. The CDC would use this additional funding to support core public health capacity improvements in states and territories, modernize public health data collection nationwide, train new epidemiologists and other public health experts, and build international capacity to detect, prepare for, and respond to emerging global threats.

Pathology leaders published a paper on the importance of pathology workforce training in Academic Pathology on April 7. The paper titled, “Evidence-Based Alignment of Pathology Residency With Practice II: Findings and Implications,” written by Stephen Black-Schaffer, MD, FCAP; Stanley J. Robboy, MD, FACP; David J. Gross, PhD; James Crawford, MD, PhD, FCAP; Melissa Austin, MD, FCAP; Donald S. Karcher, MD, FCAP; Rebecca Johnson, MD, FCAP; Suzanne Powell, MD, FCAP; Joseph Sanfrancesco, MD, FCAP; and Michael Cohen, MD, FCAP, outlined survey data research from new-in-practice pathologists and of new pathologists, assessing how pathology graduate medical education prepares its pathologists for the practice of laboratory medicine.

The quantitative analysis presented in the paper suggests the current three-or-four year “one size fits all” pathology residency curriculum, plus one or two one-year fellowships, does not optimally address the breadth and variety of actual practice. The authors analyzed four years of new-in-practice pathologists' surveys on how the extent of their training in a broad range of practice areas compared with the importance of these areas in actual practice. These surveys consistently showed areas important in practice in which new practitioners report they would have benefited from more training, as well as areas in which their training had been more than what was useful to them in practice.

These issues point to a need to reconsider the emphasis of training in pathology graduate medical education and the relative roles of residency and fellowship training. Academic Pathology is an open access journal sponsored by the Association of Pathology Chairs, established to give voice to the innovations in leadership and management of academic departments of pathology.

As new cases of COVID-19 were peaking in late 2020, most physicians reported that health plans continued to impose prior authorization policies that delay access to necessary care, according to new survey results by the American Medical Association (AMA). The CAP has worked with the AMA to address programs requiring prior authorization because they can negatively affect patient access to necessary diagnostic tests, create inconsistencies with current clinical practice, and increase burdens on pathologists and laboratories.

According to the AMA survey, almost 70% of 1,000 practicing physicians surveyed in December of 2020 reported that health insurers had either reverted to past prior authorization policies or never relaxed these policies in the first place. More than nine in 10 physicians (94%) reported care delays while waiting for health insurers to authorize necessary care. Nearly four in five physicians (79%) said patients abandon treatment due to authorization struggles with health insurers.

Additionally, nearly one-third (30%) of physicians reported that prior authorization requirements have led to a serious adverse event for a patient in their care. More specifically, prior authorization requirements led to the following repercussions for patients:

• Patient hospitalization—reported by 21% of physicians
• Life-threatening event or intervention to prevent permanent impairment or damage—reported by 18% of physicians
• Disability or permanent bodily damage, congenital anomaly, birth defect, or death—reported by 9% of physicians

The findings of the AMA survey demonstrate a need to streamline or eliminate low-value prior-authorization requirements. In January 2018, the AMA, the CAP, and other health care organizations signed a consensus statement outlining a shared commitment to improving five key areas associated with the prior authorization process. However, health plans have made little progress in the last three years toward implementing improvements in each of the five areas outlined in the consensus statement.

Think you are advocacy savvy? Then take the Advocacy News Quiz. Last month, over 90 pathologists took the quiz. See how you compare against your fellow CAP members’ in the April News Quiz and brag about your top scores on social!

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