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Following advocacy by the CAP to oppose proposed changes to cervical cancer screening recommendations, the US Preventive Services Task Force (USPSTF) retained guidelines for cytology and human papillomavirus (HPV) co-testing and cytology screening options.

In an October 9 letter, the CAP opposed a proposed change to the recommendations that women ages 30 to 65 get screened every three years with cervical cytology alone or every five years with high-risk human papillomavirus (hrHPV) testing. The CAP urged the task force to retain the co-testing option, which is current clinical practice and is supported by medical scientific evidence. Current practice guidelines also advocate for concurrent testing.

The USPSTF finalized the guidelines to maintain co-testing for cervical cancer screening on August 22. In addition to the CAP, the guidelines to maintain co-testing were strongly supported by the Cytology Education and Technology Consortium. The CAP is a member of the consortium.

The CAP also had urged that primary HPV screening use only a test platform validated for that purpose and that any HPV primary screening method be applied every three years, not every five years as recommended by the USPSTF. At the time of the CAP’s comments, the only HPV testing method approved by the Food and Drug Administration (FDA) was the Roche cobas method, whose approval was based on a clinical trial that had only three years of follow-up data. BD received FDA approval for its Onclarity HPV assay in February with indications for HPV primary screening, reflex testing, and co-testing. The American Society for Colposcopy and Cervical Pathology and the Society of Gynecologic Oncology also recommended primary HPV screening at least every three years, says the CAP in its comments. However, the USPSTF finalized the proposal of testing every five years.

The final USPSTF recommendation statement and evidence summary were published today in the online edition of JAMA and are available on the taskforce’s website.

Editor’s Note: This article has been updated with information about BD receiving FDA approval for an HPV assay in February.

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In response to a request for information (RFI) on how the Stark self-referral law may hinder value-based payment models, the CAP has urged the Centers for Medicare and Medicaid Services (CMS) to move cautiously when reforming physician self-referral regulations in an effort to remove barriers to coordinated care.

In an August 24 letter to the CMS, the CAP strongly encouraged the Medicare agency to close the in-office ancillary services (IOAS) exception for anatomic pathology (AP) services as part of any reform. The CAP also emphasized that any changes to the Stark Law should not create new opportunities for abusive self-referral arrangements to develop in alternative payment models (APMs).

The CAP has actively engaged in efforts to assess opportunities for pathologists in care coordination initiatives, including the development of alternative payment models under the Medicare Access and CHIP Reauthorization Act (MACRA) and engagement with the Physician-Focused Payment Model Technical Advisory Committee (PTAC). However, the CAP noted that concerns about the availability and success of APMs should be addressed by increasing specialty provider participation and that “physician input and buy-in is critical to effective delivery system reform.”

While CMS is focused on how Stark impacts care coordination, the CAP is most importantly concerned about the IOAS exception to the Stark Law that incentivizes physicians to self-refer AP services. The intent of the IOAS exception was to allow for the provision of certain noncomplex ancillary services, such as simple blood tests, that are deemed necessary by the clinician to help inform the diagnosis and treatment of a beneficiary during an initial office visit. However, AP services are specialized physician services in which pathologists prepare and analyze biopsied tissues to diagnose the absence or presence of disease. These highly technical AP services often require at least 24 hours to be completed. As such, AP services differ greatly from routine clinical laboratory tests that reasonably can be performed while the patient is in the office, providing results rapidly at the point of care.

In its comment letter, the CAP explained this difference, and stated that it is critical that as the CMS continues to contemplate barriers to value-based care transformation, any technical changes or reforms to the current Stark law restrictions or exceptions do not have unintended consequences on physician self-referrals that may lead to increased improper utilization, other disruptive behavior, and unnecessary costs to the Medicare program.

In addition, the Department of Health and Human Services Office of Inspector General requested feedback on how to modify the anti-kickback statute in order to “foster arrangements that would promote care coordination.” Similar to the Stark law, the federal anti-kickback statute seeks to protect patients and federal health care programs by limiting the influence of compensation on health care decisions, but it has recently been criticized as a potential barrier to coordinated care.

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The American Medical Association (AMA) released new public opinion survey data to support the AMA Truth in Advertising Campaign, which is designed to ensure health care providers clearly and honestly state their level of training, education, and licensing. To ensure patients know which “doctor” is providing their care, the AMA model Health Care Professional Transparency Act:

  • Requires all health care professionals to clearly and accurately identify themselves in all writings, advertisements, and other communications.
  • Requires all health care professionals to wear, during patient encounters, a name tag that clearly identifies the type of license they hold.
  • Prohibits advertisements or websites advertising health care services from including deceptive or misleading information.

The new Truth in Advertising survey results confirmed that patients:

  • Remain confused about who is a medical doctor or doctor of osteopathic medicine
  • Strongly prefer that a physician perform certain medical procedures
  • Overwhelmingly support legislation to ensure clarity and transparency in health care advertising
  • Agree that only licensed medical doctors or doctors of osteopathic medicine should be able to use the title “physician”

Full survey results are available from the AMA to download.

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Register for the second webinar on September 6

Navigating all the requirements related to successfully complying with MIPS can be confusing; especially for non-patient-facing physicians such as pathologists. And on top of that, you may be at risk for losing bonus opportunities if you don’t fully optimize your participation.

As part of our ongoing commitment to ensure pathologists are able to successfully participate in new and evolving payment models, the CAP is offering a MIPS educational webinar series. The first webinar on how to Maximize Your MIPS Bonus Potential is now available for download.

Emily E. Volk, MD, FCAP

The second in this webinar series – MIPS Reporting: Which Path is Right for Your Practice? – will take place on Thursday, September 6 at 11 AM ET/ 11 AM CT. During this 30-minute webinar, Emily E. Volk, MD, MBA, FCAP, Vice-Chair of the Council on Government and Professional Affairs and Chair of the CAP Clinical Data Registry Ad-Hoc Committee, will explore the MIPS readiness checklist and learn how to choose the best reporting options for your practice. Register today.

Other upcoming webinars in the MIPS series are open for registration:

Pathologist Improvement Activities Under MIPS
Tuesday, September 20, 2018, 1 PM ET
Diana Cardona, MD, FCAP
Explore the MIPS readiness checklist and learn how to choose the best reporting options for your practice.

2019 Final Medicare Policy and Payment Changes
W Stephen Black-Schaffer MD, FCAP
Donald S. Karcher, MD, FCAP
Emily Volk, MD, MBA, FCAP
Details coming soon.

Quality Measures that Will Improve Your MIPS Score
Tuesday, December 4, 2018, Noon ET
Diana Cardona, MD, FCAP
Examine ways of improving your performance and MIPS scores using CAP-developed quality measures.

Steps to Take Before Reporting MIPS Data
Tuesday, January 8, 2019, 3PM ET
Emily Volk, MD, MBA, FCAP
Discover ways of maximizing your scoring for 2018 before submitting results to CMS.

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Are you being paid fairly for the services you provide? Payment for pathology services has a direct impact on the success of your practice. Do you know who makes these decisions—and what criteria they use? Are there steps you can take to ensure fair compensation? These topics and more will be explored at CAP18.

Educational Sessions

  • MACRAscopic Analysis of the New Quality Payment Program: Maximize Reimbursement While Demonstrating Value (S1620)
  • How Is My Payment Determined for Pathology Services? Non-CME course (STA008)
  • The CAP’s Policy and Advocacy Agenda (STA010)
  • The Role of Pathologists in Population Health: An Interactive Discussion (STA011)
  • What You Need to Know About the CAP’s Pathologists Quality Registry Non-CME course
  • Lunch Roundtables
    • Current Payment Policy Challenges in Pathology Practice (R1691)
    • My Surgical Pathology and Cytopathology Coding Dilemmas: Getting It Right—An Advanced Discussion (R1690)

Learning Pavilion Sessions

  • Understanding and Maximizing your MIPS Score
  • How to Keep Your Practice Afloat While Reimbursement Rates Decline

CAP Exhibit Booth

  • Pathologists Quality Registry Demos
  • MIPS Resources for Pathologists
  • Billing and Cost Assessment Toolkits

Registration is now open for vital CAP policy and advocacy courses and roundtable discussions during CAP18.

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STATLINE will take a scheduled break on September 4 in observance of the Labor Day holiday. You will receive the next edition of STATLINE in your email inbox on September 11. Please continue to check the CAP TWITTER, FACEBOOK, and CAPCONNECT accounts for updates from the CAP.

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