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The CAP urged the Centers for Medicare & Medicaid Services (CMS) to maintain its current autopsy regulation in response to the agency’s proposal to eliminate this federal requirement. The CAP responded to a provision in a proposed regulation titled “Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction,” released by the CMS on September 17. While titled broadly, this proposed regulation is limited to addressing Medicare compliance requirements for health care facilities that were identified by the CMS as unnecessary, obsolete, or excessively burdensome. The CAP also urged the CMS to consider reforming other regulatory policies such as the CMS’ Local Coverage Determination (LCD) process and requirements for pathologists participating in the Quality Payment Program (QPP), the CAP stated in a November 19 letter to the CMS.

CAP Opposes CMS Autopsy Policy Change 

The CMS’ proposal includes removing a recommendation that hospital medical staff attempt to secure autopsies in all cases of unusual deaths and of medical-legal and educational interest.”

In the November 19 letter, the CAP asked the agency to retain the current autopsy policy and to review alternative ways to regulate autopsies conducted in hospitals. The CAP disagreed with the CMS’ proposal to remove the recommendation since it may result in fewer autopsies performed in hospitals. Currently, hospitals should have a policy to offer autopsies as a condition of payment under Medicare.

However, the CAP agreed with the CMS that “hospitals need to know their state or local laws with respect to medico-legal cases and need to appropriately report deaths to their local medical examiner/coroner/medicolegal death investigation authority,” the CAP said. “Hospitals should not be trying to obtain family permission in such cases and ought not perform such autopsies without first consulting that authority.” The CAP will continue to engage with the CMS on this issue.

LCD Manual Changes Do Not Go Far Enough

The CAP addressed recent revisions to the LCD section of the Medicare Program Integrity Manual and stated that more needs to be done as it still fell short of achieving patient protections and reforms contained in the Local Coverage Determination Clarification Act. For example, further changes are still required to address reconsideration/appeals and process compliance issues, which will improve the quality of care for patients and increase access to innovative technologies. In the November 19 letter, the CAP urged the CMS to support legislative efforts to ensure these improvements are enacted into law.

Pathologists’ QPP Participation

To ensure recognition of the value pathologists bring to patient care in new innovative payment and delivery models, the CAP urged the CMS to increase opportunities for pathologists to participate in the QPP.

Specifically, the CAP sought to ensure pathologists and other specialists are represented when new payment models are developed under the Advanced Alternative Payment Model (APM) track of the QPP. For example, the Physician-Focused Payment Model Technical Advisory Committee (PTAC) reviews and recommends new models, but at least three recent proposals submitted for review included pathology services in the models without first consulting the CAP. The only opportunity pathologists had to engage on these models was during a public comment period.

The CAP recommended that model developers be required to provide evidence of consultation and concurrence by specialties included in a proposed model before submission for the PTAC’s review.

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The CAP published issue briefs on current compensation trends for pathologists and on the characteristics of new-in-practice pathologists, providing a snapshot of current pathology business environments. These issue briefs, developed by the Policy Roundtable, are based on data from the 2017 Practice Characteristics Survey (PCS), which provides information on how pathologists deal with current health care trends and the changing business environment and informed advocacy priorities set by the CAP. The 2017 PCS report and these issues briefs are exclusive to CAP members.

The pathologist compensation issue brief, Differences in Pathologist Income By Setting, Year-in-Practice, and Region Lock reviewed the various factors of pathologists’ compensation, including base salary, bonuses, incentives, and other income from professional services. This issue brief examined the extent to which pathologist compensation varies by practice setting, years in practice, and region of the country in which they practice. The analysis does not include data on non-cash employer-provided benefits, such as health insurance premiums, retirement contributions, paid time off, and malpractice insurance premiums.

The new-in-practice issue Lock brief analyzed differences between newer in practice pathologists (in practice for 10 years or less) and later-in-practice pathologists (in practice for more than 10 years) in three distinct areas:

  • Work settings
  • Total compensation
  • Perceptions of which advocacy issues are most important to each group

The 2017 PCS, which generated more than 1,600 responses from practicing pathologists, also revealed more information on these pathology business and advocacy issues. CAP members can review the 2017 PCS report Lock and the 2018 Practice Leader Survey Lock .

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Reports for performance in the 2016 Physician Quality Reporting System (PQRS) will only be available to download from the CMS until December 31.

A pathologist can access his or her PQRS feedback report and The Quality and Resource Use Report through a CMS portal, which requires using an Enterprise Identity Management system account. The CMS has additional instructions on signing up for an account and accessing the reports on its website.

The Quality Payment Program’s MIPS reporting track replaced the PQRS program.

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Emily E. Volk, MD, FCAP

As part of our ongoing commitment to ensure pathologists can successfully participate in new and evolving payment models, the CAP continues to offer MIPS educational webinars. All MIPS webinars are available for download.

The final webinar in the Decoding MIPS series is open for registration, Steps to Take Before Reporting MIPS Data, will take place on Tuesday, January 8, 2019, 3 PM ET. During webinar, Emily Volk, MD, MBA, FCAP, will ways of maximizing your scoring for 2018 before submitting results to CMS. Register today.

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An accurate diagnosis is perhaps the most critical factor in effective patient care. No one knows this more than you. Connect with and educate legislators and policy experts on the value that pathology brings to the health care continuum.

Register and join us at the:

2019 Policy Meeting
April 29—May 1
Marriott Metro Center, Washington, DC

Make pathology’s impact on patient care heard in Washington.

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