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Congress enacted several health care provisions as part of a two-year budget deal that stopped a temporary government shutdown. Several sections of the bill will affect physician payment under the Medicare program, as well as extend the Children Health Insurance Program (CHIP), expand funding for Teaching Health Center Graduate Medical Education, and reauthorize funding for community health centers for two years.

President Donald J. Trump signed the Bipartisan Budget Act of 2018 into law after the Senate and House had earlier voted on legislation the morning of February 9. The new law eliminated the Medicare Independent Payment Advisory Board (IPAB), which was mandated by the 2010 Affordable Care Act. The IPAB would have recommended cuts to Medicare if costs exceeded growth targets. The IPAB never convened, but the CAP, American Medical Association, and many other physician organizations strongly opposed it and advocated to repeal the cost control board because it would circumvent congressional authority to legislate changes to Medicare.

The new law also mitigated potentially deeper cuts to the 2019 Medicare Physician Fee Schedule’s conversion factor by eliminating the misvalued code provision. The misvalued code provision applied a savings recapture target to automatically reduce the conversion factor each year if savings are not achieved. The CAP has opposed the misvalued code initiative as roughly half of all pathology physician fee schedule services have been reviewed or revalued in recent years. The law will reduce a 0.5% update to the fee schedule to 0.25% for 2019.

Other Key Changes to Health Care Programs

Below are other noteworthy changes included in the February 9 bipartisan budget deal:

  • Extended the geographic practice cost indices (GPCI) floor for physician work by two years. A GPCI is a factor that adjusts payment for every Medicare payment locality. The work GPCI floor prevents negative adjustments to the work value of physician services in certain areas of the country. The GPCI work floor had expired on December 31, 2017. The law now extends the floor and stops negative work GPCI adjustment until 2020.
  • Added an additional four years of CHIP reauthorization, which gave the program funding through 2027.
  • Reached agreement to include $2 billion for the National Institutes of Health for research, $4 billion to rebuild and improve Veterans Affairs hospitals and clinics, and $6 billion for the opioid crisis and for mental health funding in an omnibus spending package by March 23.
  • Increased Medicaid funds for Puerto Rico and the US Virgin Islands.
  • Permanently repealed Medicare outpatient therapy caps beginning January 1, 2019.

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Judy Woodruff

The CAP is pleased to announce that broadcast journalist Judy Woodruff will join leading political commentators Charlie Cook and William Kristol at the 2018 Policy Meeting. By discussing the current political landscape through her reporter’s lens, Ms. Woodruff will provide a unique perspective on the potential impact of the 2018 mid-term elections during her talk at the Policy Meeting, which is scheduled April 30 – May 2, at the Washington Marriott in Washington, DC.

Ms. Woodruff is the anchor and Managing Editor of “PBS NewsHour,” and has covered politics and other news for more than four decades at CNN, NBC, and PBS. For 12 years, Ms. Woodruff served as anchor and senior correspondent for CNN, where her duties included anchoring the weekday program, "Inside Politics." At PBS from 1983 to 1993, she was the chief Washington correspondent for The MacNeil/Lehrer NewsHour. From 1984-1990, and she also anchored PBS' award-winning weekly documentary series, "Frontline with Judy Woodruff.”

Ms. Woodruff joins Charlie Cook and William Kristol as the headline speakers at this year’s engaging Policy meeting.

William Kristol

Mr. Kristol is the editor-at-large of The Weekly Standard, is a regular on ABC’s “This Week” and on ABC’s special events and election coverage, and appears frequently on other leading political commentary shows. Before starting The Weekly Standard in 1995, Mr. Kristol led the Project for the Republican Future, where he helped shape the strategy that produced the 1994 Republican congressional victory. Prior to that, Kristol served as chief of staff to Vice President Dan Quayle during the George H.W. Bush Administration and to Education Secretary William Bennett during the Reagan Administration. Before coming to Washington in 1985, Mr. Kristol was on the faculty of Harvard University’s Kennedy School of Government and the Department of Political Science at the University of Pennsylvania.

Charlie Cook

Mr. Cook is editor and publisher of The Cook Political Report and a columnist for National Journal magazine. Mr. Cook founded The Cook Political Report in 1984 and became a columnist for Roll Call, the Capitol Hill newspaper, in 1986. Mr. Cook has served as a political analyst for CBS, CNN, and NBC and has also appeared on "Meet the Press" and "This Week."

Attendees at the Policy Meeting will receive the latest information on the implementation of new Medicare and laboratory regulations. The 2018 Policy Meeting will also include discussions with congressional offices during the Annual Hill Day on May 2, which is the specialty's opportunity to focus on the federal issues most important to pathologists now and in the future.

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

Register for the 2018 Policy Meeting.

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Lawmakers in Arizona have passed out of committee a genetic testing bill that includes an amendment negotiated by the CAP and the Arizona Society of Pathology (ASP) allowing a pathologist who is licensed in the state to order and perform genetic testing for a patient and receive results of that testing.

Under an Arizona law enacted in 2016, pathologists are prohibited from ordering genetic tests on a patient specimen “without the specific written consent of the subject.” As reported in the January 30 edition of STATLINEthe CAP and ASP have long argued that because the definition of genetic test in the law is overly broad, pathologists were legally hindered from ordering or requiring the performance of genetic testing to diagnose a patient for optimal patient care.

“Most cancer diagnoses now involve some molecular/genetic testing for biomarkers to aid treatment decisions,” the groups said in a recent letter sent to the Arizona Medical Association. “In many of these cases, pathologists order these tests. In addition, many tests that are normally not considered genetic tests but rather detect proteins (gene products) are encompassed by this definition. The standard of care in other states allows pathologists to order these tests as medically necessary without legal impediment or legal encumbrance (i.e., without informed consent in addition to the informed consent obtained by the treating physician who obtained the specimen).”

By a vote of 8-1, lawmakers on the House Health Committee Feb. 8 adopted the amendment and passed Arizona HB 2450. The measure will now go to the state House for a vote. STATLINE will continue to follow and report on the bill’s progress through the Arizona Legislature.

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If your practice still needs to report their 2017 Merit-based Incentive Payment System (MIPS) data, and you missed the deadline for the CAP 2017 MIPS Reporting Solution, the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program has a 2017 MIPS Reporting Portal to help you avoid the penalty.

The CMS portal is available on the Quality Payment Program to website. Eligible clinicians can report as a group and submit their 2017 performance data for the Quality Payment Program by 8 pm ET on March 16, 2018. All other MIPS eligible reporting clinicians who are reporting individually have until 8 pm ET on March 31, 2018.

However, if you have already submitted your 2017 MIPS data via the CAP 2017 MIPS Reporting Solution, then you are covered.

If your billing company has submitted claims data for your practice’s quality measures to the CMS, but not attested to your practice’s improvement activities, you still can report your improvement activities through the CMS portal. If you choose this option, each pathologist needs to attest in the CMS portal to their Improvement Activities as an individual pathologist, and not as a group.

CAP members should also be aware that the CMS reporting portal is not optimized for non-patient-facing clinicians yet, so the portal may not accurately reflect your score. The CMS assures the CAP that this will be fixed in the near future.

Eligible clinicians who need assistance with the data submission system may contact the Quality Payment Program by email at or toll free at 1-866-288-8292.

For a fact sheet on the Quality Payment Program data submission system, including more information for clinicians participating in APMs, please see QPP 2017 Data Submission Factsheet.

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STATLINE will take a scheduled break on February 20 due to the President’s Day holiday. You will receive the next edition of STATLINE in your email inbox on February 27. Please continue to check the CAP TWITTERFACEBOOK, and CAPCONNECT accounts for updates from the CAP.

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