Advocacy Update

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July 2, 2019

In This Issue:

The CAP welcomed the introduction of the Protecting People from Surprise Medical Bills Act on June 26 by announcing its support for the legislation, HR 3502, which has quickly earned 40 cosponsors in the House of Representatives.

“The solutions in the Protecting People from Surprise Bills Act would accomplish our goals of holding patients financially harmless from surprise medical bills while creating an independent arbitration system that keeps patients out of the middle of out-of-network billing disputes,” said CAP President R. Bruce Williams, MD, FCAP. “The root cause of a surprise bill is an insufficient health insurance provider network. The inclusion of a baseball-style arbitration process would allow physicians and insurers to come together and settle an out-of-network medical bill through the consideration of a range of factors reflecting the market value of physician services. The CAP appreciates that the proposal avoids the use of one rate that could be wholly controlled by insurers.”

The CAP urged all pathologists to contact their representatives to cosponsor HR 3502, which was introduced by Rep. Raul Ruiz, MD (D-CA) and Rep. Phil Roe, MD (R-TN). CAP members can easily communicate with Congress on this important issue through our grassroots action network, PathNET, which is available for you to contact your Federal legislators. More than 1,200 CAP members have contacted their federal representatives over 8,300 times on this imperative issue.

CAP Opposes S. 1895

While the CAP applauded the introduction of the Ruiz-Roe bill, pathologists opposed S. 1895, the Lower Health Care Costs Act, that was marked up by the Senate Health, Education, Labor, & Pensions (HELP) Committee on June 25.

Despite increased calls for changes to the physician pay mechanism for out-of-network services in S. 1895, the HELP Committee marked up its bill without adding an independent dispute resolution process that’s successfully kept patients from receiving surprise medical bills in several states. The CAP and other physician specialty associations warned that S. 1895’s reliance on rate setting for out-of-network services would create imbalance and threaten patient access in the US health care system.

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President Donald J. Trump issued an executive order directing the departments of Health & Human Services (HHS), Treasury, and Labor to issue regulations to improve the transparency of health care prices and quality. The CAP will utilize this opportunity to engage on several issues from the executive order of concern, including price transparency, establishing a health quality roadmap, and surprise medical bills.

Price Transparency and Informing Patients

Earlier in 2019, the Trump administration required hospitals to post their list prices online, and the executive order proposes expanding this provision by requiring hospitals to disclose prices negotiated with health plans. This proposed policy is receiving significant pushback from the Federation of American Hospitals, the American Hospital Association, and America’s Health Insurance Plans. 

The order also calls for new regulations that require health care providers and insurers to provide or facilitate access to information about out-of-pocket costs to patients before they receive care. The CAP has expressed concern about requiring pathologists to inform patients about out-of-pocket costs for a service before patients are furnished that service, as there is significant risk for patient harm from any delays. Pathologists understand how access to cost information before services may be useful for some patients and provider care, but the CAP opposed adding additional administrative requirements on physicians that interfere with or impair the patient’s medical diagnosis and care. The CAP will continue to engage on this issue as the rulemaking process moves forward.

Health Quality Roadmap

The administration asked federal agencies to align and improve reporting on data and quality measures across Medicare, Medicaid, the Children’s Health Insurance Program, the Health Insurance Marketplace, the Military Health System, and the Veterans Affairs Health System. Recently the Centers for Medicare & Medicaid Services (CMS) published “quality roadmaps” that consolidate quality measures. As a non-patient-facing specialty, the CAP will continue to develop measures that demonstrate the value of pathology to the health care system, and ensure pathology is valued and represented well when data is made available to the public.

Surprise Medical Billing

The directive asks the HHS to submit a report to implement principles to end surprise medical bills. This directive does not address an arbitration process as an approach to solve the problem. The CAP is fully engaged on the issue of surprise billing. While Congress is seeking to address the issue through several legislative proposals, a report from the HHS on surprise billing could influence implementation.

The CAP will utilize the forthcoming regulatory process to submit comments on our concerns and priority issue areas, including price transparency, data and quality measures, and surprise billing.

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Citing patient safety concerns, the CAP reiterated its opposition to proposed reforms that would allow gene patenting under the Patent Act which.

In a June 26 letter, the CAP asked members of Congress to change an amendment to the Patent Act that would permit patenting of human genes.
Gene patents pose a severe threat to medical advancement, medical education, and patient care, the CAP said. The CAP outlined how the draft legislation in Congress would “permit patenting of human genes and naturally occurring associations between genes and disease and would create barriers to patients’ access to life-saving genomic tests, eliminate access to confirmatory testing, and substantially increase costs of tests.” Moreover, the legislation would overturn US Supreme Court decisions and create barriers to patient access to lifesaving genomic tests.

Until the 2013 landmark Supreme Court decision in Association of Molecular Pathology v. Myriad Genetics, a woman could find out if she carried the mutated gene only from a test provided by Myriad Genetics test at the cost of more than $3,000. The Supreme Court’s decision allowed other companies to create tests on the previously patented genes. Now there are tests for BRCA1 and BRCA2 as well as 72 other genetic tests for as little as $249.

The proposed congressional amendment to patent law threatens over a century of precedent, the CAP said. The CAP urged Congress to amend the draft legislation to address these concerns and offered further to work with members of Congress on this issue.

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On June 24, President Trump signed bipartisan legislation that reauthorizes the Biomedical Advanced Research and Development Authority (BARDA), which will strengthen the country’s preparedness against a variety of global disease threats. The new law authorizes the HHS to increase funding for pandemic flu and emerging infectious diseases programs, as well as reauthorize funding for bioterrorism preparedness and the Hospital Preparedness Program, among other initiatives. The CAP will engage with the HHS as physicians on the front lines of pandemics to ensure that new guidance in this area adequately protects our communities and our country.

The new law calls for the CMS to “identify and develop and set of guidelines relating to practices and protocols for all-hazards public health emergency preparedness and response,” including laboratory capacity during such all-hazard emergencies. It also directs agencies under the HHS to develop protocols or best practices for safety and protection of workers handling human remains, such as forensic pathologists. The CAP will engage with these agencies as they develop the protocols to mitigate any increased burden on pathologists.

The law established a new Assistant Secretary for Preparedness and Response (ASPR), which will oversee and work with the Centers for Disease Control and Prevention in emergency and response activities. The new office will develop guidelines to inform regional systems of hospitals and health care facilities to treat patients affected by chemical, biological, radiological, or nuclear threats, including emerging infectious diseases, and to bolster medical surge capabilities and capacity.

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The CMS just started to roll out the 2018 Merit-based Incentive Payment System (MIPS) data where participating clinicians can view their performance feedback and final MIPS scores.
If you submitted MIPS data for the 2018 reporting period, you can access your performance feedback and final score by:

The final score should take into account any special status, such as non-patient-facing or hospital-based physicians. In the coming weeks, the CMS will provide further assistance in interpreting your feedback.
Your 2018 MIPS performance will determine payment adjustments to your Medicare Part B payments in 2020 of +/- 5%.

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Soon the CMS will issue its proposed updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations, including the Merit-based Incentive Payment System (MIPS). On July 17 at 1 PM ET, the CAP is proud to offer a complimentary live webinar where CAP experts will review regulatory changes that will impact payment for services and pathologists’ participation in MIPS.

Webinar presenters will be the Chair of the Council on Government and Professional Affairs Donald S. Karcher, MD, FCAP; Vice-Chair of the Council on Government and Professional Affairs and Chair of the Clinical Data Registry Ad-Hoc Committee Emily E. Volk, MD, FCAP; and Chair of the Economic Affairs Committee W. Stephen Black-Schaffer MD, FCAP.

During the 60-minute webinar, attendees will learn about updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations and its impact on pathologists. The CAP panel will also answer questions from attendees.

Register today for the webinar.

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The CAP has an Advocacy News quiz for June, where you can test your knowledge and share your scores on social media. Last month more than 70 CAP members took the quiz and shared their results on social media. See how you measure up against your fellow pathologists on this month’s quiz. This is the last week to take the June quiz. Good luck!

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Advocacy Update will take a scheduled break on July 9 due to the Independence Day holiday. You will receive the next edition of Advocacy Update in your email inbox on July 16. Please continue to check the CAP TWITTER, FACEBOOK, and CAPCONNECT accounts for updates from the CAP.

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