Advocacy Update

March 16, 2021

In this Issue:

NJ Pathologists, CAP Fight for Network Adequacy

The New Jersey Society of Pathologists (NJSP) and the CAP worked closely with the New Jersey Physician Coalition to advocate for increased network adequacy requirements for health plans. The NJSP and the CAP introduced legislation that requires network adequacy in health plans for pathologists and other specialty physicians. The CAP has worked with the NJSP to ensure that New Jersey health plan networks are inclusive of pathologists to reduce surprise bill incidents for patients.

New Jersey Senate Bill 3518 requires health carriers to submit a network access plan to the state Commissioner of Banking and Insurance, or the Commissioner of Human Services, on the percentage of physicians participating in their network to ensure patients have meaningful access to in-network physician services. The bill outlines health care networks include pathologists, emergency physicians, anesthesiologists, radiologists, radiation oncologists, oncologists, pediatric oncologists, and hospitalists. The bill requires the commissioner to approve a health plan’s network only if the number of providers, medical specialties, and geographic parameters is sufficient for insured patients' access to care.

The CAP stands as an active proponent in securing network adequacy policies in the state of New Jersey and across the United States. Network adequacy is imperative to the market value of pathology services. State legislatures and regulators have a unique role to play to ensure health plans maintain robust networks of physicians for timely access to health services and care to patients. With the introduction of Senate Bill 3518, New Jersey pathologists and patients have the opportunity to discuss the importance of adequate health plans and guaranteed access to specialty providers to their legislators.

The CAP will continue to follow developments on the measure.

Do you have the Advocacy News Chops? Take the Quiz

Think you have the Advocacy know-how? Test it out in our monthly news quiz. Last month, over 70 pathologists took the quiz and about 50% shared their results on social media. See how you compare against your fellow CAP members’ in the March News Quiz and share your results on social!

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CAP Urges Congress to Stop Medicare Budgetary Cuts to Pathologists

The CAP supports bipartisan efforts in the House and Senate to stop Medicare Sequester cuts that will take effect April 1. The CAP sent a letter to congressional leaders urging Congress to prevent additional financial burdens on pathologists during the ongoing COVID-19 pandemic. The CAP will continue to fight for relief for pathologists, who have faced financial hardships during the pandemic, as documented by several surveys throughout 2020.

In the March 15 letter, the CAP strongly supported bipartisan congressional action to stop the Medicare sequester cuts and provide critical relief for pathologists who have been on the front lines to fight the pandemic.

The bipartisan legislation includes extending the moratorium on the 2% Medicare sequestration cuts through the duration of the pandemic. Congress needs to act to prevent across-the-board Medicare sequester cuts in a few short weeks.

The AMA, the CAP, and 127 medical and state organizations have also lobbied Congress to relieve the financial burdens of the COVID-19 pandemic on physicians during the current national emergency. In a February 12 letter to congressional leaders in the House and the Senate, the CAP joined the groups to support legislation that would suspend a 2% across-the-board Medicare budget sequester cut. The CAP supported similar efforts over the past year to stop Medicare cuts and protect pathology services' value. Without additional action, the 2% Medicare cut to physician services will go into effect on April 1.

President Biden Signs American Rescue Plan Providing $48 Billion for COVID-19 Testing

On March 11, President Biden signed into law the American Rescue Plan that includes $48.3 billion for COVID-19 testing. The new law enables the Department of Health and Human Services (HHS) to use the new funding for COVID-19 testing programs in its national strategy. In addition, the law also expanded COVID-19 vaccination efforts and included other key health care provisions supported by the CAP.

The CAP advocated for several provisions related to pathology and ensuring access to testing for patients, including the $48.3 billion. The funding for testing included moneys for contact tracing and sequencing programs, as well as funding for a national strategy and providing technical assistance, guidance, and grants to state, local, and territorial public health departments. The legislation also provided $1.733 billion for enhanced genomic sequencing.

Additionally, the law provided $7.5 billion to strengthen the medical supply chain. The law provided funding specifically for federal vaccine distribution programs and grant programs to support state, local, territorial, and tribal governments’ vaccination efforts.

The law also changed several federal health benefit programs. It aims to make the Affordable Care Act’s exchanges more affordable and increase Medicaid’s federal match for the states. The law further covered COVID-19 vaccines and treatments mandatory under Medicaid and the Children’s Health Insurance Program (CHIP).

New Survey Reveals Almost Half of Labs Can’t Get Enough COVID-19 Testing Supplies

A new CAP survey of board-certified pathologists nationwide showed that less than half, or 45% of laboratories testing for COVID-19 still have difficulties obtaining the testing supplies they need. While this represents an improvement since last summer, shortages still represent a significant burden on those laboratories diagnosing coronavirus disease and require national attention to mitigate disruptions. The CAP is engaged with the Biden administration as it fights the COVID-19 pandemic, especially those elements of the new strategy concerning diagnostic testing and obtaining testing supplies.

This latest CAP’s COVID-19 Pathologist Impact Survey was fielded to all board-certified pathologists from January 27 through February 11. The CAP received 680 responses, constituting a 4.6% response rate, making the sample nationally representative with a +/-3.7 margin of error. The CAP routinely conducts socioeconomic surveys to inform its advocacy.

In this latest survey, the respondents reported continued difficulties acquiring testing supplies, such as reagents (45%) and pipette tips (30%), within the last three months. A significant number of survey respondents also experienced difficulties obtaining other COVID-19 testing supplies: nearly 20% reported difficulties securing supplies such as SARS-CoV-2 instruments (19%), flocked nasopharyngeal swabs (18%), and viral transport media/universal transport media (17%).

The survey also asked pathologists about vaccination and vaccine access for their staff. Ninety-four percent reported that pathologists in their practice have access to the COVID-19 vaccination, and 89% reported that they, themselves, have been vaccinated. When asked about laboratory staff gaining access to the COVID-19 vaccine, pathologists reported that 82% of phlebotomists, 83% of laboratory testing personnel in a hospital. However, just 39% of testing personnel in independent laboratories have received the vaccine.