Read the Latest Issue of STATLINE

The CAP has secured legislative language in the Medicare sustainable growth rate (SGR) repeal bill that would give pathologists much needed flexibility in Medicare's quality initiatives. The CAP language also would be tied to a new Merit-based Incentive Payment System (MIPS) created under the bill.

Congress introduced the "Medicare Access and CHIP Reauthorization Act of 2015" (HR 2), which includes "pay fors" and additional Medicare polices released on March 24. The House is scheduled to vote on the full SGR package over the next few days. However, a vote in the Senate is not clear since Democratic members of the chamber's Finance Committee are concerned with some of the potential policy changes in HR 2.

Repealing the broken SGR formula would stabilize the overall Medicare payment system, but it also would include reforms such as the quality language supported by the CAP. The CAP provision in the permanent repeal bill would give the Secretary of Health and Human Services the flexibility to develop measures and activities for pathologists, and other physicians that don't have direct interaction with patients, to enable them to comply with Medicare’s quality requirements under the new MIPS incentive program.

In addition to eliminating the SGR, Medicare payment rates would increase slightly. The legislation would increase pay rates for physician services by 0.5% for the final six months of 2015 and then an additional 0.5% each year through 2019. The bill also provides financial incentives for providers participating in alternative payment models such as Accountable Care Organizations.

The deadline for this current SGR patch is March 31. A physician payment cut of 21% will be realized unless Congress acts.

If the full SGR repeal legislation is not enacted, Congress will likely pass another patch bill. Lawmakers since 2003 have enacted 17 temporary patches that delay SGR cuts.

Paying for the Bill

The CAP, along with its Alliance for Integrity in Medicare (AIM) partners, continues to call on Congress to close the Stark self-referral loophole protecting physicians who refer anatomic pathology (AP) services to laboratories in which they own or in which they have a financial interest, as a means for paying for SGR reform.

The initial draft of pay fors to offset the legislation did not include closing the self-referral loophole. The CAP continues to push the House and Senate to add the provision.

Lawmakers have discussed partially offsetting the roughly $200 billion cost of an SGR repeal bill. A partial offset would reduce the need to cut spending elsewhere in the federal budget or program benefits. House leadership has stated that a partial "pay for" would include higher premiums in Part B and D for higher income seniors; deductibles for Medigap beneficiaries and cuts to hospitals and post-acute care providers.

A summary of the bill's provisions is available at the House Ways and Means Committee website.

National Physicians Call-In Day

The American Medical Association (AMA) has organized a National Physicians Call-In Day on March 24 to encourage physicians to contact Congress and urge passage of HR 2. Call (800) 833-6354 to be connected with your member of Congress.

The CAP will continue to keep members informed on the latest SGR developments through STATLINE.

(Editor's note: This story has been updated with a new bill number and title for the SGR repeal legislation.)

Back to the top

Following strong CAP advocacy and the support of congressional lawmakers, the Centers for Medicare & Medicaid Services (CMS) has proposed continuing the hardship exception from the Electronic Health Record (EHR) Meaningful Use program's penalties for eligible providers, like pathologists, that "lack face-to-face interactions with patients and lack of need for follow-up care" for at least 2016.

The CMS and Office of the National Coordinator for Health Information Technology (ONC) released the proposed rules for meaningful use of EHRs on March 20. The rules would be for stage 3 of the program. They seek to improve the way health information is shared and the way care is delivered and experienced. Further, the goal of the proposed rules is to provide additional flexibility for providers, simplify the program, drive interoperability among EHRs, and increase the focus on patient outcomes to improve care.

The Medicare program proposed to grant pathologists relief from 2016 payment penalties tied to the meaningful use. The 2016 penalty is 2% for those physicians who did not meet meaningful use criteria in 2014.

The CAP has vigorously opposed the penalty. The current meaningful use criteria include objectives that are outside the scope of pathology practice. Most pathologists do not use certified EHRs because they have limited direct interaction with their patients. As a result of CAP advocacy on this issue, pathologists are exempt from a 1% Medicare payment penalty in 2015.

The CAP had engaged with the CMS and Congress to advocate for relief beyond 2015. In 2014, a CAP grassroots effort resulted in a bipartisan group of more than 100 lawmakers in the House and Senate to write the CMS to urge the agency to grant pathologists relief for the next five years.

For 2015, the CMS has said that the penalty relief for pathologists, radiologists, and anesthesiologists will be automatic. This means pathologists, unlike other physicians applying for the other categories of exceptions, will not need to apply for this relief but should receive it automatically presuming that their specialty is coded correctly in Medicare’s enrollment system.

Based on a CAP preliminary assessment, the pathology significant hardship exception is proposed to continue for 2016. Specifically, the CMS proposal states: "we propose no changes to the types of exceptions previously finalized for [eligible professionals], nor do we propose any new types of exceptions for 2017 and subsequent years. Accordingly, we propose that the exceptions continue as previously finalized." The CAP continues to analyze the proposed rules especially regarding whether the 2016 exception for pathologists is automatic or on a case-by-case basis. The CAP will post more information in STATLINE as it becomes available.

Back to the top

Sign up today to register for the CAP’s March 31 webinar, Results from CAP's 2014 Practice Characteristics Survey.

The Practice Characteristics Survey is a primary source of basic data on the socioeconomic aspects of CAP member practices, and tracks and reports changes that are occurring in the practice of pathology among College members. In December, the 2014 Practice Characteristics Survey Report was published by the CAP Policy Roundtable, a subcommittee of the Council on Government and Professional Affairs.

This 60-minute presentation will review the survey findings and provide a forum for CAP members to ask questions about the report. The webinar, previously scheduled for February 26, is now March 31 at 2 PM ET and will feature Policy Roundtable Subcommittee Chair Michael B. Cohen, MD, FCAP; Policy Roundtable Survey Project Team Chair Thomas M. Wheeler, MD, FCAP; and Policy Roundtable Director David J. Gross, PhD.

Register today!

Back to the top