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March 26, 2019

In This Issue:

By using CAP-developed quality measures in 2017, the vast majority of pathologists stopped a 4% Medicare penalty and optimized their Merit-based Incentive Payment System (MIPS) scores to earn positive adjustments to their payments in 2019.

According to a data report (appendix) released by the Centers for Medicare & Medicaid Services (CMS) on March 19, 13,409 pathologists were eligible for MIPS and 12,950 pathologists, or 96.6%, participated during the 2017 MIPS performance period by reporting quality measures and attesting to improvement activities. The CAP’s strategy assisting pathologists to participate in the new payment system included eight pathology-specific quality measures and release of 2017 MIPS Reporting Solution as part of the launch for the Pathologists Quality Registry.

The CMS allowed physicians to “pick your pace” in 2017 and 376 pathologists opted to either report just one quality measure or attest to completing one improvement activity to avoid the penalty. Thousands of pathologists did much more. For instance, 8,646 providers reported the CAP’s pathology-specific Barrett’s esophagus measure and 5,136 reported the melanoma reporting measure.

The top five improvement activities reported by pathologists were:

  • Provide 24/7 access to eligible clinicians or groups who have real-time access to patient's medical record (5,036 pathologists attesting to the activity)
  • Implementation of improvements that contribute to more timely communication of test results (1,614)
  • Patient-centered medical home attestation (1,387)
  • Engagement of patients through implementation of improvements in patient portal (1,239)
  • Transforming clinical practice initiative (TCPI) participation (1,089)

The CMS has told the CAP that the improvement activity of providing “24/7 access to eligible clinicians or groups who have real-time access to patient’s medical record” is not intended for pathologists. For the list of improvement activities reviewed by the CMS, access the applicable activities for pathologists on the CAP’s website.

Do you have any questions about MIPS? Email the CAP’s experts at for the right answers.

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The CAP working with New Mexico Society of Pathologists (NMSP) successfully averted passage of an out-of-network payment formula that could have slashed payment for certain pathology services. Specifically, the proposed formula would have established payment at the 60th percentile of allowed rates of health plans, based upon data derived from an independent database. The CAP, in its efforts to protect the value of pathology services, pushed to clarify that reimbursement rates be only “commercial rates” and that the bill restore a provision ensuring no payment dropped below 150% of Medicare’s payment rate.

Without advocacy from the CAP and NMSP, the resulting effects would have harmed pathology practices across the state, said NMSP President Michael Crossey, MD, FCAP.

“Many of our pathology colleagues staff rural hospitals and function in small private practice groups,” Dr. Crossey said. “The proposed bill to prohibit out-of-network billing to patients was put into our legislative session without consideration of the financial impact to pathologists. While the bill protected emergency department physicians and others, it would have capped some of the primary pathology CPT codes well below Medicare rates. This would have severely impacted the pathologists and their practices here in New Mexico. Possibly to the point of discontinuing practice, especially outside the metropolitan area.”

Dr. Crossey credited the CAP and the strength of pathologists active in NMSP for their work to stop the steep cuts and protect the value of pathology services. Just a few weeks ago, state lawmakers were set to enact the adverse provisions of the bill into law. But New Mexico-based pathologists spoke with legislators about the value of the pathologist in patient care and argued for changes.

“The legislators were surprisingly receptive to our input and frankly thankful for the help,” Dr. Crossey said. “I could not have done that without help from the CAP’s Advocacy leaders and its programs supporting state pathology societies.”

The legislation, Senate Bill 337, passed without opposition in the state Senate on March 10 and the House on March 15. The bill currently is awaiting Governor Michelle Lujan Grisham’s signature.

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At the 2019 Policy Meeting, award-winning journalist and host of Fox News Sunday Chris Wallace will draw from his decades at the news desk to deliver valuable insight and perspective on the unprecedented election that put President Donald Trump in the White House and what America looks like two years later under our 45th president.

Register and join your colleagues at the 2019 Policy Meeting April 29-May 1 in Washington, DC. In addition to unique opportunities to hear from leaders and newsmakers in US politics, the 2019 Policy Meeting is your chance to speak directly to members of Congress and their staff during the CAP’s annual Hill Day on May 1. The Policy Meeting is the pathologist’s opportunity to educate legislators and policy experts on the value that pathology brings to the health care continuum.

Mr. Wallace will address Policy Meeting attendees during lunch on April 30. With an expert’s eye and a historian's perspective, Mr. Wallace will illustrate various potential scenarios to provide a more in-depth understanding of how to prepare for the immediate future. From recent tax reform to the state of health care to the potential impact of the 2018 midterm elections on Congress, Mr. Wallace will breakdown the day’s headlines and news stories effecting individuals and industry with the clarity and distinction that have established him as a go-to source for the most important political issues of today and tomorrow. Wallace will offer behind-the-scenes anecdotes about Washington and perspective on the critical and evolving role of the media in the national dialogue.

Register today to hear from Mr. Wallace and health care policy leaders.

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