Read the Latest Issue of STATLINE

November 21, 2017

In This Issue:

The American Medical Association (AMA) continues to work with physician organizations like the CAP to tackle issues from regulatory burden relief to payment for services provided to patients. At the recent AMA 2017 Interim Meeting, physicians outlined health reform issues and regulatory relief concerns. A delegation of pathologists, led by the CAP, advocated on behalf of laboratory medicine.

The priority issues include, regulatory relief, changes to Medicare's 14 Day rule, tissue handling, the Opioid Epidemic and Prior Authorization. Of note, 120 state and specialty medical societies from across the country reaffirmed existing AMA policies on health reform, reducing regulatory burdens and payment for services.

Moreover, Colin Murphy, MD, a CAP member and pathology resident, was elected chair-elect of the residents and fellows section council at the recent meeting. Dr. Murphy is the first pathologist to serve in this role leading the contingent of new-in-practice physicians in the AMA House of Medicine.

The AMA announced that it will release an Economic Impact Study, which provides state-specific data for each of the 50 states and DC demonstrating that physicians have a huge impact on the national and state economies through the creation of jobs, purchase of goods and services and support for state and local tax revenue. This study is expected to be published in the early part of 2018.

The Value of AMA Membership

The CAP encourages its members to strengthen pathology's voice at the AMA. The number of the CAP's delegates at the AMA's House of Delegates depends on the number of CAP members who join the AMA. By joining the CAP and AMA, pathologists can make sure our perspectives are considered during debate on health care reform and other issues important to the specialty.

Medicare 14 Day Rule

The CAP, working with the American Society of Clinical Oncology (ASCO), introduced a resolution into the AMA House of Delegates calling on the AMA to actively lobby the federal government to change Medicare’s 14 day rule policy. This resolution was adopted and supports separate payment for complex diagnostic laboratory services performed on pathologic specimens collected from a hospital inpatient or outpatient. The CAP was successful in raising awareness about the deleterious impact of the 14-day rule and testified in support of the resolution.

Tissue Handling Resolution

The Pathology Section Council presented testimony to oppose any proposed laws or regulations that would require the handling of fetal tissue from terminated pregnancies are any different than tissues obtained during other medical procedures. Requirements to the contrary have no proven scientific basis and there are practical implications for patients and physicians. The AMA adopted the policy that disposition of tissue obtained during a terminated pregnancy should be determined by medical professionals without intervention from regulators. Pathologists, in particular, are aware of the complexity of this issue and are best positioned to lead on this issue.

Opioid Addiction Crisis

Opioid abuse remains a key priority for the AMA. The CAP provided expertise regarding toxicology an epidemiology and anticipates presenting on this at the AMA annual meeting in June 2018.

Prior Authorization

The CAP acknowledged the AMA's work to help relieve the excessive burden from prior authorizations through regulatory and/or legislative means. Recently, the CAP opposed a pilot program in Florida and remains actively engaged with United Healthcare how its program is fundamentally flawed and negatively affects patient access to services, delays results, and increases administrative burden without a corresponding improvement in care. The program creates inconsistencies with current clinical practice, professional judgment, and laboratory operations. The CAP supported the AMA resolution because we believe this resolution asks for sensible changes to the prior authorization process which is in the best interest of our patients and our practices.

Stay tuned to STATLINE for further updates from the AMA.

Back to the top

The CAP advocated for pathologists Medicare reporting requirements by submitting comments to the Centers for Medicare and Medicaid Services (CMS) regarding a new direction for its Innovation Center in response to the Agency's Request for Information (RFI).

In the November 20 letter to the agency, the CAP urged that CMS' innovation center engages stakeholders in all phases of model development, ensure that non-patient-facing specialist are considered in its evaluation, give priority to specialty-focused quality measures, and allow for voluntary participation in Alternative Payment Models. The CAP further highlights the role of pathologists in care coordination, and urges the agency to work with the CAP on ways to incorporate ideas highlighted in the letter into new and existing models.

The CMS is looking to set a new direction for its Innovation Center and the RFI will assist in evaluating how they can move forward to enhance prior work in this area. In particular, the CMS Innovation Center is interested in testing models in the following eight focus areas:

  1. Increased participation in Advanced Alternative Payment Models (APMs);
  2. Consumer-Directed Care & Market-Based Innovation Models;
  3. Physician Specialty Models;
  4. Prescription Drug Models;
  5. Medicare Advantage (MA) Innovation Models;
  6. State-Based and Local Innovation, including Medicaid-focused Models;
  7. Mental and Behavioral Health Models; and
  8. Program Integrity.

STATLINE will provide any further updates regarding the CMS Innovation Center.

Back to the top

On November 17, the CMS published the final Medicare 2018 clinical laboratory fee schedule (CLFS) despite the CAP and other industry groups' reservations about the laboratory data collection process and methodology to calculate the new rates. The CAP has called this collection process flawed and continues to urge the CMS to delay the implementation of the new fee schedule to allow for time to fix their flawed data collection process.

A 2014 federal law mandated changes to the CLFS and the CMS has since worked to implement the law. The final 2018 CLFS rates were published on CMS' website on November 17 and the full file is available for download. The CAP provided comments to the agency on its proposed 2018 rates on October 23. Read the full STATLINE alert.

Back to the top

The 2017 Practice Characteristics Survey revealed that advocacy issue priorities vary by practice setting. In a new issue brief (NEED A LINK) about the survey outlines how participants ranked advocacy issues that they felt were important to them and their practice. Of those issues, Medicare payment for pathology services was the most important issue for pathologists with 23% having identified it as their top concern and 63% of the total respondents having cited the issue as one of their top five concerns. Nearly half the respondents cited changes to pathology scope of practice as one of their top five concerns. The other top 5 issues included:

  1. Direct billing for pathology services
  2. Maintenance of Certification (MOC) requirements
  3. Personalized/precision medicine, genomics
  4. FDA regulations and oversight of laboratory developed tests

Moreover, academic hospitals, independent labs, and community (non-academic) hospitals shared three advocacy issue priorities, the remaining advocacy issues priorities were unique to each setting and differed from those listed in the top 5 advocacy issue priorities. Pathologists based in Academic Medical Centers are more likely than other pathologists to express concerns about funding for graduate medical education, FDA oversight of laboratory developed tests, and personalized/precision medicine. Pathologists based in community hospitals are uniquely concerned with federal government reporting requirements for quality measures, while independent labs are concerned with for laboratory payment. These differences demonstrate the importance of recognizing that pathologist concerns can vary by their practice setting.

Check out this latest 2017 Practice Characteristics Survey Issue brief.

Back to the top

Eric Y. Loo, MD, FCAP

Each month, STATLINE will feature one of the many CAP members who have been champions for pathology in Washington and at the state level through our grassroots and PAC programs. If you would like to get involved, you can join PathNET, contribute to PathPAC, or join your state pathology society.

Name: Eric Y. Loo, MD, FCAP
Position: Assistant Professor of Pathology, Hematopathology, and Molecular Genetic Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Why should your colleagues get involved in advocacy?

There is a staggering amount of political activity that impacts our profession, but slips by pathologists unnoticed. As you would expect, special interest groups are consistently at the discussion table with their knives out. By comparison, the degree of physician underrepresentation is striking. Even worse, policy-makers are unfamiliar or have gross misconceptions about laboratory medicine. We must proactively reach out to inform these groups. No one else is willing or able to meaningfully articulate our contributions to patient care. Don't give in to apathy—nonparticipation guarantees restricted access to care, misalignment of policy and practice, inequitable reimbursement for services, and increasing regulatory burdens. We recently secured co-sponsorship for S. 794, the Local Coverage Determination Clarification Act, from one of our U.S. Senators, Jeanne Shaheen (D-NH), and the process was surprisingly painless. All it took was a few emails and one very pleasant meeting with the Senator’s health policy staff to explain the issue.

Do you have a favorite memory or experience that stands out in your advocacy work?

A few months ago, I was asked to provide testimony at our statehouse regarding proposed balance-billing legislation. Although the CAP was excellent in helping me to prepare, the day itself was not especially pleasant. A few of the committee members were in active collaboration with state insurance regulators in creating unfavorable balance-billing/rate-determination legislation and were probably more aggressive in cross-examination than necessary. However, I was still left with a favorable memory because I was able to take a couple of pathology residents along with me to observe. The experience positively contributed to their holistic pathology training, and I think they came away more enthusiastic and interested in advocacy participation.

What was your greatest fear or concern about becoming an advocate for the profession before you got involved? Was your fear/concern justified?

I was not originally interested in political advocacy but fell into it by blindly volunteering to help my co-workers by filling a vacant state pathology society position. I didn’t have typical concerns about advocacy because I didn’t know what I was getting into! The various issues affecting our profession were only theoretically important to me, but not especially concerning on an everyday level. Actual participation in the process has clearly demonstrated that these political issues are real, in active play, and in desperate need of assistance from local pathologists. However, I can say that with the abundant assistance from the CAP, I have never felt unprepared when asked to help with advocacy.

Back to the top

Wednesday, November 29, 2017
12:00 PM CT

As the CMS has now finalized rules for the 2018 Quality Payment Program, learn how you can prepare and plan for next year's MIPS performance period.

In 2018, most pathologists will need to take action to stop penalties from reducing future Medicare payments for their services and nearly all pathologists will be required to participate in MIPS.

On November 29, the CAP will host a 60-minute webinar to discuss 2018 options for preventing Medicare penalties and, in certain cases, increase reimbursements in 2020. The webinar will begin at 1 PM ET and will be moderated by Donald Karcher, MD, FCAP, Chair of the CAP Council of Government and Professional Affairs. Dr. Karcher will be joined by W. Stephen Black-Schaffer MD, FCAP, Chair, of the CAP Economic Affairs Committee and; Diana Cardona, MD, FCAP, Chair of the CAP Economic Affairs Measures & Performance Assessment Subcommittee, who will discuss how these proposed Medicare program changes under the Quality Payment Program will affect pathologists in 2018.

Register today.

Back to the top

Registration is open for now the 2018 CAP Policy Meeting–Protecting the Practice of Pathology and Our Patients.

The annual CAP policy meeting, which is set for from April 30–May 2 at the Washington Marriott in Washington, DC, enables CAP members to connect with government leaders and policy experts to discuss the impact of federal regulation on their pathology practices.

New regulations are taking shape that will impact pathology reimbursements for years to come. Attendees at the CAP Policy Meeting will receive the latest information and analysis on the implementation of new Medicare and laboratory regulations. The CAP is actively engaged in the legislative and regulatory arenas on the critical issues facing pathology and laboratory medicine, including physician payment reform, reducing regulatory burdens, and improving health care quality.

The CAP Policy Meeting will also include meetings with members of Congress and their staff during the CAP's 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 CAP Policy Meeting is a benefit of CAP Membership. There is no fee to register.

Register for the 2018 Policy Meeting.

Back to the top

STATLINE will take a scheduled break on November 27 in observance of Thanksgiving and will next appear in your email inbox on December 5. Please continue to check the CAP Twitter, Facebook, and CAPConnect accounts for updates from the CAP.

Back to the top