Advocacy Update

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In This Issue:

The CAP strongly opposed the Centers for Medicare & Medicaid Services (CMS) decision to remove the autopsy standards for hospitals. As a condition for Medicare reimbursement, hospitals were required to have an autopsy program. With this regulation change, hospitals are no longer required to have autopsy programs to qualify for Medicare reimbursement.

In September 2018, the CMS released a proposed regulation to reform Medicare regulations that are identified as unnecessary, obsolete, or excessively burdensome on health care providers and suppliers. Within this proposal, the CMS had recommended removal of the autopsy standard that requires autopsies in all cases of unusual deaths, medical-legal, and educational interests. The CAP strongly opposed the removal of this provision as it would open the door to not performing or offering autopsies at hospitals. This would, in turn, have a detrimental impact on public health, patient care, organ donations, and potential health or genetic predispositions to diseases and disorders, creating even more burdens within the health system, the CAP said.

On September 26, the CMS went ahead and released the final regulation which alarmingly removed the autopsy standards for hospitals by justifying this change as a means to reduce regulatory burdens on physicians and the health care system. In the final regulation, the CMS changed its Medicare reimbursement policy where hospitals are no longer required to have autopsy programs to qualify for Medicare reimbursement. The agency clarified that the removal of this standard does not prohibit hospitals from performing autopsies and encouraged hospitals to implement policies for autopsy, where appropriate.

The CAP continues to oppose this change and will keep its membership updated on any new actions concerning this policy.

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The CAP strongly opposed laboratory date of service proposals by the CMS that would severely restrict access to critical diagnostic treatment for patients. Specifically, the CAP urged the CMS to reconsider changes for its laboratory date of service policy in a September 24 letter to the agency.

To reflect the interests of the CAP’s membership of pathologists, we opposed changes to test results requirements and limiting the laboratory date of service exception to advanced diagnostic laboratory tests (ADLTs) as proposed in a 2020 Medicare regulation for the Hospital Outpatient Prospective and Ambulatory Surgery Center payment systems. In the letter, the CAP stated that “ADLTs and molecular pathology testing are appropriately separable from the hospital stay that preceded the test and should have a [date of service] that is the date of performance rather than the date of collection. Any potential changes would limit beneficiary access to these important tests, taking a step backward and creating an administrative burden and documentation costs.” Moreover, the CAP warned the Medicare agency that past decisions created more problems regarding the date of service. 

The CAP reinforced that the problem that led to CMS finalizing changes in the date of service policy in 2017 was “the precise issue of independent laboratories being unable to bill for tests, and hospitals being required to bill for them, highlighting the point that these tests are not commonly performed by hospitals.” In 2017, the CAP worked with the American Medical Association (AMA) and others to ask CMS to implement a solution. The CAP underscored that patient care should come first, and that laboratory tests must be “timely and accurate, [and] absent incentives for a delay that can hinder the initiation of targeted pharmacotherapies.” 

The CAP also asked the CMS to expand the exclusions from the laboratory date of service rules to include in situ hybridization and flow cytometry technical component services. As molecular testing increases in the age of personalized medicine, the CAP urged the agency to keep the exception in the laboratory date of service policy that covers molecular pathology tests, as this “expansion will only serve to exacerbate problems that would result from a change in current policy.” Additionally, the CAP agreed with and urged finalization to exclude blood banks and blood centers from the laboratory date of service exception policy. The CAP further asked for further clarification of all molecular testing performed by blood banks and blood centers is excluded from the policy exception.

The CAP engaged with the AMA, ensuring that their comments reflect the CAP’s strong opposition to present a unified effort in opposition to the proposed change.

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Try your advocacy luck and take the new October Advocacy News Quiz.

Last month, over 100 of your fellow CAP members tested their advocacy knowledge. See how you stack up against your fellow pathologists on this month’s quiz and share your results. It’s easy, so good luck!

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Participants at the 2019 Tri-State Pathology Conference will receive an update from immediate past-President R. Bruce Williams, MD, FCAP, on federal and state advocacy and other CAP activities on October 5.

To strengthen the profession of pathology at the local level, the CAP supports state pathology societies to bolster advocacy efforts on issues such as private insurance, billing, and scope of practice. The CAP’s leaders also directly speak and visit with pathologists at several state pathology society meetings throughout the year. On October 5, Dr. Williams will address the Tri-State Pathology Conference hosted by the Alabama Association of Pathologists in Birmingham. Topics Dr. Williams will discuss include the CAP’s advocacy to enact federal surprise billing legislation, protect that value of pathology services, and the upcoming Pathologists Leadership Summit.

Check our state pathology societies webpage for more information about support the CAP provides to state societies.

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