Advocacy Update

Read the Latest Issue of Advocacy Update

In This Issue:

Seeking to reverse a federal agency’s decision to eliminate an autopsy standard, the CAP is urging its membership to directly contact government officials with their concerns for removing the requirement of an autopsy program as a condition for hospital participation in Medicare.

Engaging on this issue is easy through our grassroots action center, PathNet. In just a few clicks, pathologists can send a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma about this issue. Pathologists should use this as an opportunity to educate federal officials about the dire consequences this decision will have on the entire health care system.

In late September, the CMS decided to remove autopsy standards for hospitals from its regulation, which the CAP and other national pathology organizations strongly opposed. 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 response, the CAP, the National Association of Medical Examiners, the Association of Pathology Chairs, the American Society for Clinical Pathology, and the American Society of Cytopathology urged the CMS to restore the autopsy standard in a letter sent to Ms. Verma on October 9.

Contrary to the CMS’s opinion, the dire effects of removing this standard will contribute to the further decline in the national autopsy rate, impacting quality patient care. In the letter, the pathology organizations said that “clinical autopsy is an important aspect of clinical service, providing clinicians with critical feedback regarding diagnostic accuracy, therapeutic efficacy, and medical complications… Moreover, clinical autopsy has [an] indispensable role in supporting the ability of health care professionals to improve and furnish high quality patient care by contributing knowledge in ways that can inform and/or change medical practice.”

Back to the top

Although the CMS would not intensify problems with physician self-referrals in its proposal to amend Stark law regulations, the federal agency is missing an opportunity to close the self-referral loophole and protect patients by removing anatomic pathology from its exceptions list.

On October 9, the CMS issued a proposed regulation to modify its administration of the Medicare physician self-referral law, which is often called the Stark law. The proposed regulation was prompted by concerns that the Stark law may be inhibiting beneficial arrangements that would advance the transition to value-based care. As a result, the agency proposed several exceptions for certain value-based compensation arrangements. Before the proposal’s release, the CAP strongly encouraged the CMS to also remove anatomic pathology from the in-office ancillary services (IOAS) exception list. 

The CMS agreed with the CAP’s 2018 comments that any changes to the Stark law should be approached with caution. The proposed regulation includes safeguards to “ensure the Stark law will continue to provide meaningful protection against overutilization and other harms.” 

However, the agency did not address the IOAS exception, allowing certain noncomplex ancillary services, such as simple blood tests deemed necessary by the physician, to inform patient diagnosis and treatment. The CAP has argued that anatomic pathology services are specialized physician services in which pathologists prepare and analyze biopsied tissues to diagnose the absence or presence of a disease. Moreover, anatomic pathology services differ greatly from routine clinical laboratory tests that can be performed reasonably while the patient is in the office, providing results at the point of care.

The CAP will respond to the proposed regulation by reiterating its concerns about the IOAS exception for anatomic pathology services. By narrowing the exceptions for self-referral and removing anatomic pathology services, Medicare would address concerns regarding inappropriate utilization.

Back to the top

The CMS will soon publish updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations, which may affect your payment for pathology services during the next year and beyond. On November 8 at 1 PM ET, the CAP will host a live webinar where CAP experts will review the final regulation changes that impact pay and pathologists’ participation in the Merit-based Incentive Payment System (MIPS).

Webinar presenters will be the Chair of the CAP Council on Government and Professional Affairs Jonathan Myles, MD, FCAP; Chair of the CAP Measures & Performance Assessment Subcommittee Diana Cardona, MD, FCAP; and Chair of the CAP Economic Affairs Committee W. Stephen Black-Schaffer MD, FCAP.

During the 60-minute webinar, the panel will also answer your questions on the fee schedule, MIPS, and other payment policies.

Register today for the webinar.

Back to the top

Try your advocacy luck and take the October Advocacy News Quiz. See how your scores compare to your fellow CAP members and share on social media.

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

Back to the top