Read the Latest Issue of STATLINE

October 23, 2018

In This Issue:

On October 19, the American Clinical Laboratory Association (ACLA) filed an appeal in its lawsuit against the Department of Health and Human Services’ (HHS) implementation of market-based reforms mandated by the Protecting Access to Medicare Act (PAMA). The CAP supports the ACLA in filing the appeal and filed an amicus brief in the original lawsuit.

In September, the US District Court dismissed the ACLA’s lawsuit citing “lack of subject matter jurisdiction.” However, the court also acknowledged the merits of the ACLA’s arguments regarding the HHS actions. “We believe it is critically important for ACLA to address these concerns in court,” ACLA President Julie Khani said. “While ACLA continues to pursue legal action, we also call on Congress to reform and modernize the clinical laboratory fee schedule (CLFS) to ensure that beneficiaries can continue to access the lab services and diagnostics they need.” The CAP has also urged Congress and engaged with the Centers for Medicare and Medicaid Services (CMS) to amend the PAMA statute to reflect an accurate, market-based payment system for laboratories paid through the CLFS.

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In a critical step to fight the opioid epidemic, health care providers and patients in Pennsylvania will no longer need to seek advance approval to prescribe medication-assisted treatment for opioid misuse. American Medical Association (AMA) Chair-elect Jesse M. Ehrenfeld, MD, MPH announced the successful outcome during the CAP18 session “The Role of Pathologists in Addressing the Opioid Epidemic” on October 21.

According to the AMA and the Pennsylvania Medical Society, not only have insurers removed this unnecessary step, but they have committed to including a comprehensive range of medications to treat substance use disorders.

"We have long advocated for the removal of prior authorization and other barriers to increase access to medication-assisted treatment (MAT) for substance use disorders," AMA President-elect Patrice A. Harris, MD said in a written statement. "The leadership shown by the governor and his administration to reach this agreement should act as a call for all states to demonstrate that they support patients' access to care over needless administrative burdens."

The agreement will apply to individual, small-group, and large-group fully insured plans.

During CAP18, Dr. Ehrenfeld provided additional information on actions the AMA has taken through its Opioid Task Force. CAP Toxicology Committee Chair Barbarajean Magnani, MD, PhD, FCAP also spoke about actions led by the CAP and Council of Medical Specialty Societies CEO Helen Burstin, MD, MPH, updated attendees on coordination between physicians, hospitals, and other organizations.

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W. Stephen Black-Schaffer MD, FCAP

W. Stephen Black-Schaffer, MD, FCAP, received the inaugural CAP Advocate of the Year Award during the 2018 Meritorious Service Awards ceremony at CAP18 in Chicago on October 21. The CAP honored Dr. Black-Schaffer, who currently chairs the Economic Affairs Committee, by recognizing his accomplishments in political advocacy on the CAP’s behalf in the legislative and regulatory arenas.

For the past 35 years, Dr. Black-Schaffer has advocated in a variety of federal and state venues and by a multitude of means on behalf of pathologists, the discipline of pathology, and the patients served by pathologists. His advocacy has focused on two distinct but ultimately related areas: protecting the value of pathology services and educating pathology residents and fellows.

Dr. Black-Schaffer has also served as an active member and frequent leader of innumerable advocacy committees and councils in the Massachusetts Society of Pathologists, Massachusetts Medical Society, New England Society of Pathologists, AMA, and several other pathology organizations. Through his efforts and leadership on various councils and committees, Dr. Black-Schaffer has been responsible for maintaining, and in many cases enhancing, payment to pathologists for their clinical work.

The CAP Advocate of the Year Award, established in 2018, recognizes outstanding accomplishments in advocacy on behalf of the CAP in the legislative, regulatory, and/or political arenas. It’s presented to a CAP member who has made significant contributions to the CAP’s advocacy efforts and demonstrated dedication to helping achieve the CAP’s advocacy goals.

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CAP member Karim Sirgi, MD, FCAP meets with Sen. Cory Gardner (R-CO).

CAP members continue to urge senators to co-sponsor the Local Coverage Determination Clarification (LCD) Act and hope to move it to a final Senate vote by the end of the year. Recently CAP members Jared Abbott, MD, FCAP; Tim Allen, MD, FCAP; Steve Bigler, MD, FCAP; Candice Black, MD, FCAP; Eric Konnick, MD, FCAP; Elizabeth Martin, MD, FCAP; Dylan Miller, MD, FCAP; Richard Press, MD, FCAP; Karim Sirgi, MD, FCAP; and Brian Wilkinson, MD, FCAP, met with their respective senators in Washington, DC to ensure that local Medicare coverage decisions are made by qualified health experts. After the midterm elections in early November, the Senate is scheduled to reconvene on November 13. Currently the LCD bill has 22 Senate co-sponsors after the House passed a weakened version of the bill on September 12 .

CAP members Tim Allen, MD, FCAP, Brian Wilkinson, MD, FCAP, and Steve Bigler, MD, FCAP meet with Sen. Cindy Hyde-Smith (R-MS).

The LCD bill would improve transparency and accountability when Medicare contractors set local coverage policies for physician services provided to Medicare beneficiaries. These decisions affect millions of Medicare beneficiaries and impact critical access to innovative technologies and procedures.

The Senate version of the LCD bill would also create a meaningful appeal process that requires a qualified third party to make decisions about the validity of LCD reconsideration requests.

STATLINE will continue to report on LCD updates.

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In the next few weeks, the CMS will finalize the 2019 Medicare Physician Fee Schedule and Quality Payment Program changes that will impact Medicare pathology payment and services next year. The CAP is offering one of its most popular webinars - 2019 Final Medicare Policy and Payment Changes - where CAP experts will review the final regulation changes on November 9, 2018, at 11 AM ET.

Presenters are:

Donald Karcher, MD, FCAP

Donald S. Karcher, MD, FCAP
Chair of the Council on Government and Professional Affairs

Emily E. Volk, MD, FCAP

Emily E. Volk, MD, FCAP
Vice-Chair of the Council on Government and Professional Affairs
Chair of the CAP Clinical Data Registry Ad-Hoc Committee

W. Stephen Black-Schaffer MD, FCAP

W. Stephen Black-Schaffer MD, FCAP
Chair of the CAP Economic Affairs Committee

An accurate diagnosis is perhaps the single most important factor in effective patient care. No one knows this more than you. Connect with and educate legislators and policy experts on the value that pathology brings to the health care continuum.

Register and join us at the:

2019 Policy Meeting
April 29—May 1
Marriott Metro Center, Washington, DC

Make pathology’s impact on patient care heard in Washington.

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