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With serious concerns regarding the data collection and methodology used to calculate new rates for clinical laboratory tests, the CAP strongly urged the Medicare program to delay its implementation of the proposed 2018 Medicare clinical laboratory fee schedule (CLFS).

On September 22, the Centers for Medicare and Medicaid Services (CMS) published preliminary CLFS rates using methodology mandated under the Protecting Access to Medicare Act (PAMA) of 2014. Based on a review of the proposed rates, the CAP believes that there are flaws in the underlying data collection, the implementation of the PAMA methodology, and transparent data release that are causing major discrepancies in the proposed rates. The CAP submitted a comment letter to the Centers for Medicare and Medicaid Services (CMS) on October 23 asking to delay the implementation of the proposed CLFS rates and engage with the laboratory stakeholder community and reconcile the CAP's noted discrepancies. The comment letter addresses the following issues:

  1. Data Collection: The CMS interpretation of the PAMA's statute on applicable laboratories subject to data reporting does not accurately reflect the national laboratory landscape because it excludes many laboratories including most hospital outreach laboratories and physician office laboratories. The exclusion of these laboratories causes the underlying data collected by the CMS to underrepresent many segments of the industry and skews the resulting PAMA rates.
  2. Methodology: The CMS did not correctly apply the PAMA methodology's 10% decrease limit to codes with a $0 National Limit Amount (NLA), which caused certain codes to have larger than 10% decreases.
  3. Data Release: The CMS neglected to provide full, coherent, and transparent data with the PAMA rate release that would have helped stakeholders better understand the proposed changes. The CMS could benefit from more time to fully explain the changes to the CLFS and the materials that were published.

Given the integral roles pathologists play in directing clinical laboratories, overseeing the quality and appropriateness of laboratory testing in their medical communities, and developing laboratory tests, the CAP and its members have a significant stake in the correct implementation of PAMA. Therefore, the CAP recommends that the CMS delay the implementation of the proposed CLFS rates until the CMS can work directly with the laboratory community to solve the identified issues.

In addition to submission of comments, the CAP has also directly engaged with officials and the Department of Health and Human Services and the CMS to highlight the flaws in the agency's implementation of the new clinical laboratory rates mandated by PAMA. The CAP also continues to join laboratory, physician and other stakeholder groups in fighting the implementation of the new rates based on flawed methodology and data.

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The CAP's Local Coverage Determination Clarification Act of 2017 continues to gain momentum and make strides in the House with the addition of two key sponsors.

The CAP is proud to announce that Rep. Jan Schakowsky (D-IL) and Rep. Bobby Rush (D-IL) join Representatives Markwayne Mullen (R-OK), Joseph Crowley (D-NY) and Pete Sessions (R-TX) and the original House co-sponsors Lynn Jenkins (R-KS) and Ron Kind (D-WI) to sponsor this fundamental piece of legislation to improve the LCD process for patients.

The Representatives join Senators Jerry Moran (R-KS), Mike Rounds (R-SD), Tammy Duckworth (D-IL), Roger Wicker (R-MS) , Chuck Grassley (R-IA), Pat Roberts (R-KS) who join the original Senate co-sponsors Debbie Stabenow (D-MI), John Boozman (R-AR) and Thomas Carper (D-DE).

The Senate bill, together with the House version of the bill, paves the way for much needed LCD reform. The CAP continues to work and advocate for its members by helping to improve transparency and accountability when Medicare contractors set local coverage determination (LCD) policies for physician services provided to Medicare beneficiaries.

Moreover, an OP-ED article in the current edition of the Moring Consult, a leading policy newsletter, by the CAP’s Immediate Past President Richard C. Friedberg, MD, PhD, FCAP, discusses how the current LCD process may jeopardize patient health care and safety.

Key provisions of both the Senate and House LCD bills include:

  • Open Meetings
  • Upfront Disclosure
  • Meaningful Reconsideration and Options for Appeal
  • Stopping the use of LCDs as a backdoor to National Coverage Determinations (NCDs)

The CAP, along with members of the coalition, will host a Congressional Hill briefing on LCD late in October. Stay tuned to STATLINE for more details.

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In 2017, the CAP and its registry vendor partner FIGmd are offering pathologists free access to registry reporting to aim for a full bonus in Medicare's Merit-based Incentive Payment System (MIPS).

Pathologists can use the 2017 MIPS Reporting Solution to maximize their opportunity to increase their Medicare payment. There is no cost to report with the 2017 MIPS Reporting Solution. Learn more about enrolling and using the 2017 MIPS Reporting Solution.

With the 2017 MIPS Reporting Solution, pathologists can fully meet program requirements.

  • If you currently report quality measures through billing or other ways: Increase your bonus potential by attesting for the improvement activities.
  • If you have not decided how to report for MIPS 2017: Report on quality measures for a 90-day period—or a full year of patients—and attest to improvement activities to increase your payment potential and, at a minimum, avoid a payment penalty.

The 2017 MIPS Reporting Solution includes eight pathology-specific quality measures developed by the CAP and all 92 improvement activities included in the MIPS program. The CAP has identified a subset of the improvement activities that are most pertinent to pathologists (e.g. reports to referring physicians, maintenance of certification part IV, etc.).

Contact CAP registry staff if you have questions about the 2017 reporting option.

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For the first time, the CAP and other Pennsylvania state medical societies have coalesced to call for network adequacy coverage in Pennsylvania. The CAP along with the Pennsylvania Association of Pathologists, the Pennsylvania College of Emergency Physicians, the Pennsylvania Radiological Society, the Pennsylvania Society of Anesthesiologists, the Pennsylvania Society of Oncology and Hematology, the Robert H. Ivy Society of Plastic Surgeons, and the Pennsylvania Medical Society have formed the Pennsylvania Coalition on Out of Network Services to support network adequacy coverage legislation and more stringent oversight over the health insurance industry. Out of network and balance billing legislation is currently pending in the Pennsylvania State House and may be considered before the end of the year.

The Pennsylvania House Bill (HB) 1553, which is supposed to protect consumers against surprise balance bills for health care services provided in in-network facilities, but which does not address what the coalition believes to be the central issue—that large insurance companies in the state (and the nation) should be required to provide patients' with reasonable and timely access to in-network physician services at in-network facilities and hospitals.

In an October 20 letter to Rep. Matthew Baker (R), chairman of the Pennsylvania House Health and Human Services Committee, the Coalition urged lawmakers to revise the legislation to address key areas, including, that insurers must be compelled to ensure that covered patients have adequate insurance networks and transparent insurance policies, physician waivers of out-of-network charges must be explicitly protected, and "usual and customary charges" must be defined to reflect the market value of services.

The CAP and the coalition will continue to oppose HB 1553 in its current form and will work to ensure that a final bill more adequately addresses the issue of network adequacy. The Pennsylvania House will take some action on this issue by year's end.

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Thursday, November 9, 2017
12:00 PM CT

In the next few weeks, the Centers for Medicare & Medicaid Services' (CMS) will finalize the 2018 Medicare Physician Fee Schedule with changes to reimbursement rates for pathology services next year. On Thursday, November 9 at 1 pm ET/12 pm CT find out which pathology payment changes will affect your practice during this informative webinar.

The CAP engages with the CMS directly to protect the value of pathology services for its members and through its direct work with the AMA Specialty Society Relative Value Scale Update Committee (RUC) for physician work relative values. Led by Donald Karcher, MD, FCAP, Chair of the Council on Government and Public Affairs, W. Stephen Black-Schaffer, MD, FCAP, Chair of the Economic Affairs Committee, and Jonathan Myles, MD, FCAP, of the Board of Governors, this 60-minute webinar will review how the final fee schedule will affect services, such as therapeutic apheresis, pathology consultations during surgery, and tumor immunohistochemistry in 2018.

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Registration is open for now the 2018 CAP Policy Meeting.

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.

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