Advocacy Update

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In a demonstration of leadership, trust, and advocacy strength on behalf of pathologists, more than 1,000 pathologists have already chosen the Pathologists Quality Registry for the 2019 performance year.

The CAP developed the registry to give pathologists the best opportunities for success in Medicare’s Quality Payment Program (QPP), and Merit-based Incentive Payment System (MIPS). The Pathologists Quality Registry allows pathologists to stop payment penalties tied to MIPS by providing a consolidated platform for all their reporting needs, including benchmarking reports. The CAP and its staff experts have worked with more than 1,000 pathologists at hundreds of practices across the US to provide unique and one-on-one support to ensure their success in the MIPS program.

“More and more pathologists are choosing the CAP and its Pathologists Quality Registry as the best solution to successfully navigate the complexities of the MIPS program,” said CAP President R. Bruce Williams, MD, FCAP. “Pathologists count on the CAP to provide strong leadership on their behalf by engaging with the Centers for Medicare & Medicaid Services and American Medical Association to make sure pathologists are able to fully and easily participate in MIPS.”

Developed by CAP members and FIGmd, a leading provider of clinical data registries for physician specialties, the Pathologists Quality Registry features pathology-specific quality measures developed by the CAP and easy-to-use guidance on attesting to Improvement Activities, specific to pathologists, to maximize a MIPS performance score. The CAP is still enrolling eligible pathologists for the 2019 MIPS performance period, and it is not too early to begin planning for 2020.

Learn more about MIPS and the Pathologists Quality Registry by emailing the CAP at

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In a September 9 meeting with key officials from the Centers for Medicare & Medicaid Services (CMS), CAP leaders firmly opposed the proposed 8% payment cut to pathologists in 2021 as part of the agency’s plan to redistribute $7 billion from medical specialties to primary care physicians. Experts representing the CAP were Ronald W. McLawhon, MD, PhD, FCAP; Swati Mehrotra, MD, FCAP; and Roger McLendon, MD, FCAP. The CAP leaders urged the CMS to abandon its current approach given the disastrous effect the cuts would have on all pathologists.

Other physician specialties facing cuts are anesthesiology at -7%; cardiac surgery and radiology at -8%; and ophthalmology at -10%. In total, $7 billion will be taken from specialists and be redistributed to family and internal medicine physicians who bill higher volumes of E/M services.

The CMS proposes to implement these cuts to pathology and other specialty physician services as part of changes to evaluation and management (E/M) payment policy set to go in effect in 2021. The CMS detailed the E/M policy in the proposed 2020 Medicare Physician Fee Schedule in July.

The CAP leadership met with the following CMS officials: Edith Hambrick, MD, JD, Medical Officer; Carol Blackford, Director Hospital and Ambulatory Policy Group; Ryan Howe, Acting Deputy Director, Hospital and Ambulatory Policy Group; Gift Tee, Director, Division of Practitioner Services; Marge Watchtorn, Deputy Director, Division of Practitioner Services; and Kathy Bryant, Hospital and Ambulatory Policy.

In addition to its engagement with the CMS, the CAP will work with other key stakeholders to oppose the E/M payment policy and mitigate the potential impact on pathologists.

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Over 1,500 pathologists sent messages or called their members of Congress to advocate for legislation to address surprise medical bills as part of a collaborative effort with other major physician specialty societies. This advocacy leadership on the issue ensured that legislators heard directly from pathologists. Moreover, the united effort also confirmed with congressional offices that health insurers should not be allowed to unilaterally determine the value of physician services.

In July, CAP members were invited to take part in a national day of action on surprise medical billing, along with several other medical societies, before Congress left for the August recess. The CAP further encouraged pathologists to remain engaged throughout August – and many CAP members did.

Our grassroots advocacy has made an impact on congressional members, as negotiations on surprise medical bill legislation will continue this Fall. While the majority of the legislative proposals are detrimental to specialty physicians, fortunately Reps. Raul Ruiz, MD (D-CA) and Phil Roe, MD (R-TN) introduced a bill that included an independent dispute resolution process, which the CAP endorsed. The bill garnered 78 co-sponsors due to constituents, such as PathNET members, who contacted legislative offices. The CAP will continue to send out alerts as final legislation still needs to pass the House.

R. Shawn Kinsey, MD, FCAP, and Rep. David Kustoff’s (TN-8) staff

Several CAP members conducted laboratory tours during the August recess to educate members of Congress about the important function pathologists have in the health care delivery system.

For instance, R. Shawn Kinsey, MD, FCAP, conducted a laboratory tour for Sen. Lamar Alexander’s (R-TN) staff. Sen. Alexander is the chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, which has jurisdiction over surprise billing.

Rep. Chrissy Houlahan and Anthony Simonetti, MD, MBA, FCAP

Anthony Simonetti, MD, MBA, FCAP, conducted a laboratory tour of the Tower Health Group for Rep. Chrissy Houlahan (D-PA).

We thank these CAP advocates for taking the time to demonstrate how a laboratory operates and educating their legislators’ offices on the how legislation impacts the health care delivery system. It is crucial for CAP members to conduct laboratory tours for policymakers. If you’re interested in coordinating a congressional laboratory tour, email

With renewed efforts to enact gene patenting into law, the CAP is lobbying against the push to amend patent law and further plans to encourage pathologists to contact their senators and representatives on this issue.

The CAP and a broad coalition of more than 150 medical, patient, and civil rights advocacy organizations have opposed House and Senate proposals to permit the patenting of products and laws of nature, such as human genes. If enacted, the legislation would allow businesses to own the rights to genes and prohibit others from developing genetic testing and pursuing research. Gene patents pose a serious threat to patient care, medical advancement, and medical education.

The CAP is opposed to the draft legislation as the negative consequences include additional barriers and decreased access to lifesaving genomic tests, loss of access to confirmatory testing, and substantially increased costs of implicated diagnostic testing. Read our issue brief opposing gene patenting.

The proposed legislation would eliminate the judicially created exceptions to patent eligibility, thereby overturning the Mayo, Myriad, and Alice decisions. Gene sequences and pathogenic variants would no longer be protected from patent eligibility as “products of natural phenomena.” Allowing commercial entities to patent genes impedes the provision of genetic-based clinical testing and patient care through exclusive license agreements, excessive licensing fees, and restrictive licensing conditions.

CAP members should watch for emailed alerts to take action on this important issue in the weeks ahead. The proposed legislation threatens to cripple self-directed patient care, and block the ability to seek second opinions on genetic or other clinical tests and interpretations.

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September is National Preparedness Month, where organizations promote family and community disaster and emergency planning. It is important for clinical laboratory professionals to recognize the importance of disaster planning and preparedness as laboratories may be involved in responding to infectious disease outbreaks.

Therefore, the Center for Disease Control and Prevention (CDC) Division of Laboratory Systems offers trainings for laboratory professionals to prepare for emerging threats and stay current with the newest standards and best practices. Trainings are free and are offered in a variety of modalities, including eLearning courses, in-person workshops, and webinars. Free P.A.C.E. continuing education credits are available for many courses.

Check out some of the CDC’s laboratory preparedness courses:

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The CAP plays a key role in the American Medical Association (AMA). 

As the largest group representing pathologists in the AMA House of Delegates, the CAP can set policy that affects the practice of pathology, ensure fair reimbursement and payments for pathologists, and reduce regulatory burdens for laboratory practice.
The AMA Specialty and Service Society is made up of more than 130 national medical societies. The CAP leads the Pathology Section Council and meets twice annually in conjunction with the Interim and Annual Meetings of the AMA House of Delegates. With your continued AMA membership, you shape the health policy agenda on issues like Medicare reform, coverage of molecular testing, the opioid crisis, physician burnout, and ensure that patients can benefit from medical innovation. 

The CAP sends a delegation of pathologists to attend the AMA meetings to ensure the voice of pathology is loud and clear and it at the forefront of health care policy. The delegation advocated for increased opportunities and educational resources for medical students interested in pursuing a career in pathology, influenced key policies on reimbursements and protected payments for pathologists, and reduced regulatory burdens on physicians. Without your AMA membership, the CAP may lose its leading position in the Pathology Section Council, therefore, losing its voice to advocate for pathologists. 

The picture shows the 2019 CAP AMA Delegation from left to right: Joe SanFrancesco, MD, FCAP, William Harrer, MD, Susan Strate, MD, FCAP; Mark Synovec, MD, FCAP; Jean Forsberg, MD, FCAP; Gregory Goldgof MD, FCAP; Valerie Lockhart, MD, FCAP; James Caruso, MD, FCAP; Rebecca Obeng, MD, FCAP and Simone Arvisais-Anhalt MD, FCAP.

Because of the strong presence of CAP members in AMA HOD leadership, the CAP shaped the following issues in recent AMA meetings:

  • Defended pathology as a specialty study in medical school education
  • Opposed neutral site of service Medicare reimbursement policies
  • Protected medical specialty societies’ right to protect specialty-developed quality measures
  • Advanced appropriate “surprise” out-of-network policy
  • Ensured opportunities and educational resources for physicians interested in accountable care organizations

AMA Wins that Benefited Pathologists

Fighting abusive insurer practices 2018 key win: 

  • Convinced Anthem to reverse its planned modifier 25 policy, which would have led to $100 million in physician payment reductions and opposed efforts by Anthem to retroactively deny coverage of emergency department care 2019 objective.
  • Advocate directly with health insurers to stop policies that adversely affect patients and physicians
    • 2019 objective: Advocate directly with health insurers to stop policies that adversely affect patients and physicians

Improving physician payment 2018 key win:

  • Led a coalition to prevent the E/M code collapse and secured multiple changes to improve Medicare physician payment policies (e.g., Quality Payment Program) 2019 objective.
  • Advocate to the Centers for Medicare & Medicaid Services and Congress for continued improvements to the Quality Payment Program
    • 2019 objective: Advocate to the Centers for Medicare & Medicaid Services and Congress for continued improvements to the Quality Payment Program

Moreover, younger and seasoned CAP members lent their voices to shape health policy that directly impacted the practice of pathology and patient care.

Pathology in Medical School Education

Valerie Lockhart, MD, FCAP, the CAP representative for the Residents Forum Section at the AMA House of Delegates (HOD), recently provided passionate testimony regarding the importance of including the study of pathology in medical school education during the 2019 AMA Annual Meeting. 

“How many clinicians know how a reference range is set? How many realize that an abnormal laboratory result is not definitive evidence that pathology exists? This is not just about the practice of pathology--this is about being able to provide the best, most cost-effective patient care possible,” Dr. Lockhart said. The CAP and the Pathology Section Council prompted the AMA to commission a study of the current medical school curriculum to possibly include more pathology focused courses of study

Protect medical specialty societies’ right to protect specialty-developed quality measures

As a follow-up to the 2018 AMA Interim meeting, the CAP and Pathology Section Council successfully argued that the Centers for Medicare & Medicaid Services (CMS) cannot force licensure on quality measures created specifically for qualified clinical data registries (QCDRs).

Mark Synovec, MD, FCAP, Chair of the AMA Pathology Section Council and CAP delegate to the AMA House of Delegates, provided testimony in support of the policy. “The AMA should consider policy that actively opposes any CMS proposal that would require QCDR measure owners, as a condition of measure approval for reporting in MIPS and other Medicare quality payment programs, to enter into a license agreement with the CMS that would allow other QCDRs to use the owner’s measures without a fee or without a direct license with the measure owner,” Dr. Synovec said. Further, the CAP asked the AMA to create policy governing where QCDR measures are shared between the original measure owner and another QCDR. 

The CAP currently has over 2,500 AMA members, which provides pathology a strong voice in shaping health care policy in the AMA House of Delegates. If you haven’t yet, register or renew your AMA membership today.

CAP Advocacy leaders will host a special Surprise Billing panel during CAP19.

This informative session will address the latest on surprise billing including a legislative update from the House and Senate. The session will review the circumstances for this legislation, its potential effects on the practice of pathology, network adequacy, and review the proposed legislative resolutions.

David Gang, MD, FCAP, Chair of the Federal and State Affairs Committee and Bobby Mukkamala, MD who is Secretary and member of the Board of Directors of the American Medical Association will lead the panel will discuss this important issue on Sunday, September 22 at 9:30 AM ET in the Osceola ballroom 1-3.

Space is limited so register today.

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Try your advocacy luck and take the September Advocacy News Quiz.

Last month, over 200 of your fellow CAP members tested their advocacy knowledge. See how you measure up against your fellow pathologists on this month’s quiz and share your results. Good luck!

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