Advocacy Update

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In This Issue:

The CAP strongly urged the Centers for Medicare & Medicaid Services (CMS) to reconsider and abandon cuts to pathology payments in the proposed 2020 Medicare Physician Fee Schedule. In a September 13 letter to the CMS, the CAP also firmly opposed a proposed 8% pay cut to pathologists stemming from changes to evaluation and management (E/M) services planned in 2021.

The 2021 cut is part of the CMS’ plan to redistribute $7 billion from medical specialties to primary care physicians due to a restructuring and revaluation of E/M office visit services. The CAP also urged the CMS to accept the CAP’s physician work and practice expense recommendations for a set of cytopathology services, among other misvalued code issues.

CAP Opposes Proposed E/M Cuts

According to estimates by the CMS, the proposal to increase payment for E/M office visit services and decrease all other specialty services and procedures, including pathology services, results in an 8% cut to pathology and a 4% cut to independent laboratories starting in 2021. The impact on an individual pathologist will depend on a physician’s case mix.

In the proposed fee schedule released in July, the CMS had agreed to implement changes in 2021 developed by the American Medical Association (AMA) E/M workgroup. The agency also proposed an add-on payment for E/M services, which redistributes an additional $2 billion, accounting for 3% of the cuts proposed for pathologists.

Other physician specialties facing cuts include 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 physicians who bill higher volumes of E/M services.

The CAP is working with other key stakeholders to oppose the E/M payment policy and further mitigate the potential impact on pathologists. Most recently, the CAP spoke with CMS officials to oppose the E/M changes.

CAP Is Against Decreases to the Cervical-Vaginal Cytopathology Series of CPT Codes

On a set of cytopathology physician interpretation services, the CMS disagreed with the American Medical Association/Specialty Society RVS Update Committee (RUC) recommendations developed by the CAP. Instead, the CMS proposed to significantly decrease the physician work relative value units to 0.26 from 0.42.

The affected services are:

  • Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by a physician (88141)
  • Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by a physician (G0124)
  • Screening cytopathology smears, cervical or vaginal, performed by an automated system, with manual rescreening, requiring interpretation by a physician (G0141)
  • Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring analysis by a physician (P3001)

The CAP opposed the proposed cuts and will further engage with the CMS to advocate for the appropriate value of these cytopathology services. Through its ongoing work to protect the value of pathologists, the CAP leads the effort to develop physician work RVUs used to calculate the professional component and global payment.

Other issues that the CAP urged the CMS to address included:

  • Potentially misvalued services under the fee schedule
  • Accepting the CAP’s submitted updates to the Market-Based Supply and Equipment Pricing.

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The CAP also strongly urged the CMS to respond to concerns regarding proposed changes to the 2020 Quality Payment Program (QPP), including its Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs), in its September 13 comment letter.

The CAP advocated for increasing flexibility for pathologists in a way that recognizes and accounts for the value pathologists play in patient care as non-patient-facing clinicians in an inherently patient-facing program. The CAP asked the CMS to consider alternative measures that are necessary to meet requirements in the MIPS reporting program and a new initiative called MIPS Value Pathways.

The CAP asked the CMS to further engage with stakeholders in the development of MIPS Value Pathways, which is “a conceptual participation framework that would apply to future proposals beginning in the 2021 performance years,” and allow adequate time for consideration and development of this major change to the program. Moreover, the CAP strongly urged the CMS to delay the implementation of the new framework “to ensure that providers can continue to participate in MIPS in its current form for several years without penalty.”

Proposed Removal of Key Pathology Measures 

The CAP strongly opposed the removal of four pathology measures and limiting the pathology specialty measure set to only two skin cancer measures. The CAP suggested to the CMS that pathology measures should more appropriately reflect the breadth of services pathologists provide.

Continued Burden of Reporting for Pathologists

Pathologists who need laboratory data for MIPS reporting are increasingly disadvantaged in the MIPS program because it is difficult to access data from hospitals Electronic Health Records (EHRs) and Laboratory Information Systems (LIS). Many pathologists increasingly need hospital-owned data to support their ongoing participation in MIPS. The CAP urged the CMS to develop ways to incentivize hospitals to make data available to hospital-based physicians, who need this data for MIPS reporting.

CAP Reiterates to CMS that Pathologists Should Not Be Attributed Cost Scores

Based on 2018 MIPS performance feedback, the CAP learned that there were some pathology group practices that were attributed to the Medicare Spending Per Beneficiary measure. Since the measure is attributed to the provider who provides plurality of Medicare Part B services, and the CMS has not provided transparent, defined data for the cost measures in 2018, it is difficult to determine how exactly the pathology practices were attributed. While pathologists routinely contribute to team-based care, the CAP urged the CMS not to attribute them to the measure under the current methodology.

CAP Disagrees with Improvement Activities Increased Participation Requirements

In the proposed 2020 QPP regulation, the CMS proposed to increase participation requirements for MIPS physicians, thus increasing reporting burdens on pathologists. The CAP did not agree with the CMS on the proposed increase of the participation threshold for groups to from one eligible clinician in a group, to at least 50% of MIPS eligible clinicians in a group participating in or performing the activity for the same continuous 90 days. The CAP urged the CMS to recognize that there are many improvement activities that would not apply to 50% of physicians in a group, and to maintain to the current improvement activity program.

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Anthony Simonetti, MD, FCAP

Periodically Advocacy Update features a CAP member who is a champion for pathology in Washington and at the state level through our grassroots and PAC programs. Recently Advocacy Update caught up with Anthony Simonetti, MD, FCAP, who is the Chair of Pathology and Laboratory Medicine at Reading Hospital in West Reading, Pennsylvania.

What drove you to get involved in advocacy? The CAP introduced me to advocacy when I joined as a resident, by underscoring its importance and providing a foundation. I was first involved in the CAP’s key contact program in the 1990s. At the time, my pathology group supported these activities and senior pathologists in the practice encouraged me to get involved. I eventually joined the CAP House of Delegates and have served in the Florida, Ohio and now Pennsylvania delegation. Currently I serve on the board of PathPAC, our specialty’s political action committee.

Do you have a favorite memory or experience that stands out in your advocacy work? My favorite memory is participating in the Policy Meeting and Hill Day for the first time. It was a great feeling to be a part of the democratic process and to visit our elected officials and advocate for patients and our specialty.

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

What advice would you give to your colleagues in order to be effective advocates? Participate in advocacy activities sponsored by the CAP, your state medical and pathology society. Members can attend the new Spring Pathologists Leadership Summit and participating in Hill Day would be a great place to start.

Have you ever done a laboratory tour? If so, was there anything that surprised you or are there any tips you would like to share with your colleagues? We hosted a laboratory for Rep. Chrissy Houlahan (PA-D) and her District Director on August 19, 2019. The tour included a tour of each section in clinical and anatomic pathology, and culminated in a case review at the multi headed microscope. Our medical and laboratory staff participated in the section presentations and some wore red, white, and blue clothing, which went over well with our guests. Our hospital senior leadership were also there in support.

I was surprised by the level of interest that the Rep. Houlahan and her staff showed for our operation. During the gross room presentation, they asked to glove and gown up so that they could examine tissue. Their level or interest, enthusiasm, and engagement was high and they were especially interested in the microscopic case review.

If you would like to get involved, you can join PathNET, contribute to PathPAC, or join your state pathology society.

CAP Advocacy is pleased to announce that Adriel Bettelheim, the health care editor at POLITICO, will join CAP leaders to discuss the latest on surprise billing at CAP19.

Mr. Bettelheim has covered government and politics from Washington since 1994. He oversees the daily work of a dozen reporters covering Congress, the Department of Health and Human Services, the FDA and other federal health agencies. He previously held senior editing and reporting positions at Congressional Quarterly, Bloomberg, PolitiFact and The Denver Post and was part of the PolitiFact team that won the 2009 Pulitzer Prize for National Reporting for fact-checking coverage of the 2008 presidential race.

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.

Mr. Bettelheim will join 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, in a riveting panel discussion on 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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