Published on September 6, 2013
Contact: Alissa Momberg
CAP Comments Highlight How Proposed CMS Rules Could Threaten Patient Access to Pathology Services
Washington, DC—The College of American Pathologists (CAP), a national medical specialty society representing more than 18,000 physician members, submitted comments to the Centers for Medicare & Medicaid Services (CMS), urging the agency to withdraw proposed cuts that could threaten patient access to vital pathology services.
On July 8, CMS issued proposed rule (CMS-1600-P) to reduce Medicare spending on physician pay by linking payment for pathology services on the Physician Fee Schedule, to lower rates paid under Medicare’s Hospital Outpatient Prospective Payment System, the fee schedule used by CMS for hospital outpatient services.
CAP strongly opposes these cuts and argues that, if finalized, the proposed rule would adversely impact a number of pathology services that are critical to the diagnosis and treatment of patients each year. CAP notes that reimbursement for 39 pathology services for non-hospital patients could be cut by as much as 80 percent, depending on the service.
Prominent Washington law firm Sidley Austin LLP, in a memo prepared for the College, concluded that “the proposal violates the statutory requirement that Medicare practice expenses be resource-based.” The proposal “relies on faulty assumptions and inapplicable facility resource data,” and “does not reflect actual resource costs in the non-facility setting—contrary to law and regulation and CMS’ stated policies and past practices.”
“We have deep concerns about the reimbursement cuts to pathology services under the proposed rule,” said Richard C. Friedberg, MD, PhD, FCAP, Chair of CAP’s Council on Government and Professional Affairs. “Not only is it based on flawed policy that contradicts CMS’ own guidelines, but it could compromise access to care for hundreds of thousands of patients.”
Additionally, CAP submitted comments to CMS calling for the withdrawal of CMS’ Hospital Outpatient Prospective Payment Proposed Rule (CMS-1601-P), which attempts to bundle pathology physician services and nearly all clinical laboratory tests into Medicare’s payments to hospital outpatient departments. CAP notes that pathologists provide a relatively narrow range of services and many of them would be affected by the bundling proposal. Further, CMS’ proposal to “bundle” over 1,000 clinical laboratory tests into the payments for hospital outpatient procedures could create financial disincentives to perform medically necessary testing, or shift testing from out-patient settings to hospital settings, creating new burdens for patients and higher costs for the healthcare system.
CAP’s comments also ask CMS to take action to restrict physician self-referral arrangements for pathology services; express concerns with Medicare coverage of molecular pathology services that are critical to the diagnosis of many cancers; and, urges CMS to approve new quality measures and exercise flexibility in the design of pay-for-performance programs to accommodate specialties such as pathology.
Read CAP’s full comments, or for more information about CAP’s position on the proposed rule, visit the Medicare 2014 Physician Fee Schedule Resource Center.
About the College of American Pathologists
As the leading organization for board-certified pathologists, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. With more than 18,000 physician members, the CAP has led laboratory accreditation for more than 50 years with nearly 7,500 CAP-accredited laboratories in 50 countries. Find more information about the CAP at cap.org.