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CAP Home > CAP Advocacy > STATLINE – CAP’s Biweekly Federal and State Advocacy E-Newsletter
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  STATLINE — CAP’s Biweekly Federal and
  State Advocacy E–Newsletter

 
STATLINE
September 25, 2014  •  Volume 30, Number 20
Next Issue: October 9, 2014
© 2014 College of American Pathologists
 

In This Issue:

Senators Support Pathologists on Preventing EHR Penalties

A bipartisan group of senators urged the Centers for Medicare & Medicaid Services (CMS) to prevent future Medicare payment cuts from the meaningful use (MU) of electronic health records (EHR) program.

Following a similar letter by House members to the CMS in July, senators wrote that the MU program overlooks the realities of pathology practice. CAP members had urged their senators to send the letter during the 2014 CAP Policy Meeting and during a grassroots campaign led by the College over the summer. In the letter, senators specifically asked the CMS to exempt pathologists from future Medicare payment penalties tied to EHRs by using an exception that federal lawmakers created.

“The current MU criteria and requirements include objectives that are outside the scope of pathology practice,” the senators wrote. “Most pathologists do not use certified EHRs because they have limited direct interaction with their patients. Instead, pathologists rely on computerized Laboratory Information Systems and Anatomic Pathology Information Systems to support their work of analyzing patient specimens and generating test results in order to diagnose disease and monitor the effects of therapy on patients.”

The CAP has worked with the CMS to exempt pathologists from the MU penalty in 2015, but the Medicare agency has not indicated if it will extend the exception to pathologists in subsequent years when the penalty stands to lower Medicare part B payments by 2% in 2016 and 3% in 2017. Further, the CMS has stated that pathologists and other physicians should not expect relief from future penalties.

The Senate letter was led by Sen. Sherrod Brown (D-OH) and Sen. Johnny Isakson (R-GA). Also signing the letter were:

  • Sen. Kelly Ayotte (R-NH)
  • Sen. John Barrasso (R-WY)
  • Sen. Mark Begich (D-AK)
  • Sen. John Boozman (R-AR)
  • Sen. Richard Burr (R-NC)
  • Sen. Bob Casey (D-PA)
  • Sen. Kay Hagan (D-NC)
  • Sen. Tim Johnson (D-SD)
  • Sen. Jerry Moran (R-KS)
  • Sen. Mark Pryor (D-AR)
  • Sen. Jack Reed (D-RI)
  • Sen. Pat Roberts (R-KS)
  • Sen. Debbie Stabenow (D-MI)
  • Sen. John Thune (R-SD)

CAP members can write and thank their senators for signing the Brown-Isakson letter through the PathNet.


CAP Urges UnitedHealthcare to Suspend FL Pilot Program

The CAP has called on the insurer UnitedHealthcare to suspend its planned October 1 implementation of a pilot program in Florida based on fundamental flaws with the program that negatively impact patient access to services, delay results, and create inconsistencies with current clinical practice, professional judgment and laboratory operations.

The College first became aware of the UnitedHealthcare Laboratory Benefits Management Program pilot earlier this year. The CAP then engaged with UnitedHealthcare and, more recently, Beacon Laboratory Benefits Solutions (Beacon) at their leadership levels over the last several months. The CAP provided feedback on the impact of the pilot on patients, pathologists, and the delivery system overall. Throughout the course of its communications, the CAP has arrayed its concerns with the program for UnitedHealthcare in great detail.

Starting October 1, the program will require Florida physicians and those who receive specimens from ordering physicians in Florida for patients enrolled in certain fully-insured UnitedHealthcare products to use the Beacon system to provide notification for over 80 frequently performed tests. The program also requires extensive secondary review and subspecialty certification requirements that will be difficult for many practices to meet. It also requires accreditation. Those who do not adhere with the program’s requirements within 90 days after the effective date may be subject to lower fees or termination, according to UnitedHealthcare. The insurer has published more information on its website regarding the benefit management program and Beacon.

The program will negatively affect patient care and pathologists, the CAP said. For instance, new requirements particularly for practices in some geographies and of a certain size will impede access to care and delay test results and diagnoses. They also impinge upon medical judgment. Further, the sheer volume of routine tests covered by the program will disrupt workflow for ordering physicians and laboratories especially as the Beacon system currently does not electronically interface with many electronic medical records and laboratory information systems.

Given the effects on patients, pathologists, and ordering physicians, the CAP advocated for suspension of the program’s implementation on October 1.

The College has offered to continue to be available to UnitedHealthcare for discussion and consultation on the pilot and any other issues affecting pathologists. The CAP will provide more information on this issue as it becomes available in future editions of STATLINE.


2013 PQRS Feedback Reports Are Now Available

Physicians who participated in the 2013 Medicare physician quality reporting programs can now access feedback detailing performance and incentive eligibility.

The bonus for the 2013 Physician Quality Reporting System (PQRS) for eligible individuals successfully meeting reporting criteria for the program equaled 0.5% of Medicare charges for that year. Feedback reports from the CMS reflect 2013 PQRS data reported by February 28, 2014. Payments for successful PQRS participation are now available.

Feedback reports are available for every taxpayer identification number, or TIN, under which at least one eligible professional (identified by his or her national provider identifier) submitting Medicare Part B claims to report PQRS measures. The CMS has a user guide with more information about accessing the feedback reports and how to read the data.

For the 2014 PQRS program, the last day to sign up for the group practice reporting option is September 30. CMS has more information about this option for entities that want to report PQRS as a group.


CMS Reports Medicare ACO Results

Medicare Accountable Care Organizations (ACOs) generated more than $372 million in total Medicare savings in 2013, according to statistics released by the Department of Health and Human Services (HHS).

According to the CAP’s recent findings, a healthy percent of pathologists participate in these or commercial ACOs. Many are also members of the College’s ACO network. If you work with an organization that is currently, or will be part of an ACO, we encourage you to join the CAP’s ACO network by sending us an email. The CAP ACO network provides pathologists with a forum to connect about their ACO experiences and best practices, and to learn from each other and the College about ACO participation. The CAP also has extensive information on coordinated care programs in its ACO/Coordinated Care Resource Center, including tools to assist pathologists.

The numbers reflect preliminary quality and financial results from the second year of performance for 23 Pioneer ACOs, and the final results from the first year of performance for 220 Medicare Shared Savings Program (MSSP) ACOs. While the HHS stated the data on savings from ACOs was encouraging, of the 220 MSSP ACOs, 53 ACOs earned bonuses and another 52 reduced Medicare costs. Another 52 ACOs had reduced Medicare costs, but reductions were not big enough to share in savings. The second year results for the much smaller Pioneer ACO program showed improvement in three key areas over the first year.

The CMS has published a fact sheet on the results.


New HIPAA Business Associate Agreement Deadline Takes Effect

A deadline under the Health Insurance Portability and Accountability Act (HIPAA) passed this week. While the current rules under the HIPAA/Health Information Technology for Economic and Clinical Health (HITECH) Omnibus regulation took effect on March 26, 2013, certain business associate agreements (BAAs) that were already in place as of that date were grandfathered. These BAAs did not have to be updated until September 23, 2014.

While compliance was required 180 days after the regulation’s effective date or September 23, 2013, agreements that fulfilled grandfathering criteria were given an additional year until they needed to be replaced. Grandfathering applies to existing written BAAs that complied with HIPAA and its implementing regulations in effect prior to January 25, 2013 unless the agreement was renewed or modified between March 26, 2013 and September 23, 2013. Those BAAs with evergreen renewals were also grandfathered.

The rule extends the definition of business associate of a covered entity to downstream entities not previously covered under HIPAA. Covered entities must now have a business associate agreement with any subcontractor creating, receiving or transmitting protected health information. This includes subcontractors of business associates. In addition, since all subcontractors are now business associates, they must now comply with HIPAA directly and as such, are directly liable for violations including being subject to civil monetary penalties.

The initial announcement from HHS about the final omnibus rule and the rule can still be accessed online.

The American Medical Association also has extensive information for physicians on HIPAA privacy and security on its website.


STATLINE Archive

Contact: statline@cap.org
202-354-7100  •  202-354-8101 (fax)  •  800-392-9994

 

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