Respondents were asked to rank advocacy issues most important to them and to their practice. Overwhelmingly, respondents cited “Medicare payment cuts” as the most important issue, with over half indicating it as their top concern and 80% citing it as one of the five most important issues. Other frequently cited issues included the sustainable growth rate, self-referral of anatomic pathology specimens, changes to pathology’s scope of practice, and direct billing for pathology services.
Illinois Anti-Markup Bill Becomes Law After CAP Secures Veto Override
The Illinois House of Representatives voted December 3 to override Gov. Pat Quinn’s veto of legislation to ban markups on pathology services. The House vote followed a successful state Senate override vote in November and an extensive grassroots effort led by the CAP and Illinois pathologists.
This is the second state with a veto override vote on this matter secured by the CAP and pathologists. A 2004 direct billing measure vetoed by the South Carolina governor, at that time, was also overridden and enacted into law by that state legislature. The Illinois State Senate had passed a veto override on November 19. With the House and Senate votes meeting a required three-fifths majority threshold, the bill now becomes state law.
The CAP and Illinois Society of Pathologists (ISP) supported the original bill and disagreed with the governor’s August 5 amendatory veto. The Governor had stated that the purpose of his amendatory veto was to “strengthen” the bill. However, Illinois legislative leadership, the CAP, and the ISP concluded that the negotiated bill should be enacted without amendment. A CAP-ISP grassroots effort in Illinois included 360 emails from 150 individuals to legislators. The CAP and ISP also sent letters to state lawmakers urging them to support the veto override.
“The CAP has long opposed markups by ordering clinicians on the actual cost of the anatomic pathology service (Pap tests and biopsies) provided to our patients,” said CAP President Gene N. Herbek, MD, FCAP, in a November 18 letter that was sent to all members of the Illinois Legislature.
The legislation requires physicians who order biopsies and Pap tests to disclose to the patient the actual amount charged by the pathologist or laboratory that provides the service. The bill also enhances patient billing protections to deter markups and grant new enforcement authority to the state when unlawful markups for pathology services are billed to insurers.
CAP-ISP work on the anti-markup bill included two years of legislative advocacy, and more than five years of building the public policy foundation to support passage.
Proposed ACO Rule Could Offer More Flexibility to Physicians
The CMS released a new proposal on December 1 that would strengthen its Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs) through a greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. The MSSP is the government ACO program for Medicare providers and hospitals.
The rule proposes more flexibility for ACOs participating in a one-sided risk model so the organization would not share financial losses for poor performance and to give ACOs more time to stay on the one-sided track before switching to a two-sided model, which exposes more experienced ACOs to financial penalties.
CMS is also seeking comments from stakeholders on alternative methodologies that would set ACO benchmarks for determining shared savings and losses gradually. “For example, the CMS is considering whether shared savings received by an ACO should be added back to the benchmark in future performance periods,” CMS said.
“CMS proposes to streamline the process for ACOs to access beneficiary claims data necessary for health care operations such as quality improvement activities and care coordination while retaining the opportunity for beneficiaries to decline to have their claims data shared with the ACO,” the agency said.
The MSSP now includes more than 330 ACOs in 47 states, according to a CMS press release. Medicare ACOs provide care to more than 4.9 million beneficiaries in Medicare fee for service.
The CAP is continuing to analyze this more than 420-page rule, and more information about this issue will be published in future editions of STATLINE.
Sen. Moran Tours Topeka Laboratory
CAP Governor Richard R. Gomez, MD, FCAP (Topeka Pathology Group, LLC), hosted Kansas Sen. Jerry Moran for a tour of St. Francis Health’s hospital laboratory on November 24.
Sen. Moran posted a photo from the laboratory tour on his Facebook page and included an article about the visit in his e-mail newsletter to constituents.
“Today I visited St. Francis Health in Topeka to tour the hospital’s laboratory, a full-service clinical laboratory providing diagnostic testing in many health areas,” Sen. Moran said. “The lab examines organs, tissues and other specimens to make a diagnosis of disease. All tests are performed upon the written order of a licensed health care provider, and a pathologist is available for consultation 24 hours a day. St. Francis Health also operates an offsite lab in Topeka for patient convenience. Thanks again to pathologist Dr. Richard Gomez for inviting me and giving me such an informative tour.”
For information about leading your own tour for your representatives, watch this PathNet video. Contact Laura Brigandi if you have questions or need more information about leading a tour.
CAP Advocates for Pathologist Role In Reviewing New Research
The CAP provided its feedback on a nongovernmental organization draft proposal that would develop and implement a process for peer reviewing primary research and making research findings publicly available in a user friendly format to patients and physicians.
The Patient-Centered Outcomes Research Institute (PCORI) proposed draft is generally aligned with the CAP’s Pathology and Laboratory Quality Center practices, the College stated in its comments to the institute. Further, the draft processes appeared consistent with the PCORI’s authorizing statutory requirements for release of research findings, peer review, and transparency and public availability.
The CAP commended PCORI for trying to balance these goals, but also recommended some minor modifications. For instance, the draft document notes how it will conduct peer review, but not how it will select peer reviewers beyond the lead methodologist. “Pathology touches virtually every area of medicine,” the CAP stated. “We therefore urge PCORI to consider pathologists for its various peer review panels not just for laboratory medicine but also in related topics in oncology, laboratory medicine, endocrinology, gastroenterology, etc.”
The PCORI, which was authorized by the 2010 Affordable Care Act of 2010, is a nonprofit, nongovernmental organization. It aims to help patients, physicians, purchasers, and policy influencers make better-informed health decisions by “advancing the quality and relevance of evidence about how to prevent, diagnose, treat, monitor, and manage diseases, disorders, and other health conditions,” the institute’s website states.
View the Archive of Our Webinar on Pathology PQRS Measures for 2015
Several changes to the Medicare Physician Quality Reporting System (PQRS) will go into effect in 2015. These new changes are important to pathologists as the Medicare program will base future payment penalties on how well physicians and groups perform in the 2015 PQRS.
On December 2, the CAP hosted a webinar on how to report new PQRS measures and meet reporting requirements during our webinar. CAP experts explained how pathologists can successfully participate in PQRS next year.
Watch the webinar replay of this 60-minute presentation. The handout for the webinar is also available for download.
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