College of American Pathologists




September 6, 2013
© 2013 College of American Pathologists
Special Report
CAP Submits Comments to CMS, Continues Campaign to Reverse Dangerous Cuts to Pathology

September 6, 2013—Today the College of American Pathologists (CAP) submitted comments to the Centers for Medicare and 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.”

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.

With the CMS comment period now closed, CAP continues its campaign to reverse these cuts, focusing its advocacy efforts on Capitol Hill. To date:

  • More than 900 CAP Members have responded to multiple action alerts.
  • 3,000 messages have been sent to Capitol Hill.
  • 33 in-district meetings with respective Members of Congress were held during the August Congressional recess, with more planned in the coming weeks.

On September 18, CAP is planning a targeted member Capitol Hill “fly-in” in order to maximize advocacy efforts during Congress’ short legislative session. CAP members will lobby key members of the House Ways and Means, Energy and Commerce, and Senate Finance Committees.

During the weeks of September 23 and October 14, CAP will continue to provide opportunities for CAP members to meet with Members of Congress back in their congressional districts. If you have not requested an in-district meeting, please do so now.

In an effort to continue coordination with our coalition partners, CAP, AMA and members of our coalition have met with CMS to express our concerns regarding the proposed cuts. CMS is receiving tremendous push back on the proposed rule, with more than 7,500 comments posted on the rule to date, much of which has been in response to our grassroots campaign. On August 29, CAP, in collaboration with AMA and others, submitted comments to CMS Administrator Marilyn Tavenner.

Due to our strong grassroots efforts, Congress is hearing the message and taking action. U.S. Rep. Jim Gerlach (PA-06) and U.S. Rep. Bill Pascrell (NJ-09), key members of the House Ways and Means Committee, are circulating a letter to CMS and among their colleagues opposing the proposed rule. In support of this effort, an action alert will be going out, urging CAP members to contact their Member of Congress and asking them to sign on to the letter as well.

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