College of American Pathologists
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June 30, 2011
© 2011 College of American Pathologists
Special Report
CMS Issues Proposed Rule to Retract Physician Signature Requirement

June 30—After months of silence on the issue, CMS officials are proposing a rule to retract the physician signature requirement on test requisitions paid under the Clinical Laboratory Fee Schedule (CLFS), acknowledging that the policy could negatively impact patient care and would be difficult to implement. CAP was among the first and strongest opponents of the requirement when CMS first proposed it in the 2011 Physician Fee Schedule (PFS).

If enacted, the signature of a physician or qualified non-physician practitioner (NPP) would have been required on requisitions for tests paid under the CLFS. Initially set to go into effect on Jan. 1, CMS officials indefinitely delayed implementation while they prepared this proposed rule. Because the policy was part of the 2011 PFS, the agency had to issue a notice and request for comment, as it did in today’s Federal Register. After the 60-day comment period closes, a final rule will be released, likely later this year.

CAP’s Steadfast Opposition

Leading opposition to the policy since it was initially proposed in 2010, one of the CAP’s primary concerns has been the potential delay in testing due to lack of signed requisitions and the risk of increased administrative burden to practices and health care providers—including pathologists. The CAP has been working with other stakeholders and lawmakers to oppose the policy and educate the agency, both in written comments and in meetings with CMS officials, on the potential negative impact.

Advocacy efforts on the issue also garnered support from Congress. In early February, Rep. Michael Burgess, MD, (R-TX) brought congressional scrutiny to the issue, sending a letter signed by Rep. Bill Pascrell (D-NJ) and 87 other House members to CMS Administrator Donald M. Berwick, MD, urging his agency to reconsider the regulation. A similar letter was sent by the Senate, signed by Sens. Robert Menendez (D-NJ) and Pat Roberts (R-KS) and co-signed by at least 24 members.

Indeed, the proposed rule acknowledges that the agency received feedback from stakeholders outlining many scenarios where it would be difficult to obtain the physician’s or NPP’s signature on the requisition for laboratory tests under the CLFS. The proposed rule further states that while developing educational outreach material to implement the policy, officials realized how difficult and burdensome the actual implementation of this policy was for physicians and NPPs. In some cases, implementing this requirement could have a negative impact on patient care, prompting agency officials to reexamine the policy.

Rep. Burgess, MD, who serves as the Vice-Chair of the Energy and Commerce Subcommittee on Health, commended CMS for their decision to rescind the rule in a statement to Statline. “The new enforcement was unnecessary and went beyond delaying care,” he stated. “Patients, physicians, hospitals, nursing homes, and laboratories could not afford to have this change implemented, and all supported this effort. I am glad to see that CMS made the right decision in pulling this provision back so that we can put patient care first.”

The comment period for the proposed rule ends on Aug. 29.

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