College of American Pathologists

  STATLINE — CAP’s Bi–Weekly Federal and
  State Advocacy E–Newsletter

January 2, 2014  •  Volume 30, Number 1
Next Issue: January 16, 2014
© 2014 College of American Pathologists

In This Issue:

CMS, ONC Delay Tougher Standard for EHR Meaningful Use

Many physicians will have additional time under stage 2 of the meaningful use of an electronic health record program after the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) delayed the start of tougher criteria under stage 3 by one year. Stage 3 of the meaningful use program is now scheduled to begin in 2017.

“The goal of this change is two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in stage 2; and second, to utilize data from stage 2 participation to inform policy decisions for stage 3,” CMS and ONC officials stated in a Dec. 13 announcement.

Despite the timeline revision, the College of American Pathologists remains vigilant about preventing penalties linked to the meaningful use of an EHR program. Beginning in 2015, eligible professionals who fail to meet meaningful use criteria will see their Medicare payments cut. The penalty is unfair to pathologists because the EHR program is geared toward office-based physicians who have routine face-to-face contact with Medicare beneficiaries.

CAP has worked with CMS to carve out a hardship exemption that stops the penalty for pathologists and other specialists who lack face-to-face interaction with patients or cannot control the availability of certified EHR systems. CAP has called on CMS to go further by providing pathologists with relief from the penalty for the full five years allowed under current law. CAP has also endorsed H.R. 1309, the Health Information Technology Reform Act, which would permanently eliminate pathologists from eligibility from penalties or incentives.

Furthermore, like the American Medical Association and many other key stakeholders, the CAP advocated in prior comments a slower switch from stage 1 to stage 2 to allow adequate time for this significant implementation. Stage 2 imposes many new requirements on laboratory data. For more information, see the CAP’s FAQs on meaningful use as well as CMS’ criteria and timelines for stage 2.

Under the new timeline for stages 2 and 3, physicians with at least two years of demonstrating stage 1 meaningful use criteria will demonstrate stage 2 of meaningful use in 2014. They will continue under stage 2 for three years after gaining an extra year for this stage by delaying the start of stage 3.

A physician with only one year under stage 1 would continue under stage 1 for 2014 and then be required to meet stage 2 criteria in 2015 and 2016. Physicians just beginning the meaningful use program in 2014 would demonstrate meaningful use for stage 1 in 2014 and 2015, and stage 2 in 2016 and 2017 before moving to stage 3 in 2018, according to CMS and ONC.

Register for the 2014 CAP Policy Meeting

Online registration is now open for the 2014 CAP Policy Meeting, to be held May 5–7, at The Fairmont in Washington, DC.

The implementation of health care reform will change the landscape of medical practice and the roles of individual pathologists. At the same time, the rapid pace of technological innovation continues to raise the stakes and accelerate demand for services that pathologists should be prepared to provide. Pathologists need to address these realities by learning about new payment and delivery models, payor efforts to drive value through more efficient use of health care resources and ways to address regulatory impediments to delivery of personalized medicine.


Join pathology leaders to discuss policy and regulatory issues that impact our profession. This is the only national policy meeting for pathologists that brings together experts throughout the pathology and health care community. This meeting is a ‘must attend’ event for anyone interested in learning about emerging policy trends from nationally recognized experts.


At this meeting, CAP Members will:

  • Gain insights on the rapidly changing issues that will impact your practice and your patients
  • Be the voice of pathology at our Annual CAP Hill Day


Several key issues that present risks to pathologists will come before Congress and the Administration in the coming months. These risks are driven by public and private payers’ attempts to restrain health care costs; by other health care professionals who are seeking to capture revenue from pathology practices; and the roll out of the Affordable Care Act.

Register Today

The meeting begins Monday, May 5, and concludes Wednesday, May 7 with our Annual CAP Hill Day. Meeting registration is free and includes all meeting materials, breakfasts, lunches, and receptions during the meeting. Attendees will be responsible for their travel, hotel and other expenses. The 2014 CAP Policy Meeting is available exclusively to CAP Members.

Need Additional Information/Questions?

If you have any questions regarding the 2014 CAP Policy Meeting, call 800-323-4040 or email us.

Pathologists Host Rep. O’Rourke for El Paso Lab Tour

After leading a tour of her practice, Jennifer Stratton Do, MD, FCAP found her representative in Congress had walked away with a better understanding of the value pathologists bring to the health care system.

Dr. Do and her colleagues at Pathology Professional Services in El Paso, Texas, welcomed Rep. Beto O’Rourke (D-Texas) for a tour of the practice and a discussion about key federal issues effecting pathology on Dec. 18, 2013. The tour itself was fairly easy to set up, but it also was an extremely important opportunity to speak about how decisions in Washington impact pathology, Dr. Do said.

“It is our responsibility if they don’t know who we are to explain the value of pathology,” Dr. Do said when asked if she would recommend hosting tours to other pathologists. “If others think that we are just technologists then we’re all destined to fail.”

Left to right: Jennifer Stratton Do, MD, FCAP; Jaime Diaz, MD, FCAP; Mary Anne Dominguez (office manager); Jorge Bilbao, MD, FCAP; Maria Elena Sanchez (histology supervisor); Vanessa Fierro; Rep. Beto O'Rourke; Thelma Bustillos; and Cesar A. Abbud, MD, FCAP. (Credit: Dr. Do)Dr. Do and her colleagues first approached Rep. O’Rourke during a local town hall meeting after CMS proposed Medicare cuts to pathology services. Rep. O’Rourke and his staff expressed interest in learning more about this and other issues. They then invited the congressman to visit their lab. Dr. Do used guidance from CAP’s advocacy staff to help organize the tour.

“It was simple—I spoke with a staffer to set up meeting,” Dr. Do said. “It didn’t take more than a total of two or three hours of my time.”

The harm caused by the Medicare cuts to anatomic pathology was emphasized during the tour. Dr. Do and her colleagues also discussed closing the self-referral loophole that allows a doctor to order anatomic pathology services to a laboratory when he or she has a financial interest in that lab. The loophole has led to overutilization of services and inefficient patient care, according to several studies.

Overall, laboratory tours continue to provide a unique, hands-on opportunity to familiarize members of Congress with the important role pathologists play in health care. When lawmakers make legislative decisions that impact pathologists, it is crucial that they have a strong understanding of what pathologists do and how changes to the system will impact their ability to deliver quality care and accurate diagnoses to their patients.

For information about leading a tour with your representatives, please watch this PathNet video. Please contact Laura Brigandi if you have questions or need more information about leading a tour.

CAP Calls on CMS to Address Billing Policy for Listing the Date of Service

In a Nov. 27 comment letter, CAP outlined its strong case regarding billing policy for reporting the date of service of the professional component for laboratory tests on Medicare claims. In the absence of a national policy, some Medicare Administrative Contractors (MACs), which are responsible for processing claims, have developed new date of service guidelines while other contractors have left the decision to providers.

The CAP letter recommended to CMS that it issue a national policy adhering to the long-standing industry practice that the date of service for the professional component (PC) be the same as the date that the technical component (TC) is performed. CAP also recommended that CMS prohibit MACs from imposing penalties or denying claims to providers that are working in good faith to implement changes to comply with the contractor policies.

The common accepted practice has been to use the same date of the technical component of the service when billing for the professional component. Several MACs, such as Wisconsin Physicians Service Insurance Corp. (WPS) and Palmetto GBA, recently required the date of service for the PC to be on the day the physician interprets the test, regardless of when the TC was provided.

The CAP recommends to members that they check with their MAC to determine if the contractor also has adopted a new date of service policy.

Editor’s note: This article has been updated to remove a reference to the Medicare contractor National Government Services (NGS). NGS has stated it does not have a mandated policy on which the date of service providers are to bill in this situation. For more information, please visit the NGS website.

Medicare ACOs Expand by 123 in 2014

New accountable care organizations (ACOs) have formed to oversee care for 1.5 million additional Medicare beneficiaries starting Jan. 1, 2014, CMS announced on Dec. 23. The 123 new ACOs will join about 250 others in the Medicare Shared Savings Program (MSSP) that are working to improve quality of care and lower costs for an assigned Medicare patient population.

CMS has published a list of the new MSSP ACOs. CAP has extensive information on coordinated care programs in its ACO/Coordinated Care Resource Center including tools to assist pathologists. If you are at one of the new MSSP ACOs, we encourage you to join CAP’s ACO network by sending us email.

Since 2012, ACOs from rural and urban areas across the country have become participants in the MSSP created by the Affordable Care Act. ACOs now number approximately 600 in the public and private sectors. These organizations are projected to double from late 2013 to the end of 2014, while participation has almost quadrupled since 2012.

More than half of the 123 new ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries, according to CMS. Currently, more than 5.3 million of the roughly 50 million Medicare patients are being served by an ACO. About 1 in 5 of the new ACOs include community health centers, rural health clinics, and critical access hospitals focused on serving low-income and rural communities.


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