College of American Pathologists
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  STATLINE — CAP’s Bi–Weekly Federal and
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March 28, 2013  •  Volume 29, Number 7
Next Issue: April 11, 2013
© 2013 College of American Pathologists

In This Issue:

New Bill Shields Pathologists From MU Penalties

New legislation, H.R. 1309, the Health Information Technology Reform Act, was introduced last week to exclude pathologists from facing penalties for failing to meet federal requirements for meaningful use (MU) of electronic health records (EHR).

The Meaningful Use incentive program for Medicare and Medicaid physicians currently awards incentive payments to physicians who can demonstrate “meaningful use” of EHRs based on a set of rigid requirements. Starting in 2015, physicians who fail to demonstrate meaningful use of EHRs will face a 1% penalty on their Medicare payments. That penalty could rise to as much as 5% in 2017 and beyond.

Most pathologists are unable to participate in the current federal MU incentive program because the requirements do not allow for differences among physician practices, and specialists like pathologists who practice in medical laboratories using laboratory information systems, (rather than EHRs) cannot meet the prescribed MU requirements.

Through CAP’s advocacy, CMS granted pathologists a hardship exception from penalties in 2015, but the exception is granted only for one year at a time, for a maximum of five years. This bill will permanently exempt pathologists from participating in the program.

A similar bill introduced in the 112th Congress by Rep. Tom Price, MD (R-GA) was supported by CAP and received 60 co-sponsors before the session ended. This new bill was co-sponsored by Rep. Price and Rep. Ron Kind (D-WI), both members of the House Ways and Means Committee. The bill has been referred to that committee and the Energy and Commerce Committee.

CAP Urges Congress to Build Flexibility Into New Payment Models

CAP urged lawmakers to avoid the problems of existing pay-for-performance initiatives by building flexibility into future physician quality measurement programs that will accommodate the different scopes of practice and practice settings of specialists and subspecialists, including pathologists.

These and other recommendations were delivered in a letter from CAP President Stanley J. Robboy, MD FCAP, to Rep. Dave Camp (R-MI), chairman of the House Ways & Means Committee, and Rep. Fred Upton, (R-MI) chairman of the House Energy & Commerce Committee. The committees are gathering input that will help shape their joint proposal to repeal the SGR and reform Medicare physician payment. They are filling in details on a three-phase framework proposed this year that includes repealing the SGR formula and freezing physician pay for an underdetermined period (this is a transition phase) while a new payment system based on pay-for- performance principles can be developed. The Committees invited CAP’s input on how to measure quality and pathologists’ performance.

CAP used the opportunity to illustrate the drawbacks of current programs like the EHR Meaningful Use (MU) program and the Physician Quality Reporting System (PQRS), which reward physician performance against rigid constructs and impose the same requirements on all physicians. Without intervention and advocacy from CAP, the majority of pathologists would be penalized for failing to demonstrate meaningful use of electronic health records, despite the fact that pathologists work outside the EHR and the MU requirements cannot be applied to most pathologists’ practice. (See related story above.)

CAP’s recommendations focused on actions that would enable pathologists’ participation or at least allow pathologists to avoid penalties in a one-size-fits-all paradigm.

  • In transitioning to a new payment system, current performance programs, such as PQRS and EHR MU should not penalize physician specialties, such as pathology, for misaligned requirements that do not fit their scope of practice or are beyond their control.
  • Any new “standard process” or pathway for development of meaningful quality measures and clinical improvement activities must be flexible enough to account for variability amongst physician specialties and practices, including subspecialties.
  • Pathology is practiced in a wide variety of settings, including hospitals and in the public health arena, where pathologists promote quality, patient safety and contain costs. Mechanisms must be established to allow performance credits for quality activity in such settings outside the physician fee schedule.

CAP also called for any new physician performance ranking system to be stratified by sub-specialty, and scoring to be based only on decisions/outcomes that are within pathologists’ control.

  • When developing quality and efficiency performance “scores,” the fact that some physicians, such as pathologists do not control volume must be taken into account. Also, relative rankings amongst specialty peer groups must take into account sub specialization within a specialty. A general pathologist should not be compared to a neuropathologist or a neuropathologist to dermatopathologist. Physicians should be able to review their rankings before such information is more widely shared.

The Joint Committee has not indicated when its full proposal will be released, but the goal is to draft and move legislation in 2013 to repeal the SGR and replace it with a transition period of stability. As previously reported in Statline, the cost of freezing physician rates at their current level for 10 years dropped dramatically to $138 billion this year, opening the door to an array of proposals that would replace SGR and the fee-for-service payment model with a physician payment system focused on improving outcomes and cost containment.

If Congress fails to intervene before December 31, 2013, the Medicare Payment Advisory Commission (Medpac) reported in its March Report to Congress that the SGR formula would cut Medicare physician pay by 24.4% in 2014.

Statline will continue following and reporting on this important issue.

CMS Announces Provider Edits for May 1

Starting May 1, referring and ordering physicians listed on claims for laboratory services must be enrolled in Medicare or have valid opt-out status or the claims will be denied, even if the provider submitting the claim is enrolled in the program, according to an announcement issued by CMS earlier this month.

The announcement marks final implementation of CMS edits initiated in 2009, requiring physicians or other eligible professionals who order or refer items or services for Medicare beneficiaries to be enrolled in the Medicare Program, and requiring each claim to contain the exact name and unique identifier of the ordering or referring physician on all applicable Part B, DME, and Part A HHA claims in order to be paid.

Statline readers will recall the efforts of CAP, AMA and other physician groups to oppose the burdensome requirement, including issuing a letter to CMS to prevent or delay its implementation. As a result of that effort, CMS has until now continued paying claims that fail to meet the requirement while alerting billing providers in those cases that the identification of the ordering or referring provider is missing, incomplete, or invalid, or that the provider is ineligible to order and refer. A practice may get an indication of the impact of this change by asking its billing operations for its volume of Medicare adjusted claims that meet the criteria defined in the announcement.

If such a message appears on any of your correspondence, even if they have been paid in the past, they will not be paid starting on May 1, 2013.

Providers who do not have a Medicare enrollment record must submit an enrollment application to Medicare in one of two ways: via the internet-based Provider Enrollment, Chain and Ownership System (PECOS) or by completing the Medicare paper enrollment application (CMS08550). CMS is encouraging effected physicians not yet enrolled in Medicare to do it as soon as possible or risk having claims denied.

Stephen Black-Schaffer Joins MEDCAC Advisory Panel

Stephen Black-Schaffer CMS announced last week that (William) Stephen Black-Schaffer, MD, FCAP, has been chosen to serve on the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC). He is one of only 100 experts selected to advise CMS on clinical and administrative coverage issues.

Dr. Black-Schaffer is the Associate Chief of Pathology for Education and Director of the Pathology Training Program at Massachusetts General Hospital, and an Associate Professor of Pathology at Harvard Medical School. He is Vice-Chair of the CAP Economic Affairs Committee, and Chair of the Payment Policy Work Group and of the CAP Policy Roundtable Committee Workforce and Education Work Group.

In addition to participation on key CAP committees, Dr. Black-Schaffer is active in the US and Canadian Academy of Pathology (USCAP), the American Society of Cytopathology (ASC), and the Association of Pathology Chairs (APC), where he serves on the Program Directors Section Council. His commitment to pathology is reflected in national, regional and state initiatives he has led over the years, and he has been recognized with numerous honors and prizes.

Among these, in 2011, Dr. Black-Schaffer received the CAP “President’s Honor Award” for service to the discipline of pathology above and beyond the line of duty. In 2010, Partners HealthCare System recognized him with their first “Outstanding Graduate Medical Education Program Director Award” for outstanding local and national contributions to graduate medical education, while the CAP Residents Forum honored him with its “Resident Advocate Award”.

In nominating Dr. Black-Schafer, CAP President Stanley J. Robboy wrote, “Dr. Black-Schaffer is an outstanding pathologist who has the necessary qualifications to guide the agency in making laboratory and diagnostic care coverage decisions.”

MEDCAC provides independent guidance and expert advice to CMS on specific clinical topics. CMS appoints a pool of experts working in clinical and administrative medicine capacities to serve on MEDCAC, and selects 15 MEDCAC panelists to serve at each MEDCAC meeting, matching panelists’ expertise with the topics that will be covered at each meeting. MEDCAC meets four–eight times per year. The next meeting is scheduled for May 1, 2013.

Dr. Black-Schaffer is the second pathologist to currently serve on MEDCAC. Jan Nowak, MD, PhD, FCAP also serves on the committee.

Direct Billing Law Clarified in Indiana

The Indiana legislature on March 12, 2013 unanimously passed CAP and Indiana Society of Pathologists (ISP) backed legislation, HB 1105, to clarify the application of that state’s direct billing law for anatomic pathology services. The bill is expected to be signed into law by the Governor. Indiana’s direct billing law (Public Law 222) was enacted in 2011. House Bill 1105 clarifies that physicians who perform anatomic pathology services on a patient sample can bill a patient or payer a global bill that includes the cost of histological processing (technical component), provided that they do not add a fee to the cost of the histological processing. In addition, the legislation clarifies that the direct billing law does not regulate hospital billings for in-patients or out-patients of their facilities. All other provisions of the 2011 direct billing law remain in effect, including provisions prohibiting clinicians from billing for anatomic pathology services that they do not supervise or perform. This year’s legislation was advocated by CAP and ISP to clarify and codify the legislative intent of 2011 law.

NJ Governor Signs CAP-NJSP Supported Bill Into Law

Governor Chris Christie signed into law legislation amending New Jersey’s genetic counselor law by removing a genetic counselor’s statutory authority to interpret genetic tests and other diagnostic studies from their scope of practice.

The new law (Public Law 2013, Chapter 30), signed by the Governor on March 18th, is effective immediately. The bill, which unanimously passed the New Jersey legislature, also clarifies that physicians are categorically exempt from the genetic counselor licensure law.

Enactment of the legislation is the result of a two-year collaboration between the New Jersey Society of Pathologists and the CAP to ensure New Jersey State law conforms to the scope of practice agreement between the CAP and the National Society of Genetic Counselors (NSGC). The bill was also supported by the New Jersey Medical Society and Oncology Society of New Jersey.

Policy Meeting to Focus on the Future of Pathologists

Shape Your FutureThe changes we’re already seeing in healthcare are only the start of things to come. Now is the time to get important information that can help shape the future for your practice.

Join key lawmakers and policy influentials at the CAP 2013 Policy Meeting, May 6–8 in Washington, DC, for rare access to the people who are changing healthcare delivery. Understand the real issues facing pathologists. Learn about new opportunities as well as threats. See how you can prepare your practice for the changes ahead.

Topics to be covered:

  • new payment models
  • ACOs and other collaborative care models
  • personalized medicine
  • pay-for performance and value based purchasing
  • resources for pathologists

Register online.


202-354-7100  •  202-354-7155 (fax)  •  800-392-9994


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