College Provides Amicus Brief to Court in Case Challenging Medicare Anti-Markup Provisions
The College last month filed an amicus curie brief to the U.S. District Court for the District of Columbia in a case that has challenged the Medicare Anti-Markup provisions in the 2008 Medicare Physician Fee Schedule rule.
The brief comes in a case in which UroPath, LLC and three urology groups filed suit against the Department of Health and Human Services seeking an injunction to halt implementation of the provisions in the rule, which came into effect Jan. 1.
In the amicus curie, or “friend of the court” brief, the College explains why pod lab arrangements do not comply with the intent of the in-office ancillary exception to the Stark law prohibition on self-referrals.
Additionally, to help the District Court better understand the issue, the brief demonstrates how pod labs can lead to over-utilization, and argues for immediate implementation of the November final rule as it relates to pathology services.
In order to allow time for consideration of the suit, the court ordered the Centers for Medicare & Medicaid Services not to apply the final anti-markup rule to claims submitted prior to April 1, 2008.
Initially, an April 1 decision was expected—however, now the Court has asked CMS to extend its moratorium until the end of the month. If the injunction is granted, pathology services will be included in the previously announced one year delay for services other than pathology.
Cytology Proficiency Improvement Act to be Voted on in the House Next Week
With Congress back in session after a two-week recess, the House of Representatives expects to vote on HR 1237, the Cytology Proficiency Improvement Act of 2007, next week.
Yesterday morning House Majority Leader Steny Hoyer (D-MD) announced during opening remarks that HR 1237 has been scheduled by House leadership for a vote during the week of April 7.
The CAP, in conjunction with the Cytology Proficiency Improvement Coalition, has developed a substantial grassroots program to generate support for this important bill.
The recent addition of the American Society for Clinical Pathology to this coalition will only strengthen our grassroots support for this legislation as it is voted on in the House and gains momentum in the Senate.
The House legislation has 175 co-sponsors, while the Senate companion bill, S.2510, has nine cosponsors—including four members of the Health, Labor, Education, and Pensions Committee, the committee of jurisdiction.
The College appreciates those who have provided critical grassroots support on this issue, and asks all members to continue to monitor their email for further updates and action alerts.
Majority of CAP Healthcare Use Case Recommendations Accepted by HHS
The majority of the 60 recommendations issued by the College on HHS’s draft Detailed Personalized Health Care Use Case to the National Coordinator for Health Information Technology were accepted with the release of the March 21 document.
The action emboldens CAP efforts to advocate for the pathologist and laboratory role in personalized healthcare through standard setting and policy development of the electronic health record.
With approximately 436 feedback items provided by 38 organizations, the acceptance of the majority of CAP recommendations marks a significant development in promoting fundamental change to more accurately represent how genetic tests are used and interpreted by pathologists.
HHS Use Cases describe events and system-needs for achieving specific missions or stakeholder goals, convey how individuals and organizations interact with the involved systems, and strive to provide enough detail and context for follow-up activities to occur. Since use cases are used for standard setting, data standards, and in policy development, it is important that the role of stakeholders is accurately represented.
According to the CAP’s comments, issued Feb. 15, “Throughout the current draft of the use case, the laboratory and testing functions are incorrectly separated from the interpretative role of a laboratory physician and incorrectly delegated to the clinician directly caring for the patient.”
“It is true that clinicians do use genetic test interpretations in developing management plans for their patients, however, the clinician responsible for interpreting test data from the medical laboratory is the pathologist working within the laboratory.”
Based on these use cases, the Health Information Technology Standards Panel will develop data standards and technical standards for AHIC approval.
Advocacy Briefs
Support continues to grow in Congress for the Cytology Proficiency Improvement Act of 2007—the newest members to sign on as co-sponsors of this important legislation include:
House – H.R. 1273
- Steven C. LaTourette (OH-14)
- Vernon J. Ehlers (MI-3)
- Niki Tsongas (MA-5)
- Peter Hoekstra (MI-2)
- Dan Boren (OK-2)
- Tom Feeney (FL-24)
- Carol Shea-Porter (NH-1)
Senate – S. 2510
- Sherrod Brown (D-OH)
- Bernie Sanders (I-VT)
 Representative Tom Feeney of Florida and Dr. Pedro Carmona at a recent laboratory tour.
- Pedro Carmona, MD, hosted a lab tour at Parrish Medical Center with Rep. Tom Feeney (R-FL).
- Jamie Adam, MD, hosted Rep. Phil English (R-PA) for a lab tour of the Sharon Regional Health System.
For more information on how you can host your Senator or Representative, as well as register for the 2008 Advocacy School, contact Chris Sherin either by phone, 202-354-7129, or via e-mail.
(For Statline reprint permission, please contact Justin Herman.)
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