Photo: Kansas Congresswoman Lynn Jenkins Tours Pathology Lab in Home District
Pathologists Continue Talks with Legislators as House Releases Draft Reform Bill
House Democrats released an 852-page draft health care reform bill June 19 which includes sweeping changes to the physician payment system and expansion of health insurance coverage, as the College continues to fly-in pathologists from around the country to discuss the CAP Health Care Reform Policy Agenda with legislators.
Pathologists have met with Congressional leaders in both the Senate and House
in recent weeks to discuss the critical role of pathologists in patient care.
The House draft reform bill would establish a coordinated-care medical home
program, accountable care organizations, as well as provide financial bonuses
to primary care doctors. The legislation would also replace the Sustainable
Growth Rate formula and replace it with a system allowing pay increases based
on the Medical economic index.
Without a legislative fix for the SGR, Medicare physician payment will be cut 21.5 percent in 2010, and by an estimated 40 percent over the next ten years.
The CAP Health Care Reform Policy Agenda also advocates to have financial bonuses to primary care physicians funded, however not in a budget neutral manner at the expense of specialty physicians.
“Congress is moving fast to reform health care in this country, with mark-ups for this draft bill expected sometime in mid-July,” said Richard Gomez, MD, FCAP, chair of the CAP Federal and State Affairs Committee, who flew to D.C. from Kansas to speak with his representatives. “Pathologists must act now to make sure their voices are heard, because it’s now that the decisions are being made that will affect our profession now and into the future.”
A Senate draft bill is under development, and is also expected to be considered by the Finance Committee in July.
Now is the time to take action—for more information on how you can join the fight with other pathologists and the College to assure the future of our profession, contact Chris Sherin via
Pathologists Support Health Care Reform Efforts at the AMA Annual Meeting
More than 200 policy recommendations and reports were addressed by the Pathology Section Council during the American Medical Association’s 158th annual meeting, which included a speech from President Obama on the course of health care reform.
Top issues at the conference, held in Chicago, IL June 14-17, included guidelines for a flexible approach to Medicare payment reform, support for the patient-centered medical home, and the need to address workforce shortages in the context of health care reform.
Throughout the President’s speech, he called “right now” the “moment” for health care reform.
“Every American deserves to have good health care,” said Jean M. Forsberg, MD, FCAP, a member of the CAP delegation to the American Medical Association, in response to President Obama’s remarks on June 15 before a crowd of 2,200. “As a hospital based pathologist, it sounds like he has very positive ideas. We need to make sure as pathologists that our role is properly defined as these ideas take shape into legislation.”
The Section Council on Pathology serves as an advocate for pathology and provides a caucus for all of the pathology specialty organizations with delegate status in the AMA House of Delegates.
The Pathology Section Council includes six delegates from the College including:
Rebecca L. Johnson, FCAP, chair of the Council; William V. Harrer, FCAP, MD,
chair of the CAP delegation; James L. Caruso, FCAP, MD; Jean E. Forsberg, FCAP,
MD; Susan M. Strate, MD, FCAP; and Mark S. Synovec, MD, FCAP.
Other delegates also reprepresent the American Society of Cytopathology, the American Society of Clinical Pathology, the National Association of Medical Examiners, and the United States and Canadian Academy of Pathology.
Connecticut Passes Direct Billing Legislation Protecting Patients from Markups
The Connecticut legislature passed Direct Billing legislation June 3 that will protect patients against “markup” charges by prohibiting an ordering physician from billing patients for anatomic pathology services performed or supervised by another physician.
6678, supported by the College in partnership with the Connecticut Society
of Pathologists to pass this bill, is anticipated to be signed into law by the
governor, who has 30 days to do so from the time of passage.
Once signed, Connecticut would become the 16th state to have a direct billing law for certain pathology service. The effective date of this legislation is July 1, 2009.
Direct billing is consistent with American Medical Association ethics principles
and has been a Medicare requirement since 1984. The Connecticut legislature’s
passage of the bill is the latest in a string of College successes at the state
level to enact laws that regulate or outlaw client billing by referring physicians
for anatomic pathology services.
eGFR Legislation Successfully Opposed by State Pathology Societies and CAP
Proposed legislation in Texas and New York requiring laboratory performance of an estimated glomerular filtration (eGFR) rate calculation on every serum creatine test was opposed by CAP and the states’ pathology societies this year.
CAP has consistently advocated against the requirements, as state mandates for performance of the calculation were expressly rejected under a January 2007 joint statement by the College and the National Kidney Foundation (NKF). In the declaration, CAP and NKF state that the eGFR “is a clinically useful calculation that should be promoted in the medical community in a scientific manner that does not require state legislation or state law.”
In New York, Assembly Bill 5158 was pulled from the Assembly Health Committee agenda following the opposition of CAP and the New York State Society of Pathologists (NYSSPATH). CAP and NYSSPATH cited AMA policy concern that an eGFR calculation requirement in state law “deprives a physician of the ability to make appropriate patient-specific clinical judgments.”
In Texas, House Bill 2330 was amended by the Texas Society of Pathologists (TSP) with the support of the CAP and the Texas Medical Association (TMA). Specifically, the amended Texas legislation exempts hospital laboratories without limitation and laboratories with “equipment that cannot be reprogrammed.”
In addition, the amended bill only requires performance of the calculation when all “relevant clinical information is provided.” The Texas bill passed the legislature and was signed into law June 19 by the Governor, effective Sept. 1, 2009.
Since the issuance of the joint CAP-NKF statement the push for a state legal mandates for eGFR calculations has largely ceased, however the College will continue to advocate against their inclusion in state legislation when necessary.
NYSSPATH and CAP Avert Passage of Legislation to Limit Laboratory Billing
Legislation to compel out-of-network clinical laboratories to accept in-network payment rates from health plans and prohibit labs from billing health plan enrolled patients for clinical laboratory services was averted from passage in New York.
SB 3180 and AB
6741 would have likely led to reduction in payment for clinical laboratory services in the state; however the legislation was amended June 9 in both the Assembly and Senate to remove the provisions of concern as the result of advocacy by the CAP and the New York State Society of Pathologists (NYSSPATH). Subsequently, the amended language in AB 6741 passed the New York Assembly June 22.
The new language now limits the bill’s requirement for health plans to reimburse out-of-network labs directly for services in a time frame consistent with the New York prompt payment law.
Several proponents of the legislation had intended to direct payment from health plans directly to out-of-network clinical laboratories, in lieu of payments being made to enrollees.
However, the legislation included concerning language that would have had the effect of forcing every clinical laboratory to accept in-network payment rates.
CAP and NYSSPATH’s opposition to the measure was joined by two county medical societies, Onondaga and Westchester, and assisted with support from the Medical Society State of New York.
CAP Advocacy Webinar on FTC Identify Theft Prevention Regulations Now Available for Download
The CAP webinar on complying with the Federal Trade Commission’s Red Flags Rule for identify theft prevention regulation is now available for download.
Guest speakers for the webinar, which was open exclusively to CAP members, included:
- Naomi Lefkovitz, Esquire, Federal Trade Commission Division of Privacy and Identity Protection
- Jim Dechene, Esquire, Sidley Austin, LLP
- Andrew Horvath, MD, FCAP, chair of the CAP Council on Government and Professional Affairs
Download the webinar, along with the accompanying PowerPoint presentation and supporting documents, in the Audio Conferences area of the Advocacy web pages.
CMS Alerts Physicians of Faxing Scam
The Centers for Medicare & Medicaid Services (CMS) issued a warning about a scam where perpetrators are sending faxes to physician offices posing as the Medicare carrier or Medicare Administrative Contractor (MAC).
The fax instructs physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments. The fax may have the CMS logo and/or the contractor logo to enhance the appearance of authenticity.
Medicare FFS providers, including physicians, non-physician practitioners, should be wary of this type of request. If you receive a request for information in the manner described above, please check with your contractor before submitting any information.
Medicare providers should only send information to a Medicare contractor using the address found in the download section of the CMS.gov website found at http://www.cms.hhs.gov/MLNGenInfo/ or http://www.cms.hhs.gov/MedicareProviderSupEnroll.
Congressional Laboratory Tours
CAP members hosted two lab tours recently, giving their Congressional representatives the opportunity to see first hand the role of pathology in patient care and discuss key issues in healthcare reform:
- Michael Deck, MD, FCAP, and Imran Shahab, MD, FCAP, hosted Representative Sam Johnson (R-TX), member of the House Ways and Means Subcommittee on Health, at MD Pathology May 29 in Plano, TX.
- Richard Gomez, MD, FCAP, hosted Representative Lynn Jenkins (R-KS) at St.
Francis Health Center Laboratory June 23 in Topeka, KS.
For more information on how you can host your Senator or Representative on a laboratory tour, contact Chris Sherin either by phone, 202-354-7129, or email.
202-354-7100 • 202-354-7155 (fax) • 800-392-9994