College of American Pathologists

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

August 1, 2013  •  Volume 29, Number 16
Next Issue: August 15, 2013
© 2013 College of American Pathologists

In This Issue:

CAP Issues Action Alert on Proposed PFS Pathology Cuts

CAP issued an action alert this week urging its members to fight the pathology pay cuts included in the 2014 Proposed Medicare Physician Fee Schedule Rule released last month. If the cuts survive in the final rule, they would dramatically reduce technical component payments for many codes by as much as 50–80%.

“As you are well aware, the Centers for Medicare and Medicaid Services (CMS) recently proposed to radically cut the technical component (TC) and global payments for many anatomic pathology services by over 50% and as much as 80% for certain codes. If CMS finalizes this proposal, it will have devastating results,” CAP said in its action alert. “Your help is needed to succeed in our political advocacy efforts. Every Member of Congress must hear from you and your colleagues.”

Specifically, CAP asked members to email their members of Congress and let them know they oppose the pathology cuts in the 2014 Physician Fee Schedule proposed rule. The alert included a link to the capwiz website which hosts CAP member communications to Congress. Once on the website, a member enters their home zip code, and the Capwiz system immediately identifies their members of Congress and displays a pre-drafted letter to Congress which members can customize and send in a matter of two or three clicks.

CAP also invited members to send comments on the proposed cuts to CMS during the 60-day public comment period which ends September 6, 2013. Do this by going to the federal government website,; then search for RIN: “0938-AR56”; then click on Comment Now to write your comment.

See the CAP’s 2014 Medicare Physician Fee Schedule Resource Center for additional resources, including sample text and CAP’s talking points on the proposed cuts.

Register now for an exclusive CAP webinar on the proposed 2014 Medicare Physician Fee Schedule: Understanding the 2014 Proposed Medicare Physician Fee Schedule scheduled for Wednesday, August 7, 2013 at 3:00–4:30 PM Eastern Time.

Rep. Speier (D-CA) Introduces Bill Ending Self-Referral of AP Services

Friedberg Press Conference Today Rep. Jackie Speier (D-CA) introduced legislation that would prohibit physician self-referral of anatomic pathology (AP) and other specified health services.

The legislation, the “Promoting Integrity in Medicare Act of 2013” amends the Stark Law’s In-Office Ancillary Services exception by removing anatomic pathology, physical therapy, radiation oncology, and advanced diagnostic imaging from the list of allowed services. It would not change the status of clinical pathology or other services covered by the IOAS exception.

CAP expressed strong support for the bill. “The College has been sounding the alarm on the wasteful incentives current policies on self-referral present to physicians. We applaud Representative Speier for putting patients first and preventing powerful interest groups from exploiting a loophole in the law that wastes billions of Medicare dollars and adds no patient benefit,” said CAP President-Elect, Gene Herbek, MD.

Introduction of the bill comes just two weeks after the GAO reported that self referral of AP and the other services included in the bill cost Medicare billions. (See information on related CAP webinar on August 8, below). The President’s 2014 budget also projected saving over $6 billion by narrowing the IOAS.

CAP has supported research quantifying utilization by self-referring physicians and their impact on Medicare spending. The research was conducted by well known health policy economist, Jean Mitchell, PhD, and published in the leading peer-reviewed health policy journal, Health Affairs. It compared Medicare billing practices for anatomic pathology services related to prostate biopsies by self-referring and non self-referring urologists, and using Medicare’s own data showed that self-referring urologists billed Medicare for 72% more prostate biopsy specimens compared to non self-referring physicians, with no increase in cancer detection. In fact, self-referring urologists had a 40% lower cancer detection rate than those who did not self refer despite billing for nearly twice as many specimens.

“Now that we have clear data documenting the problem and bill that would prevent it, Congress must act quickly to pass it and close this loophole once and for all,” Herbek said.

Register now for CAP’s Expert Panel Discussion “GAO Calls For Action to End Physician Self-Referral: A Panel Discussion”, featuring CAP President-Elect, Gene Herbek, MD FCAP; health policy researcher Jean Mitchell; Susan Dentzer, former editor of Health Affairs, which published Dr. Mitchell’s research in 2012, and Matt Foster, MD. The panel will be held on Thursday, August 8, 2013 at 3:00–4 p.m. p.m. Eastern Time.

House Committee Votes to Repeal SGR

Bringing the repeal and replacement of the Sustainable Growth Rate (SGR) formula closer than ever, the House Energy and Commerce Committee yesterday (July 31) passed the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810) on a vote of 51-0.

The legislation, which now moves to the full House, would replace SGR with 5-year period of stability as it moves toward a system that rewards physicians for delivering quality care.

The committee chair, Rep. Fred Upton (R-Mich.), called the vote “an important milestone, but we are all resolved to achieve reform in a fiscally responsible manner… we will not be satisfied until the ink is dry on the president’s signature.”

According to the committee’s summary of the bill, the legislation provides an annual statutory update of 0.5% per year for 2014 through 2018. During this time, current incentives programs, such as the Physician Quality Reporting Program (PQRS) and the Electronic Health Record (EHR) Incentive Program will continue. Quality measure development also will continue to ensure robust availability of measures for rewarding provider performance. Providers will also have the option of using current delivery system reform avenues as well as a new Alternative Payment Models (APM) process to put forward and test new models of care delivery and improvement.

As reported here in STATLINE previously, CAP advocates in Congress to replace the fundamentally flawed Sustainable Growth Rate (SGR) formula with a physician payment system that rewards physicians for improving the quality of patient care and curbing the rate of growth in costs.

The American Medical Association issued a statement following the committee’s vote yesterday.

“In addition to repealing the SGR, [the] vote is a significant step toward allowing physicians and other health care providers to design systems of care that best serve their patients through new and innovative health care delivery models,” said Jeremy Lazarus, MD, immediate past president of the American Medical Association. “Key to Medicare’s success is ensuring adequate funding for the program’s budget neutral physician payment system that will promote sustainable practice environments and allow physician investment in new ways of improving patient care,” Lazarus said.

Legislative momentum has been building this year in support of repealing the SGR. A timeline of SGR reform efforts is available on the E&C Web site.

The health subcommittee of the House Energy and Commerce Committee approved the current version of H.R. 2810 July 23 (full text of the bill, published July 24), saying on its Web site: “After more than two and a half years of transparent and bipartisan work, today’s advancement brings Congress closer than ever to establishing a system that rewards physicians for delivering quality care to seniors with measures determined with the help of expert medical organizations.”

STATLINE has reported (June 6) that the Medicare Payment Advisory Commission (MedPAC) said it would revise its proposal to pay for repealing the SGR by making it less painful for specialists. In written testimony submitted to the Senate Finance Committee May 14, MedPAC Executive Director Mike Miller said the Commission would propose cutting specialists’ pay by 3% or less (each year for three years) based on the lower cost of SGR repeal. MedPAC had proposed a 5.9% pay cut in 2011.

PQRS Group Reporting Registration Continues Through October 15

CMS’s Physician Value (PV)–Physician Quality Reporting System (PQRS) Registration System is now open through Oct. 15. Group practices who want to use the Group Practice Reporting Option to report on PQRS measures in 2013 must register with CMS by October 15, 2013. Eligible professionals reporting as individuals are not required to register unless they are choosing to use the Administrative Claims Option.

Under the Group Practice Reporting mechanism, the entire group may potentially qualify to earn PQRS incentive payments equal to 0.5% of the group practice’s total estimated Medicare Part B PFS allowed charges for covered professional services furnished during a 2013 PQRS reporting period based on the group practice meeting the criteria for satisfactory reporting specified by CMS.

This option is particularly important for Groups with Members who do not have any measures to report, as long as those Members with measures report, this option can be used to avoid penalties in 2015. Alternatively, the group can sign up for the administrative claims option to avoid the 2015 penalty, although they would not then be eligible for the 2013 bonus.

The PV–PQRS Registration System is a new application to serve the Physician Value Modifier and PQRS programs. The PV–PQRS Registration system will allow: (1) physician group practices to select their CY 2013 PQRS Group Reporting Mechanism, and if the group has 100 or more eligible professionals, elect quality tiering to calculate their CY 2015 Value–based Payment Modifier; and (2) individual eligible professionals to select the CMS–calculated Administrative Claims reporting mechanism for CY 2013 in order to avoid the PQRS negative payment adjustment in CY 2015.

See CAP’s recommendations presented at the CLFS meeting on July 10, 2013.


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