College of American Pathologists
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November 10, 2011  •  Volume 27, Number 23
Next Issue: November 23, 2011
© 2011 College of American Pathologists

In This Issue:

Super Committee Deadline Nears as CAP Pushes Key Issues
Pathologists Should Not Be Subject to the CMS’s ePrescribing Penalty
CAP Offers Webinar on Reporting New Pathology Measures to CMS
CMS Delays PECOS Revalidation Effort Through 2015
Keep Up with the Latest CAP Advocacy News on Twitter

Super Committee Deadline Nears as CAP Pushes Key Issues

As the Joint Committee on Deficit Reduction’s Thanksgiving deadline draws closer, the College continues to pursue its lobbying agenda through meetings with staff of both this “Super Committee” and leading lawmakers—including House Speaker John Boehner (R-OH)—on three advocacy priorities: removing anatomic pathology (AP) from the in-office ancillary services (IOAS) exception to the Stark Law, extending the TC “grandfather” provision, and repealing and replacing the flawed Medicare physician payment formula under the sustainable growth rate (SGR)—currently slated to be cut by 27.4% by the end of the year.

Get Involved: Contact Congress Now

To become involved in CAP’s continued advocacy efforts, visit the PathNET Legislative Action Center.

These fall “fly-in” Hill meetings between lawmakers and CAP members have focused on how closing the IOAS loophole can contribute to significant health care savings without harming delivery of health care services. The Super Committee now has less than two weeks to deliver on its charge to recommend to Congress $1.2 trillion to $1.5 trillion in cuts. With the clock ticking down, CAP is pushing Congress to support a legislative fix to closing the IOAS loophole before Thanksgiving, as part of the deficit reduction plan.

CAP Members Engaging Congress

Since October, the CAP fall “fly-in” campaign has brought 23 CAP members to Washington, D.C., to participate in meetings with the staff of 10 of the 12 Super Committee members. This tally includes this week’s meetings between Super Committee member Rob Portman’s (R-OH) staff and CAP member Robert Gurdak, MD, FCAP. Dr. Gurdak also met with another Super Committee member, Rep. Dave Camp (R-MI).

member Robert Gurdak, MD, FCAP met recently with Super Committee member, Rep. Dave Camp (R-MI). In his discussion with Super Committee member Rep. Camp (R-MI) and the office of member Sen. Portman, Dr. Gurdak honed in on the need to curb overutilization and the potential savings that could result from removing anatomic pathology (AP) services from the IOAS exception. As President of the Ohio Society of Pathologists, Dr. Gurdak joined with 43 other state pathology society presidents in writing to the Super Committee, urging members to focus on the significant health care savings that could be gained by closing the IOAS “loophole.”

In addition to his meeting with the staff from Sen. Portman’s and House Speaker John Boehner’s offices, Dr. Gurdak also met with the staff from the offices of Reps. Tim Ryan (D-OH), Steve Austria (R-OH), and Pat Tiberi (R-OH). Rep. Austria is a member of the House Appropriations Committee, Rep. Ryan is a member of the House Budget Committee, and Rep. Tiberi serves on the House Ways and Means Committee. Dr. Gurdak also met with the staff from the office of Sen. Sherrod Brown (D-OH), who developed considerable knowledge on health care issues having once served on the Senate Health, Education, Labor and Pensions (HELP) Committee.CAP President-Elect Gene Herbek, MD, FCAP and CAP member Michael A. Deck recently met with House Majority Leader Eric Cantor (R-VA) to discuss self-referral and other advocacy issues.

In meeting with the staff of these other lawmakers, Dr. Gurdak said that there was concern about the potential for overutilization, and none committed to taking on the political and policy challenges any changes to the Stark law would present.

TC “Grandfather” Advocacy

The College also is continuing to advocate in Hill meetings for the extension of the TC “grandfather” provision which is particularly important to rural hospitals and laboratories. CMS is once again proposing to end this provision, which allows independent laboratories, under certain conditions, to bill Medicare for the technical component (TC) of surgical pathology services for hospital patients. Without Congressional action, this provision will expire on Dec. 31, 2011.

The College has been working to gather support from lawmakers to make this provision permanent, as CAP member Jared Abbott, MD, PhD, FCAP, noted recently in his meeting with the staff from the office of Sen. Chuck Grassley (R-IA), a member of the Senate Finance Committee. “Our pathology group works with about 15 hospitals, and all but one of these are considered TC grandfather hospitals,” said Dr. Abbott. “If this provision ends, these facilities will be facing a huge burden, as I explained to Sen. Grassley’s staff.”

There are two pending legislative options dealing with the TC grandfather. A one-year TC-grandfather extension was included in the Rural Hospital and Provider Equity Act (R-HOPE; S. 1680) introduced on Oct. 12 by Sen. Pat Roberts (R-KS), co-chairman of the Senate Rural Health Care Caucus, and Sen. John Barrasso (R-WY). Sens. Kent Conrad (D-ND) and Sen. Tom Harkin (D-IA) are also co-sponsors on this legislation. The College, however, continues to push for a permanent solution, as included in H.R. 2461, the Physician Pathology Services Continuity Act of 2011. Introduced this summer by Representatives Geoff Davis (R-KY) and Mike Ross (D-AK), this bill recently added two new co-sponsors—Reps. Vern Buchanan (R-FL) and Tim Griffin (R-AR). Rep. Buchanan is on the House Ways and Means Health Subcommittee.

Looking Ahead

CAP expects the Congress to continue to negotiate on a package of spending cuts through the end of the year. If the Super Committee fails meet its initial deadline of November 23, Congress could opt to extend its deadline for producing such a package to closer to its second deadline, which is December 31, 2011. If this happens, it raises the possibility that sequestration will be triggered in 2013, which would produce a 2% across-the-board Medicare cut in 2013.

In terms of how the CAP advocacy agenda could play out in this timeline, the College expects its issues to remain live and active throughout this process and through the end of the year. There are a number of possible legislative scenarios being tracked by the CAP. There is a strong possibility that the SGR and the TC Grandfather issue will be addressed separately outside the Super Committee process. The $300 billion price tag to permanently correct the SGR may be untenable in the current fiscal environment and Congress may opt to grant a one or two-year “fix” instead. Stay tuned to Statline for continuing updates on key developments in Washington, DC.

Pathologists Should Not Be Subject to the CMS’s ePrescribing Penalty

CMS is set to impose a 1% payment reduction penalty on physicians who fail to comply with the agency’s e-prescribing (eRx) program beginning in 2012; however, pathologists appear to be exempt from the program.

According to CAP’s analysis, pathologists meet two criteria that automatically exclude them from the penalty, as recently outlined by the AMA:

  • Office visits and other services listed in the CMS eRx measure specifications represent less than 10 percent of your allowed Medicare Part B charges in the first six months of 2011 (Jan. 1, 2011–June 30, 2011). CMS’s measure specifications are available online, click on “2011 eRx Measure Specifications, Release Notes and Claims-Based Reporting Principles.” As none of the denominator codes appear to be used by pathologists, the measures should not apply.
  • Less than 100 of your claims for Medicare Part B patient services contain visit and service codes that fall within the eRx measure specifications for dates of service between Jan. 1, 2011 and June 30, 2011. Again, pathologists do not appear to use these codes, so the measure should not apply.

This program is part of 2008’s Medicare Improvements for Patients and Providers Act that established a five-year incentive program beginning in 2009 to promote the adoption of eRx among eligible professionals, including physicians. Included in that law was a penalty phase, that will begin on Jan. 1, 2012, for physicians who are eligible for the incentive payments, yet fail to e-prescribe.

Physicians who do not successfully participate in the program or fail to file an exemption by Nov. 8, 2011, will be subject to a penalty. However, because pathologists meet the exclusion criteria, they will automatically be excluded from the program and do not have to file for an exemption.

CAP Offers Webinar on Reporting New Pathology Measures to CMS

Next year’s final Medicare Physician Fee Schedule (PFS) includes three additional CAP-developed pathology measures for the CMS’s Physician Quality Reporting System (PQRS), bringing the total number of measures that pathologists can report on to five.

Webinar Event: Understanding CMS PQRS New Pathology Measures: How CAP Members Can Participate

  • When: Dec. 7, 1:00–2:30pm EST
  • Register online
  • To assist CAP members preparing to report on these new measures, the Advocacy Division is sponsoring a Webinar on Dec. 7 from 1-2:30 pm EST. This Web event, “Understanding CMS PQRS New Pathology Measures: How CAP Members Can Participate,” will be moderated by Jonathan L. Myles, MD, FCAP, Chair of CAP’s Economic Affairs Committee, who will also present along with Emily Volk, MD, PhD, FCAP, Chair of CAP’s Public Health Policy Committee; and Kim Schwartz, Nurse Consultant and Program Manager with CMS’s PQRS program.

    This Web event will focus on preparing CAP members who have yet to participate in the program due to lack of appropriate measures and inform participants about changes in the PQRS reporting specifications for the new measures. In addition, the speakers will provide information on use of registries for reporting, as the new measures may allow some pathologists to use this reporting option.

    It’s important that CAP members know the latest on this program, as CMS will begin to impose penalties on non-PQRS participants in 2015. CAP members are encouraged to attend this Webinar, which will also feature a Q&A session with the speakers following their presentations. For a link to register online, please see box.

    CMS Delays PECOS Revalidation Effort Through 2015

    CMS Administrator Donald M. Berwick, MD, has announced that the agency will delay efforts to revalidate the enrollment of every provider and supplier from 2013 until 2015. In addition, physicians will be among the last to revalidate, according to a communication to the CAP from the AMA.

    CMS recently announced a new revalidation initiative requiring a physician to resubmit and recertify the accuracy of their enrollment information sooner than the typical every five years. Under CMS’s original “off-cycle” revalidation initiative, many physicians would have been required to revalidate by March 23, 2013.

    In response to concerns by the AMA, however, CMS has extended the initiative an additional two years to March 2015. AMA’s concerns centered on CMS’s initial legal analysis of certain revalidation procedures that related to screening physicians as outlined in the health care reform law.

    In addition, AMA outlined problems that physicians have encountered in the past when using the Internet-based Medical Provider Enrollment, Chain, and Ownership System (PECOS). In response to these concerns, CMS announced certain changes to PECOs expected to be in place by the end of 2012. These include e-signatures, electronic document upload, batch upload capability, seamless password reset, among other improvements.

    For more information, visit the AMA Web site.

    Keep Up with the Latest CAP Advocacy News on Twitter

    CAP Advocacy is now on Twitter. Follow CAP Advocacy’s daily “tweets” to keep pace with regulatory and legislative news affecting the pathology industry. For the latest health care news, be sure to check out what we are following on Twitter.

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