Advocacy Update

August 1, 2023

In this Issue:

In Case you Missed it: Proposed 2024 Medicare Physician Fee Schedule Webinar Recording

Did you miss the proposed 2024 Medicare Physician Fee Schedule webinar on July 26? Listen to the recording of our expert panel Jonathan Myles, MD, FCAP, chair, Council on Government and Professional Affairs; Diana Cardona, MD, FCAP, chair, Quality and Clinical Data Registry Affairs Committee; and Ronald W. McLawhon MD, PhD, FCAP, chair, Economic Affairs Committee present and answer questions about the latest Medicare payment policies concerning individual pathology services and the Quality Payment Program next year. Download the presentation slides.

CAP Calls on Policymakers to Increase Transparency in Medicare Local Coverage Determination

The CAP is urging policymakers to increase transparency in Medicare’s local coverage determination (LCD) processes while maintaining – and increasing – meaningful opportunities for pathologists and other physicians to provide input on the delivery of health care in the communities in which they serve their patients.

On July 18, the House Energy and Commerce Committee’s Subcommittee on Health held a hearing titled “Innovation Saves Lives: Evaluating Medicare Coverage Pathways for Innovative Drugs, Medical Devices, and Technology.” The CAP is providing recommendations to the subcommittee asking for improvements to both the LCD and national coverage determination processes to ensure access to quality care for Medicare beneficiaries, increase transparency in the LCD process, and provide feedback on the definition of “reasonable and necessary” as well as new coverage pathways for breakthrough devices.

Over the past few years, the CAP has sent letters to the Center for Medicare and Medicaid Services (CMS) advocating for regulatory frameworks that enhance patient safety and maintain quality laboratory testing and innovation without creating a significant regulatory burden on laboratories.

  • The first comment letter, from October 2022, includes the CAP recommendations to the CMS to improve the LCD process and address the current underutilization of Contractor Advisory Committee members.
  • The CAP also provided comments in November 2022 to help ensure appropriate conditional coverage through an effective coverage with evidence development (CED) process.
  • Finally, in late 2020 the CAP provided comments to the CMS on the Medicare Coverage of Innovative Technology proposed rule.

The CAP is passionate about improving current coverage processes and ensuring that patients benefit from technological advances in health care.

Pathologists Encourage Congress to Prioritize Medicare Payment Reform

The CAP sent out an Action Alert to its grassroots advocacy network encouraging outreach to their legislators to sign a Dear Colleague letter to House leadership that emphasized the urgent need of Medicare physician payment reform.

Last week, Reps. Ami Bera, MD (D-CA), Larry Bucshon, MD (R-IN), and over 90 members of Congress sent that bipartisan letter to House Speaker Kevin McCarthy (R-CA) and Minority Leader Hakeem Jeffries (D-NY). In the letter, the lawmakers called for reforms to the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) that appropriately pay providers for health outcomes. While the goal of MACRA was to shift the Medicare payment system to one that pays providers based on quality, value and the results of care delivered rather than the number of services provided, it has been plagued with issues since 2015.

This letter builds off the congressional request for information these bipartisan lawmakers issued last September, soliciting feedback from stakeholders to update the physician Medicare payment program. It also comes shortly after the first MACRA oversight hearing held by the House Energy and Commerce Subcommittee on Oversight and Investigations on June 22.

Grassroots advocacy is at the root of driving change at the federal and state level on health care policies that will impact pathologists’ ability to practice and protect the patients they serve. Learn more about CAP’s grassroots advocacy network, PathNET.