Advocacy Update

Read the Latest Issue of Advocacy Update

August 11, 2020

In this Issue:

CAP Tells HHS to Rescind Data Reporting Rules for Labs, Reissue a Workable Regulation

During a meeting with federal agency officials on August 6, leaders representing the CAP urged the Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC) to rescind new data reporting requirements for laboratories until workable rules can be implemented.

CAP Governors Jonathan Myles, MD, FCAP and Rajesh Dash, MD, FCAP, and informatics experts Alexis Byrne Carter, MD, FCAP, and Joseph Sirintrapun, MD, FCAP, met with the HHS and CDC officials to reiterate that the new data reporting rules are too burdensome and, in some instances, impossible for laboratories to comply with. Beginning August 1, laboratories are required to meet the new rules for reporting results from each COVID-19 test they provide to patients. In a June 26 letter from the CAP to HHS Secretary Alex Azar, the CAP had urged the HHS to recognize the challenges that collection and reporting of the expanded data elements would create, especially since some of these data elements are not in many laboratory information systems currently. In the letter, the CAP stated how the data reporting guidance from HHS and CDC significantly expanded requirements for reporting laboratory results with some new data elements that have not historically been required.

On August 6, administrative officials told the CAP that clinical laboratories should follow the implementation guide to distinguish the required elements versus other requested or optional elements. In addition, no enforcement mechanism has been established, they said, but clinical laboratories should attempt to comply. Additional FAQs regarding the data reporting requirements are also available.

The CAP leaders said they would further discuss the data rules and compliance issues with the agencies, but also maintained that new rules are currently unworkable and should be rescinded.

AMA, CAP Ask HHS to Revise COVID-19 Testing Guidelines for Timely Diagnostics

The American Medical Association (AMA), the CAP, and five other medical and laboratory societies called on the Department of Health and Human Services (HHS) to update its COVID-19 testing prioritization guidelines. The letter comes on the heels of a recent meeting the CAP and AMA had with the White House task force regarding current COVID-19 diagnostic test supply inventories.

In the August 11 letter led by the AMA, the groups “recommend that the Administration consider updating testing prioritization guidelines to ensure that the limited testing resources available are directed at those with a medically-indicated need for tests and those identified by well-defined public health surveillance efforts.”

The group asked the HHS to update its COVID-19 testing prioritization guidelines to ensure that patients with COVID-19 symptoms are prioritized. Moreover, patients who have known exposures to COVID-19, and those in need of pre-procedure testing, can have immediate access to COVID-19 testing services and timely return of test results.

CAP Mobilizing Pathologists to Oppose 2021 Medicare Pay Cuts, Pass COVID-19 Assistance

The CAP is rallying support amongst congressional lawmakers for pathologists’ top priorities to combat the COVID-19 pandemic and to stop Medicare payment cuts to pathologists next year. On August 5, CAP members received emails requesting they take action by urging Congress to pass several health care provisions that address COVID-19 test supply shortages and offer funding to pathologists for lost revenue due to the national health emergency.

CAP members can still take action by logging in to our action center. From there, you can easily send an email to your representative and senators that calls on them to support diagnostic testing in the next COVID-19 legislative package.

Earlier this month, CAP President Patrick Godbey, MD, FCAP sent a letter to leaders in the House of Representatives and Senate with recommendations that Congress should enact to support pathology practices and laboratories.

Stopping 2021 Medicare Cuts

CAP members also have engaged with their members of Congress to discuss the impacts of future Medicare payment cuts to pathologists and other physicians in 2021. The CAP is leading a major summer advocacy campaign to urge Congress to stop these cuts.

We also encouraged members of the House of Representatives to sign a letter led by Rep. Bobby Rush (D-IL). The letter supports alleviating cuts by essentially suspending them for the next two years. At this article’s deadline, 92 House members had signed on to the letter.

On August 3, the Centers for Medicare & Medicaid Services (CMS) announced it will move forward with significant payment cuts to pathologists and other specialists in 2021. The reduction, which the CAP has strongly opposed for more than a year, is a result of budget neutrality requirements that offset the cost of major changes to evaluation and management (E/M) services set to take effect next year. Without intervention, pathologists will see an overall decrease in Medicare payment of 9% to fund increases in payment for E/M services.

When working with elected officials, the number of members in an organization helps determine its influence. Your membership matters.

If you have any questions on how you can advocate to fix the E/M issue, please contact Lauren DePutter, Director, Political Programs.

CMS Changes Laboratory Date of Service to Include Cancer Therapies, Revises Hospital Star Ratings

On August 4, the CMS released the Proposed 2021 Hospital Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) proposed regulation. In the proposal, the CMS would eliminate inpatient-only lists, revise the laboratory date of service policy, and revise the overall hospital star ratings. The CAP will ask the CMS to reduce administrative burdens for laboratories, hospitals, and treating physicians.

The proposed 2021 OPPS regulation would also expand coverage of hospital outpatient procedures. Additionally, the regulation would allow physician-owned hospitals with a high Medicaid population to apply for expansion more frequently, as they are currently restricted to applying once every two years. The hospitals would still need to submit one expansion request at a time.

Proposed Revisions to the Laboratory DOS Policy

The proposed 2021 regulation would exclude cancer-related protein-based Multianalyte Assays with Algorithmic Analyses (MAAA) from the OPPS packaging policy, and create an exception to the laboratory date of service rule for them. Medicare would pay for cancer-related protein-based MAAAs under the Clinical Laboratory Fee Schedule. The performing laboratory would bill Medicare directly for the test if the test meets all the laboratory date of service requirements. The cancer-related protein-based MAAAs are typically used to guide and manage the patient’s care after the patient is discharged from the hospital outpatient department because the test results are used to determine potential future oncologic surgical and chemotherapeutic interventions.

CMS Will Update Hospital Quality Star Ratings

The proposed regulation would update and simplify the Medicare Hospital Star Ratings System by reducing the number of measure groups, average measure scores with equal measure weightings and update the reporting threshold.

It would also include critical access hospitals and Veterans Health Administration hospitals in the overall star ratings.

CAP Encourages Pathologists to Review 2019 MIPS Performance Feedback and Scores

Eligible pathologists who submitted 2019 Merit-based Incentive Payment System (MIPS) data, can view their performance feedback and MIPS final score through the Quality Payment Program (QPP) website. Your 2019 MIPS performance will determine payment adjustments to your Medicare Part B payments in 2021 of +/- 7%. The CAP encourages all MIPS eligible pathologists to log in and review their preliminary MIPS 2019 scores soon to make sure they do not have a -7% penalty.

MIPS is a budget-neutral program, meaning that the money from negative payment adjustments obtained from poor performers are redistributed as positive payment adjustments to high performers. Therefore, if a majority of MIPS participants performed well, the maximum payment adjustment will be less than +7%.

Individual pathologists can access their 2019 MIPS scores by logging in to the QPP website with their QPP login credentials. The final scores reflect COVID-19 flexibilities that the CMS granted for 2019, including holding harmless those clinicians who were unable to submit 2019 MIPS data.

To learn more about performance feedback, the CMS has 2019 MIPS Performance Feedback Resources:

  • 2019 MIPS Performance Feedback FAQs—Highlights what performance feedback is, who receives the feedback, and how to access it on the Quality Payment Program website.
  • 2019 MIPS Performance Feedback Patient-Level Data Reports FAQs—Provides information on the patient-level data reports for download by those who were scored on a 2019 MIPS cost measure and/or the 2019 30-Day All-Cause Readmission (ACR) measure.

If you believe that there is an error in your MIPS payment adjustment, you may request a targeted review until October 5, 2020 by logging in to the QPP web site with your QPP login credentials.

CAP’s Advocacy Newsletter Wins 6th APEX Award of Excellence

For the sixth consecutive year, the CAP's Advocacy newsletter earned an Award of Excellence for 2020 in APEX’s newsletters category. This was the 32th annual APEX Awards for Publication Excellence.

APEX awards are based on excellence in graphic design, editorial content, and the ability to achieve overall communications excellence. Moreover, APEX's Award of Excellence recognizes exceptional entries submitted in dozens of individual categories covering print and digital media. The CAP’s advocacy newsletter also received APEX awards in 2015, 2016, 2017, 2018, and 2019.

For the 2020 APEX contest, staff submitted special breaking coverage of the 2020 final Medicare Payment Regulations. VIEW THE ENTIRE LIST OF 2020 WINNERS FROM THE APEX CONTEST.

The CAP’s Advocacy newsletter provides pathologists with news articles on topics ranging from federal regulation to legislation and local grassroots action. CAP members receive Advocacy Update, the official source for advocacy and policy news from Washington, DC, and electronic newsletter issues weekly.

Attention: Proposed 2021 Medicare Payment for Pathologists Webinar Postponed

Due to a delay in the CMS’ release of the proposed 2021 Medicare Physician Fee Schedule and Quality Payment Program regulations, the CAP has postponed its webinar to Friday, August 14, at 2 PM ET/ 1 PM CT.

Webinar presenters will be the Chair of the Council on Government and Professional Affairs Jonathan Myles, MD, FCAP; Chair of the Economic Affairs Committee W. Stephen Black-Schaffer MD, FCAP; and Vice Chair, Economic Affairs Committee Diana Cardona, MD, FCAP.

During the 60-minute webinar, attendees will learn about updates to the 2021 Medicare Physician Fee Schedule and the Quality Payment Program regulations and its impact on pathologists. The CAP panel will also answer questions from attendees.

If you are unable to attend the live event, a link to view an archived recording of the presentation will be sent to all registrants following the webinar. The recording can be viewed at your convenience.

We appreciate your flexibility and look forward to your participation during the webinar on August 14.

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New Month, New Advocacy News Quiz

It’s a new month and that means a new Advocacy News Quiz. Last month over 100 CAP members took the July news quiz. See how you compare against your fellow CAP members’ in this month.

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Breaking Advocacy News: Check out the Advocacy Twitter Channel

Want up to the minute CAP Advocacy news? Then follow us on twitter at CAPDCAdvocacy, where you will be the first to know about CAP Advocacy wins, see your fellow members engage with Congressional leaders on key policies affecting the practice of pathology and, of course, breaking Advocacy news.

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