Advocacy Update

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On August 28, CAP leaders will meet with officials from Anthem BlueCross BlueShield to express opposition to the insurer’s recent cuts to pathology services in several states. Since April, the CAP has engaged with Anthem to request an explanation of the changes from the insurer and urge Anthem to reverse the new policy given the serious negative impacts on pathologists and patients’ access to pathology services. The CAP sent a formal written letter on July 16 expressing continued concerns as a follow up to phone calls with Anthem leaders held in May.

The CAP has long expressed concern with policies that make it increasingly difficult for pathologists to provide essential diagnostic services to patients, and for laboratories to continue to serve the rural and smaller hospitals that have relied on them. For instance, in 2013 the CAP successfully urged the Centers for Medicare & Medicaid Services (CMS) to withdraw a proposal to link Medicare payment for pathology services on the physician fee schedule to rates paid under its hospital outpatient prospective system. If the payment policy had been implemented, pathology services would have been cut by as much as 80%.

Similarly, the CAP is requesting additional explanation of the methodology behind the recent changes and that Anthem reverse use of a one-size-fits-all payment policy that could threaten the continued ability for pathologists to provide care to patients. The CAP is also requesting that Anthem determine the impact of its decision on the ability for patients to continue to receive diagnostic services.

The CAP will follow-up with news about the meeting and other updates in future newsletter editions. See our webpage for more updates.

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CAP Secretary-Treasurer Richard Gomez, MD, FCAP met with nine U.S. senators to discuss surprise medical billing legislation in Colorado Springs, CO, from August 16-18. This retreat for lawmakers was a critical opportunity for a CAP leader to speak directly with influential legislators on the public policy issues facing pathology. There was no other organization representing pathologists present.

The senators in attendance were Sens. Jerry Moran (R-KS), John Barrasso, MD, (R-WY), Roy Blunt (R-MO), John Boozman (R-AR), John Cornyn (R-TX), Deb Fischer (NE), Cory Gardner (R-CO), Tim Scott (R-SC), and John Thune (R-SD).

As a leader for the CAP and an advocate who has spent a career building relationships with his members of Congress, Dr. Gomez attended a specific event for his home state senator, Sen. Moran. As a contributor to PathPAC, the sole political action committee serving as the collective voice of pathologists in the federal electoral process, Dr. Gomez was able to meet with him and other senators to discuss the CAP’s positions on surprise medical billing legislation. By being a knowledgeable health care expert, Dr. Gomez has been able to educate Sen. Moran via PathNET on the value of pathology and delivering quality care in his constituents. Sen. Moran has become a strong ally for pathologists in Congress.

The CAP is seeking to include an alternative dispute resolution in Senate legislation to address surprise medical bills, which is currently absent from proposals being discussed. Dr. Gomez said that establishing a fair reimbursement system for services provided in an out-of-network setting is crucial for patients to have access to quality care. Dr. Gomez also spoke with Sen. Boozman, who was a keynote speaker at the CAP’s 2017 Policy Meeting. Sen. Boozman expressed that physicians must be active in engaging with their legislators on surprise billing. Dr. Gomez also connected with all other senators in attendance.

Also at the event were several representatives from the insurance industry. Insurers have opposed physicians on the surprise medical bill legislation and have sought to use the issue to reduce payments to physicians. Dr. Gomez was able to counteract the insurers lobbying against the CAP’s position.

On surprise medical bills, the CAP has been leading a lobbying campaign with other physician groups, such as the American Medical Association, American College of Emergency Physicians, American College of Radiologists, and American Society of Anesthesiologists. The coalition has been coordinating on congressional outreach on surprise billing, such as local grassroots activities during the August recess, to ensure that the physician community has a strong, united voice in public policy process. Learn more about the CAP’s position on this issue. 

Learn more about PathPAC and how you can participate in the CAP’s grassroots program, PathNET.

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Are you being paid fairly for the pathology services you provide? Has surprise medical bills affected your reimbursements? Payment for pathology services has a direct impact on the success of your practice. These topics and more will be explored the following advocacy sessions at CAP19.

Advocacy Educational Sessions

  • Timely Topic – Surprise Billing (M1913N)
  • CPT Coding…You Can’t Practice Without It! Why Pathologists Need to Understand CPT Coding (M1962N)
  • Current Payment Policy Challenges in Pathology Practice (M1963N)
  • Thriving in MIPS and Other Value-Based Payment Programs (S1967S)
  • How is My Payment Determined for Pathology Services (MS1971S)
  • Advocacy Town Hall (M1911N)
  • Future of Pathologists in the Workforce (M1912N)

Still need to register for these courses. Check it out.

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Take our Readership Survey and Win an Amazon Gift Card

The CAP invites readers to take a quick survey regarding Advocacy Update, our weekly federal and state advocacy e-newsletter. Advocacy Update strives to keep CAP members updated on the latest regulatory and legislative issues concerning pathologists at the federal and state levels of government. Through news briefs, the advocacy newsletter provides clarity on these issues while also reporting what the CAP is doing to address matters concerning pathologists. Your valuable feedback will allow us to evaluate and improve the e-newsletter to best meet your needs. This survey should take about 3-5 minutes to complete.


The CAP recognizes the value of your time and privacy. Be assured that your individual information will be kept strictly confidential and your email address will not be distributed to anyone. All results are reported in aggregate format. If you need assistance, please email Lori Vernon at LVERNON@CAP.ORG.

As a thank you for your time and feedback, we invite you to enter into a drawing to win one of two $75 Amazon gift cards. If you would like to enter, please enter your information at the end of the study.

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The CMS released of the proposed updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations. The CAP will host a webinar this Thursday, August 29, at 3 PM ET/ 2 PM CT. Please review the latest Special Advocacy Update on the proposed 2020 Medicare Payment regulations.

Webinar presenters will be the Chair of the Council on Government and Professional Affairs Donald S. Karcher, MD, FCAP; Vice-Chair of the Council on Government and Professional Affairs and Chair of the Clinical Data Registry Ad-Hoc Committee Emily E. Volk, MD, FCAP; and Chair of the Economic Affairs Committee W. Stephen Black-Schaffer MD, FCAP.

During the 60-minute webinar, attendees will learn about updates to the 2020 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.

We appreciate your flexibility and look forward to your participation during the webinar on August 29.

Register today for the webinar.

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Join over 180 of your fellow CAP members and test your advocacy knowledge with the new August Advocacy News Quiz. This is the last week to see how you measure up against your fellow pathologists on this month’s quiz and share your results. Good luck!

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