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The CAP advocated for reducing regulatory burdens on pathologists participating in the Medicare Merit-based Incentive Payment System (MIPS) and ensuring pathologists are fairly compensated in MIPS.

In an August 21 letter to the Centers for Medicare & Medicaid Services (CMS), the CAP provided its comments concerning proposals for MIPS 2018 performance period. As first reported in STATLINE on June 20, the CMS specifically proposed in its 2018 Quality Payment Program (QPP) regulation:

  • Adding a virtual groups option which is either a solo eligible clinician or a group of 10 or less eligible clinicians who come together "virtually" with at least one other such solo eligible clinician or group to participate in MIPS.
  • Increasing the low-volume threshold so that more small practices and eligible clinicians in rural and Health Professional Shortage Areas (HPSAs) are exempt from MIPS participation.
  • A timeline for topped out measures: The CMS has proposed a three-year timeline for a process to identify topped out measures that should be removed from the program. After a measure has been identified as topped out for three consecutive years, the CMS may propose to remove the measure through comment and rulemaking for the fourth year. This proposal provides a path toward removing topped out measures over time, and will apply to the MIPS quality measures.
  • A facility-based measurement option based on the Hospital Value-Based Purchasing (VBP) program. This would be a voluntary option for facility-based clinicians who furnish 75% or more of their services in the inpatient hospital setting.

The CAP continues to advocate for its members to ensure less burdensome MIPS reporting. In the August 21 letter, the CAP called for key changes to the QPP proposed regulation:

  • Changing the definition of non-patient facing clinicians: The CAP recommended "that pathologists be automatically identified as non-patient-facing Eligible Clinicians (ECs) at the beginning of each year instead of the current proposed the CMS definition of non-patient-facing clinicians as those who bill 100 or fewer patient-facing encounters during the performance year."
  • Re-Weighting of Performance Categories: The CMS has proposed to re-weight the Advancing Care Information (ACI) performance category to 0 for non-patient-facing clinicians and to re-distribute the weight of this category either entirely to the quality performance category or between the quality and clinical performance improvement activities (CPIA) performance categories. In the comment letter, the CAP "prefers that ECs who cannot be scored for the advancing care information performance category receive a median score in that category until such time that the CAP can develop viable alternatives for pathologists to be able to participate in these categories. The CAP asks that the CMS finalize its alternate proposal to redistribute the weight of the ACI category to both the quality and improvement activities (IA) categories such that the quality category is weighted at 75% and the IA category is weighted at 25%."
  • Quality performance category: The CAP appreciated the inclusion of 8 existing pathology measures for the MIPS quality category in the proposed rule and encourages the CMS to finalize those measures. "The CAP encourages the CMS to work with the CAP to continue to develop additional measures for pathologists for future years of MIPS. However, the CAP opposed the CMS proposal to cap the score of topped out measures at 6 points. The CAP prefers the alternative approach where ECs are scored on their percentage of their performance rate."
  • Clinical Performance Improvement Activities (CPIA) Category: The CAP encouraged the CMS to keep the requirements minimal for non-patient-facing specialties until they can ensure there are enough activities applicable to these specialties, especially since pathologists are not able to participate in resource use and ACI categories at this time. "Most of the activities listed in the Proposed Rule are not applicable to pathologists. The CAP submitted several CPIA during the CMS' Call for Measures in February 2017. The CAP would like the CMS to respond with specifics as to why CAP submitted CPIA were not accepted for the 2018 MIPS proposals and hope that the CMS considers them for the future."

The final 2018 MACRA Rule is expected to come out in the Fall of 2017 and the CAP will publish a STATLINE alert and host a webinar immediately following the rule's release. The CAP will host an educational webinar on August 31 about MIPS reporting requirements.

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On August 22, the CAP along with AdvaMedDx, the American Clinical Laboratory Association (ACLA), National Independent Laboratory Association (NILA), and Navicent Health, met with the Department of Health and Human Services (HHS) to request that PAMA implementation be delayed so that the Centers for Medicaid and Medicare Services (CMS) can work with stakeholders to fix key flaws in the current reform of the clinical laboratory fee schedule (CLFS).

The laboratory stakeholders at the meeting outlined for HHS the significant parts of the laboratory market excluded in the PAMA reporting and flaws in the data submitted in 2017 for purposes of establishing the CLFS for 2018.

For instance, the final PAMA rule's applicable laboratory definition that triggers reporting excluded most of the market with only 5% of all laboratories required to report private payer market data and no hospital laboratories. Even though most of the laboratories are excluded from reporting, the new CLFS rates established under PAMA will apply to all laboratories.

As for the PAMA data reporting flaws, the number of laboratories that submitted data to the CMS was reportedly below agency estimates. Although the CMS did collect large volumes of data, the data are not reflective of the full market nor does the CMS have plans to validate its quality and accuracy. Ultimately, Medicare beneficiary access to services—particularly in the most underserved areas—could be negatively affected.

The CAP, along with other stakeholders urged the agency to delay the implementation of PAMA to allow time to work with the stakeholder community to address key flaws in the implementation. They also expressed a desire to use the delay to implement PAMA in a way that reflects with congressional intent based on all sectors of the laboratory market. In addition, data collection and reporting must be a less burdensome approach.

STATLINE will keep you updated on any major developments.

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Diana Cardona, MD, FCAP

This Thursday, August 31 at 1 PM ET, the CAP will host a 30-minute webinar presentation specifically on Medicare's Merit-based Incentive Payment System (MIPS) and how it applies to pathology practices. During this complementary program, you will learn about Medicare's new reimbursement program and how pathologists can participate. The MIPS program is part of the new Medicare Quality Payment Program stemming from the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). Beginning this year, the MIPS will set future Medicare payments based on categories that include quality and clinical practice improvement activities. Success in these categories can earn physicians higher Medicare reimbursements.

Register for the webinar, Making Sense of Medicare's MIPS Program, today.

Our presenter Diana Cardona, MD, FCAP, will discuss how pathologists can participate in MIPS in 2017 and 2018. Dr. Cardona, who chairs the CAP Economic Affairs Committee’s Measures and Performance Assessment Subcommittee, will review which quality measures and activities are relevant to pathologists, as well as which options pathology practices can use to submit performance data for MIPS scoring. These scores will determine whether physicians receive bonuses or penalties.

At the end of the presentation, Dr. Cardona will answer your questions. If you cannot attend the live portion of this webinar, it will be recorded and those who register will automatically receive a link to view the archived recording once it is available.

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Reserve your seat at featured Advocacy Courses

Registration is now open for key CAP policy and advocacy courses and roundtable discussions important to the pathology specialty during CAP17 at the Gaylord National Harbor from October 8–11, 2017.

Learn about the new Pathologists Quality Registry and how it can help you comply with the Quality Payment Program in 2017 during the Optimize Your Medicare Bonus Potential with the Pathologists Quality Registry session on Monday, October 9.

Additional CAP advocacy courses and roundtable discussions are also available at CAP17:

  • M1596: How is My Payment Determined for Pathology Services?
  • R1690: My Surgical Pathology and Cytopathology Coding Dilemmas
  • R1691: Current Payment Policy Challenges in Pathology Practice
  • S1620: Medicare's New Quality Payment Program and the Physician Fee Schedule

Moreover, hear about the current trends in Pathology Practice and how it shapes CAP Advocacy efforts.

  • STA007C: Results from the 2017 CAP Practice Characteristics Survey

Check out the full list of Advocacy courses offered at CAP17.

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This is the final week that STATLINE readers can provide feedback via the STATLINE Readership survey. The CAP invites readers to take a quick survey regarding STATLINE, our weekly federal and state advocacy e-newsletter. STATLINE 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, STATLINE 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 approximately 5–10 minutes to complete.

Take the STATLINE Readership Survey.

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:

As a thank you for your time and feedback, we invite you to enter into a drawing to win one of three $100 gift cards. If you would like to enter, please enter your information at the end of the study.

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STATLINE will take a scheduled break on September 5 in observance of Labor Day and will next appear in your email inbox on September 12. Please continue to check the CAP Twitter and Facebook accounts for updates from the CAP.

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