Advocacy Update

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In an August 28 conference call with Anthem BlueCross BlueShield executives, key CAP leaders urged the insurer to reverse cuts to pathology services the insurer has rolled out in multiple states. The conference call is only the latest in a series of CAP communications with Anthem that began in April as the planned cuts unfolded over multiple states. CAP leaders argued that the cuts would undermine the viability of pathologists’ practices and undermine access to care for pathology services, particularly in rural communities.

The CAP leaders who participated in the call with Anthem were Donald Karcher, MD, FCAP; Emily E. Volk, MD, FCAP; Jonathan Myles, MD, FCAP; Stephen Black-Schaffer, MD, FCAP; and Jeff Welsh, MD, FCAP.

In response, Anthem claimed it had seen disparities in rates it was paying across settings, providers, and states—and has moved to rebalance its rates to provide a consistent out-of-pocket cost to its insured members. Anthem asserted that it did not just look at national laboratories but considered local market contracted rates in establishing its new fee schedules.

The CAP countered that this action could result in patient access issues, quality of care issues, and downstream costs for Anthem. CAP leaders also discussed with Anthem the complexity in valuing pathology services across different settings and argued that the insurer’s new rates would be unsustainable for practices and that pathology practices could close as a result of the Anthem payment reductions.

The Anthem executives were clear that the insurer does not plan to rescind or revisit its fee schedule changes but will continue to monitor the market response and further advised that pathologists with concerns should contact their regional network manager to discuss and share those concerns directly.

The CAP encourages pathologists impacted by Anthem’s payment reductions to review their contracts and to communicate any concerns directly with their respective Anthem regional network manager.

Following the CAP-Anthem conference call, CAP leaders met with the state presidents of pathology societies in states impacted by the Anthem fee schedule cuts to brief them on its call with Anthem. A number of state pathology societies, including the California Society of Pathologists and the Virginia Society of Pathologists, also have met with Anthem to urge the insurer to reconsider the cuts to pathology services.

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