The CAP urged the CMS to increase 2022 hospital inpatient service reimbursements and graduate medical education funding. The CAP asked the CMS to use 2020 data when determining reimbursement rates for CAR T-cell services. Additionally, the CAP requested that the CMS increase funding for medical residency positions, including those in rural hospitals, and advocated for additional pathology slots.

In a June 28 letter, the CAP outlined its concerns and requests for the proposed 2022 Medicare Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Proposed Policy Changes and Fiscal Year 2022 Rates. The CAP is supportive of the CMS’ proposals to increase payments for CAR T-cell therapies and related services, but the CAP warned that the rates are still insufficient to cover these expensive therapies. Current reimbursement rates are too low for the services, which leads to limited access to critical life-saving care for patients. The CAP urged the CMS to use 2020 Medicare data when determining reimbursement rates for 2022.

“With its increased use, CAR-T-cell therapy is an expensive evolving service that presents unique challenges for providers, patients, and the CMS. The resource consumption and clinical characteristics of the patients with a given set of conditions are clinically distinct from others. It is also difficult to predict what the costs associated with other future CAR-T therapies will be – there will likely be new or different side effects or additional agents that are co-administered with the therapy with the potential to increase toxicity. The CAP urges the CMS to take these issues into account...”

More Medicare Funding Needed for Residency Programs

The CAP also urged that the CMS increase funding for medical residency positions as the country faces a shortage in medical doctors. The CMS has proposed to implement several provisions of the Consolidated Appropriations Act of 2021, including a requirement for 1,000 new Medicare-funded medical residency positions. Beginning in fiscal year 2023, a phase-in of 200 positions will be added each year for five years. The CAP supported the increased Medicare-funded medical residency positions for all medical specialties to help ease current physician shortages and bolster the foundation of our health care system.

The US health system still has access to care issues, especially in rural and other communities where shortages exist. The CAP said the CMS should prioritize residence slots accordingly. The CAP supports the “prioritization of residency positions based on Health Professional Shortage Areas and urges the agency to consider funding additional medical residency positions in pathology as it is one medical specialty that is often overlooked and experiencing shortages, especially in rural areas.”

The CAP will engage with the CMS and will provide updates periodically.