The CAP urged the Centers for Medicare & Medicaid Services (CMS) to consider the intricacy of price transparency and the potential harm in delaying critical patient care in the proposed 2022 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems (OPPS) regulation.

In the September 17 letter to the CMS, the CAP outlined several proposed regulations and provided comments on the policies and how it impacts diagnostic medicine.

Price Transparency

The CMS proposed to increase the penalty for some hospitals that do not comply with its Hospital Price Transparency final rule. The CAP is concerned about requiring pathologists to inform patients about out-of-pocket costs for a service before patients are furnished that service, as any delays in providing that service adds an administrative burden on physicians that interfere with or impair the patient’s medical diagnosis and care. The CAP urged the CMS to consider the complexity of pathology practice when drafting a regulation that would require most group health plans and health insurance issuers to disclose the price and cost-sharing information to participants, beneficiaries, and enrollees. Additionally, the CAP asked that the CMS “postpone finalizing any civil monetary penalty until stakeholders can review and propose other alternative methods of price transparency,” the CAP stated in the letter.

Proposed Changes to Service Packages

The proposed 2022 OPPS regulation packages payments for multiple interrelated items and services into a single payment, creating efficiency incentives for hospitals. “The CAP believes that the packaging of pathology services has been extremely constrictive to the practice of pathology because our services are often billed multiple times on a patient claim to complete the overall pathology service,” the CAP reinforced. The CAP asked the CMS “to exclude pathology services that are billed more than once per patient encounter from being packaged and pay them separately.”

Health Equity

The CAP provided requested feedback to the CMS on reporting health disparities and equity. “The CAP supports the inclusion of the anti-racism Improvement Activity (IA) suggested by the CMS and the modifications to other IAs to increase health equity. We also support additional policies aimed at reducing the burden on small practices, particularly small practices in underserved communities. Going forward, the CAP encourages CMS to ensure that health equity is considered in all aspects of the program,” the CAP stated.