Advocacy Update

Read the Latest Issue of Advocacy Update

• CAP Fights to Protect Value of Pathology Services in Year-End Legislation
• Registration is Open for the 2020 Pathologists Leadership Summit
• Ohio Pathologists’ Past-President Gives Compelling Testimony Opposing Minimum Pay Standard
• Senate Confirms Oncologist as FDA Commissioner
• 2019 AMA Wrap Up: Top 5 Activities Concerning Pathologists
• Want Breaking Advocacy News? Check out the Advocacy Twitter Channel
• Test Your December Advocacy Knowledge With a Year-End Quiz

While Congress debated how to address surprise medical bills during the waning moments of the 2019 legislative year, the CAP mobilized pathologists to engage and influence representatives and senators to ensure our views were heard by key decisionmakers in Washington, DC. In addition, the CAP partnered with other physician associations to provide a united front that countered efforts by insurers to reduce reimbursements for out-of-network services.

The views of physicians were heard as leaders of the Ways and Means Committee announced an agreement on strategy to address surprise billing. Committee Chair Richard E. Neal (D-MA) and Ranking Member Kevin Brady (R-TX) released a one-page plan on December 11. Following the announcement, the CAP stated it looks forward to working with the committee on its proposal to stop surprise medical bills for our patients.

“The legislative framework on surprise medical bills put forward by the House Ways & Means Committee clearly shows there are more options to address this important issue,” the CAP said. “The CAP remains focused on a balanced solution that holds patients harmless and does not institute a lopsided reimbursement mechanism to settle billing disputes between insurers and physicians.”

Similar statements were released by the American College of Emergency Physicians, American College of Radiology, American College of Surgeons, American Society of Anesthesiologists, American Association of Orthopaedic Surgeons, and American Association of Neurological Surgeons/Congress of Neurological Surgeons. Representing hospitals, the American Hospital Association and Federation of American Hospitals also welcomed the committee’s proposal.

Other lawmakers had attempted to include another legislative proposal addressing this issue in a year-end spending bill package. The CAP strongly opposed the effort as the proposal relied on insurance industry-controlled rates to pay for unexpected out-of-network services. Despite repeated calls for changes to the physician payment mechanism for out-of-network services, the legislative plan agreed to by Sen. Lamar Alexander (R-TN) and Reps. Frank Pallone (D-NJ) and Greg Walden (R-OR) used rate setting for out-of-network services. The CAP maintains that benchmark payment rates based on median or mean in-network contract rates are unacceptable.

We appreciate all CAP members who contacted their elected officials about legislation pending on surprise medical bills. You can still make your opinions known. The CAP supports HR 3502, the Protecting People from Surprise Medical Bills Act, which uses independent dispute resolution, without a threshold trigger, to provide a fair and efficient way to resolve disputes between providers and insurers. Go to our latest grassroots action alert and provide your email and zip code to login to contact your legislators.

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Join your colleagues at the 2020 Pathologists Leadership Summit.

This is an exclusive opportunity for CAP members to elevate leadership skills, take action, and be more effective advocates for positive change—particularly now that the Spring House of Delegates Meeting and our annual Hill Day are also part of this event.

The Pathologists Leadership Summit will help you better manage change within your practice, achieve greater influence, and establish and maintain relationships with the legislators who make decisions that affect your specialty.

There is no fee to attend this event, spaces are limited, and it also includes CME—so you should register and lock in your course selections as soon as you can. The Summit is open to all CAP members.

Visit pathologistsleadershipsummit.org for more information and help us set the path to a better future and register today.

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The Ohio Society of Pathologists’ (OSP) Past-President Lori Elwood, MD, FCAP testified against an out-of-network payment standard, as proposed by the House Bill 388 during a December 11 committee hearing. The OSP and the CAP oppose this legislation since it would create a payment structure for out-of-network payment services tied to median in-network rates that will impair the financial viability of pathology services in the state’s health care delivery system.

Dr. Elwood clearly stated how this legislation would impair hospital-based physicians, like pathologists, during her testimony. "This legislation is imprudent and would place Ohio in a public policy posture unique in the nation, in providing a payment structure for out-of-network services that will impair the financial viability of the health care delivery system, including the provision of pathology and laboratory services. In health care delivery, pathology and laboratory services, in many, if not most cases, are integral to medical decision-making and critical to patient diagnosis and management. Should House bill 388 be enacted in its current form, it would be the most pro-insurance out-of-network payment law in the nation since it allows insurance companies to unilaterally establish payment for out-of-network services based upon their own rate schedule, or alternatively, pay such services at 100% of Medicare, whichever is greater."

Dr. Elwood went on to answer committee members' questions about the detrimental impact of this legislation would have on pathology. When asked, Dr. Elwood provided examples from other states, such as New York and California, where safeguards are in place for hospital-based physicians for out-of-network payments. Dr. Elwood also provided an Anthem insurance reimbursement example that clearly emphasized as to why pathologists are forced to go out-of-network when the contracted rates offered are 40% below Medicare.

The CAP has also urged health plan network adequacy requirements to be included in out-of-network legislation for pathologists not only in state advocacy but also for a federal solution.

The CAP remains active on the fight for network adequacy and will continue to provide updates on Ohio and the federal front.

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Stephen Hahn, MD, a well-known radiation oncology executive, was confirmed as the next commissioner of the US Food and Drug Administration (FDA). Dr. Hahn is the current chief medical executive of The University of Texas M.D. Anderson Cancer Center in Houston. He was confirmed by the Senate on December 12 by a vote of 72 to 18.

Dr. Hahn replaces former FDA Commissioner Scott Gottlieb, MD, who resigned in April after almost two years heading the agency. Ned Sharpless, who served as acting FDA commissioner in recent months, will return to his previous role as director of the National Cancer Institute.

During a Senate confirmation hearing in November during which he was questioned about his stance on e-cigarette regulation, Dr. Hahn promised senators that his decisions as FDA commissioner would be based on “data and science congruent with the law.” In response to questions about opioid use, Dr. Hahn said he would focus on the appropriate packaging and labeling of drugs, accelerate the use of non-opioid products and embrace a holistic approach to managing patient pain.

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In 2019, the CAP led a delegation of pathologists to advocate for pathologists and their practices at the American Medical Association (AMA) House of Delegates (HOD) meetings. As the leading voice for pathologists in the AMA HOD, the principal policy-making body of the AMA, the CAP strongly advocated for many pathology concerns, but five top advocacy activities that the CAP and the AMA worked towards in 2019 were to:

• Reinstate autopsy standards at hospitals
• Protect pathology payment in Medicare
• Strengthen the study of pathology in medical school education
• Restrict prior authorization policies
• Ensure proper availability and communication of medical test results

At the 2019 interim meeting, the CAP and the AMA strongly opposed the Centers for Medicare & Medicaid Services’ (CMS) decision to remove the autopsy standards for hospitals. Previously, as a condition for Medicare reimbursement, hospitals were required to have an autopsy program. With this regulation change, hospitals are no longer required to have autopsy programs to qualify for Medicare reimbursement. The CAP and members of the Pathology Section Council called on the AMA to strongly oppose the CMS’s decision as the removal of the autopsy standard will contribute to the further decline in the national autopsy rate and the quality of patient care.

The CAP strongly advocated for policies to protect pathology payment in Medicare, including addressing mitigating the cuts to pathology payment from the revaluation of evaluation and management services revaluation to be implemented in 2021. The CAP also provided testimony in opposition to proposals advocating for site neutral payments between Medicare’s Physician Fee Schedule and the Hospital Outpatient Prospective Payment System (OPPS). The CAP believes these kinds of policies could result in inadequate payment rates for services furnished in off-campus provider-based departments.

Valerie Lockhart, MD, the CAP representative for the Resident Physicians Section at the AMA House of Delegates (HOD), highlighted the critical importance of including the study of pathology in a comprehensive medical school education, calling it the “backbone of all medicine.” The CAP supported AMA policy that states laboratory medicine is an integral component of patient care.

The CAP expressed concern that utilization programs, prior authorization protocols, and other volume control methods that dictate or limit health care provider decision-making may impinge on the practice of medicine. Moreover, these programs could improperly curtail medically necessary pathology services. The CAP delegation urged the AMA to push back on step therapy protocols imposed by health care plans and to streamline prior authorization programs. Delegates sought to protect patients further and allow timely clinician-initiated exceptions to, and place reasonable limits on, the step therapy protocols.

The CAP also discussed the importance of creating guardrails around the “immediate” availability of laboratory, pathology, and radiology results. The CMS is looking to require physicians to make patient health information available immediately through an application program interface no later than one day after it is available to the clinicians in the certified electronic health record technology (CEHRT). There are concerns about how this would work administratively as well as concerns relating to the immediate availability of medical test results because patients would have access to pathology reports prior to a consultation with their physician to aid in the understanding of the results. The AMA delegates also discussed the communication of abnormal test results and urged for additional study of the issue.

The CAP is a part of the AMA House of Delegates and encourages members to renew their AMA membership and work together to help shape a health care system that best utilizes pathologists to deliver high-quality care and meets the evolving demands of patient care. The CAP and AMA work together on many of the health and medical policies that affect the way you practice and your reimbursements. Join or renew your AMA membership today.

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Want up to the minute CAP Advocacy news? Then follow us on twitter at CAPDCAdvocacy, where you will be the first to know about CAP Advocacy wins, see your fellow members engage with Congressional leaders on key policies affecting the practice of pathology and, of course, breaking Advocacy news.

Check it out and follow today.

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Over 100 CAP members have already taken the year-end December Advocacy News Quiz. See how you compare to your fellow CAP members by sharing your results on social media. You might even learn something about the CAP’s advocacy efforts to make your practice better.

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