Read the Latest Issue of Advocacy Update
December 24, 2019
In This Issue:
- Congress Listens to CAP and Excludes Surprise Billing from Year-End Spending Bill
- Registration is Open for the 2020 Pathologists Leadership Summit
- CAP Urges Guidelines for Specimen Collection in ‘All of Us’ Precision Medicine Research
- Advocacy Communications Enhancements for CAP Members
- Editor’s Note
Congress Listens to CAP and Excludes Surprise Billing from Year-End Spending Bill
Before going to recess for 2019, Congress passed a $1.4 trillion spending package for 2020. Prior to its passage, lawmakers had debated the inclusion of a provision to end surprise medical bills and establish a benchmark reimbursement rate for out-of-network services. The CAP opposed inclusion of this proposal because of its unbalanced approach to dealing with surprise bills. Ultimately, Congress declined to move the provision forward due to lobbying and grassroots opposition from physicians, hospitals, and other stakeholders. The CAP, along with other physician specialties, led the push with many pathologists contacting their members of Congress with concerns over legislation that relied on insurance industry-controlled rates for unexpected out-of-network medical care and a flawed independent dispute resolution process.
We appreciate all CAP members who contacted their elected officials about legislation pending on surprise medical bills. You can still make your opinions known and the CAP will ask its members to remain engaged on this issue. Congress may take up the issue once it reconvenes in January.
Go to our latest grassroots action alert and provide your email and ZIP code to login to contact your legislators.
PAMA Reporting Delay
In the spending package, Congress delayed data reporting requirements under the Protecting Access to Medicare Act (PAMA). PAMA requires applicable laboratories to report private payer rates for clinical laboratory services to the Centers for Medicare & Medicaid Services (CMS). The CMS then uses the data to calculate Medicare reimbursement rates for tests on the clinical laboratory fee schedule.
The spending bill, and its inclusion of the Laboratory Access for Beneficiaries (LAB) Act, delays PAMA data reporting process by a year, from 2020 to 2021. The legislation also requires a study by the Medicare Payment Advisory Committee on how to reform PAMA.
The CAP’s goal is to improve how data is collected under the PAMA to ensure an accurate, market-based payment system for laboratories paid through the clinical laboratory fee schedule. The data collected by the CMS does not accurately reflect all sectors of the clinical laboratory market, and therefore the resulting PAMA rates are skewed.
Under PAMA, applicable laboratories are required to report private payor rates to the CMS, which currently includes rates from Medicaid managed care organizations. While Medicaid managed care utilizes private health plans, rates from Medicaid managed care can be no higher than Medicare rates and can be lower depending on the state. These rates do not reflect market-based private payor rates and therefore should be excluded from collection and rate setting.
The CAP looks forward to working with stakeholders as PAMA provisions in the spending bill are implemented.
Registration is Open for the 2020 Pathologists Leadership Summit
Over 100 CAP members have already registered for 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 and it includes CME credits. Spaces are limited—so you should register and lock in your course selections as soon as you can.
CAP Urges Guidelines for Specimen Collection in ‘All of Us’ Precision Medicine Research
The CAP has urged the National Institutes of Health (NIH) to utilize best practice guidelines for specimen collection under the its All of Us Research Program.
As the leader in pathology and laboratory medicine, the CAP has supported the development of guidelines that are clear and precise for the collection and processing of the biospecimens from a cohort of 1 million study subjects. Gail Vance, MD, FCAP, is representing the CAP in this endeavor and has engaged with the program to discuss development of best practices for specimen collection.
The All of Us Research Program is part of the federal government’s Precision Medicine Initiative. Its purpose is to be a public resource of data for researchers to easily access. Data collected can be used by any researcher around the world, as long as they follow strict privacy and security rules.
Visit the program’s website to learn more.
Advocacy Communications Enhancements for CAP Members
In 2019, the CAP created new communications opportunities for its members to stay updated and engaged on the latest advocacy news and information concerning the pathology specialty. These enhancements are available to all CAP members.
Follow our Advocacy Twitter Account
The CAP launched a Twitter channel providing news and information on advocacy topics important to pathologists. The Twitter account further allows CAP members to share and comment on legislative and regulatory issues affecting them and their patients.
Watch for Quarterly Advocacy Updates
The CAP now produces email updates following the close of each quarter to its members emphasizing the value and impact of advocacy. The quarterly updates are in addition to the weekly edition of your Advocacy Update.
Take the Monthly Advocacy News Quiz
The CAP also launched monthly Advocacy news quizzes providing members with an interactive platform to test their Advocacy knowledge. The quizzes are fun and can further provide you with information about how the CAP is advocating on your behalf in Washington, DC and around the country. Check out our year-end news quiz for December and share your score with your colleagues.