Advocacy Update

Read the Advocacy Update

• Transition: Biden Nominates Becerra for HHS Secretary; Walensky for CDC Director
• Transition: Biden Names Surgeon General, Key Health Officials for Next Administration
• Bipartisan, Bicameral Support Increases To Mitigate Medicare Cuts
• CAP Advocacy Results in UnitedHealthcare Delaying Test Registration
• 2020 MIPS Extreme and Uncontrollable Circumstances Exception Deadline Extended
• Webinar This Friday: Final 2021 Medicare Payment Policies for Pathologists
• Test Your Round Up of Advocacy News Knowledge

Editor's Note: Advocacy Update will feature stories about the upcoming transition to the Biden Administration and new Congress. These stories will highlight major news on the future of President-elect Joe Biden's cabinet, other administrative officials, and both chambers of Congress that will enact and execute new health care policies affecting pathologists, their laboratories, and the patients they serve.

On December 7, President-elect Joe Biden furthered solidified his team to fight the national COVID-19 pandemic by nominating California Attorney General Xavier Becerra to lead the Department of Health and Human Services (HHS). The President-elect also nominated leading infectious-disease specialist Rochelle Walensky, MD to lead the Centers for Disease Control and Prevention (CDC).

Following the nomination of California Attorney General Xavier Becerra as secretary of the HHS, CAP President Patrick Godbey, MD, FCAP, said that he and the CAP look forward to working with Mr. Becerra. “The College of American Pathologists congratulates Xavier Becerra on his nomination to be the next HHS Secretary. This appointment comes at a time of crisis as coronavirus cases have risen rapidly in the United States. Pathologists and the laboratories they lead have worked diligently to meet the needs of their patients. Through our commitment to the excellence in the practice of pathology and laboratory medicine, we are looking forward to working with Mr. Becerra to solve the challenges the current pandemic presents and to further improve our health care system for the benefit of the patients we serve,” said CAP President Dr. Godbey.

A former House member, Mr. Becerra has focused on protecting underserved communities and fighting to safeguard the health and wellbeing of all Californians as state attorney general. Just recently, Mr. Becerra led the defense of the Affordable Care Act in the Supreme Court on behalf of twenty states and the District of Columbia.

Infectious Disease Expert Nominated for CDC

CDC director nominee Dr. Walensky currently serves as Chief of the Division of Infectious Diseases at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School. Dr. Walensky pioneered global strategic research on HIV/AIDS.

Editor's Note: Advocacy Update will feature stories about the upcoming transition to the Biden Administration and new Congress. These stories will highlight major news on the future of President-elect Joe Biden's cabinet, other administrative officials, and both chambers of Congress that will enact and execute new health care policies affecting pathologists, their laboratories, and the patients they serve.

As Biden prepares his administration to take on the COVID-19 pandemic, he tapped members of his COVID-19 task force to play key roles in his administration’s response to the national public health crisis. These individuals are public health experts and scientists who will lead national strategies to mitigate the COVID-19 pandemic.

Former Obama administration official and President-elect Biden transition team member Jeff Zients will be the COVID-19 coordinator, while Vivek Murthy, MD, will return to the position of US Surgeon General, which he previously served during the Obama administration. Dr. Murthy led the national public health force with Ebola, Zika, and the Flint water crisis.

Additionally, Marcella Nunez-Smith, MD, who was also a co-chair of the COVID-19 task force, will focus on health disparities. Dr. Nunez-Smith is an associate professor of internal medicine, public health, and management at Yale University.

President-elect Biden has also asked Anthony Fauci, MD, to stay on as the chief medical adviser for the COVID-19 task force and help his administration with its coronavirus response plan. Dr. Fauci has provided advice and counsel for the Trump administration’s COVID-19 response.

Bipartisan support in Congress is gaining momentum to mitigate the impact of the upcoming 9% Medicare cuts to pathologists’ reimbursement, reinforced in the Centers for Medicare and Medicaid Services (CMS) final 2021 Medicare Physician Fee Schedule, is increasing. CAP members have been contacting their federal legislators to fight the Medicare cuts that the CMS confirmed in its final 2021 Medicare Physician Fee Schedule published on December 1. And, the push continues to get Congress to act. The CAP, as well as a large coalition of specialists who are affected by similar Medicare decreases, has advocated for Congress to intervene before the new year.

As of December 7, 328 bipartisan members of Congress in both the House and Senate have made their concerns known by signing letters and/or co-sponsoring legislation pending before Congress. Currently, the bipartisan House bill 8702 -The Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020, which has 83 cosponsors.

The House bill HR 8702 holds providers harmless from these Medicare cuts for two years and is supported by members of the Congressional Black Caucus and health care members of Congress. “Even without these cuts, too many practices are struggling, even as patients need access to health care now more than ever,” Rep. Bobby Rush said in a letter addressed to House leadership. “As such, we urge you to include a provision in the end of year spending package to prevent these reckless cuts from taking effect.”

Similarly, in the Senate, 50 senators signed a letter to Senate leadership expressing their desire to work with leadership on the “upcoming physician payment cuts in ongoing legislative negotiations. We believe these cuts will further strain our health care system, which is already stressed by the COVID-19 pandemic, and jeopardize patient access to medically necessary services over the long-term.”

On December 1 the CAP along with its coalition of over 66 medical and health specialty groups, including the American College of Surgeons, the American College of Emergency Physicians, and the American College of Radiology, asked Congress to include end of year legislation to prevent these Medicare cuts to protect critical patient access. In total, over 382 groups support efforts to mitigate the impact of these devasting cuts.

Without passing legislation, the devastating cuts will take effect on January 1, 2021.

Because of the CAP’s advocacy, UnitedHealthcare announced that it will further delay its laboratory test registry until December 1, 2021. After continued discussions with the CAP over concerns of overburdening laboratories during the current pandemic, UnitedHealthcare announced it delayed implementation of its test registry program by one year and pushed back the deadline to ensure compliance.

Recently, UnitedHealthcare announced that effective January 1, 2022, claims for most laboratory test services must contain the laboratory’s unique test code for each service. Additionally, each test code submitted on a claim must match a corresponding laboratory test registration provided in advance to us, or we will deny the claim. To ensure compliance with these requirements, free-standing and outpatient hospital lab providers should register their laboratory tests before December 1, 2021.

The CAP asked UnitedHealthcare to cease implementing the program and work with the CAP to address any outstanding needs for information and transparency. The CAP had stressed the difficulty of implementing this program during the COVID-19 public health emergency. UnitedHealthcare acknowledged this unique situation and further delayed the implementation of the registry.

The CMS extended the 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception application deadline to February 1, 2021. For pathologists, physicians, and other clinicians who are unable to meet requirements for MIPS in 2020 due to COVID-19, the CMS will allow you to request a hardship exception. The CAP has advocated for MIPS reporting relief for pathology practices in light of the pandemic.

As announced earlier this year, the CMS used the Extreme and Uncontrollable Circumstances policy to allow MIPS eligible pathologists to request to reweigh one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency.

The CMS’ 2020 Quality Payment Program COVID-19 response includes MIPS reporting relief for practices for whom the “COVID-19 pandemic is preventing you from collecting data for an extended period of time.” The CMS requires practices to submit an extreme and uncontrollable hardship exemption application by the new date of February 1, 2021. The CMS will review the applications on a case-by-case basis; for those practices with approved applications, the performance categories requested will be reweighted to zero. This means that if the CMS approves your application, you will have a neutral payment adjustment in 2022. Unlike for 2019, the CMS has not offered automatic neutral payment adjustment for clinicians who don’t submit data.

If CAP members have concerns about the effect of the COVID-19 public health emergency on your performance data for the 2020 performance period, the CMS encourages your practice to submit an application now and be sure to cite COVID-19 as the reason for your application.

How to Apply

Log in with your MIPS- HARP account, to qpp.cms.gov, select “Exceptions Applications” on the left-hand navigation, select “Add New Exception,” and select “Extreme and Uncontrollable Circumstances Exception” or “Promoting Interoperability Hardship Exception.”

If you apply for either of the exceptions, physicians will be notified by email if your request was approved or denied. If approved, this will also be added to your eligibility profile on the QPP Participation Status Tool, but may not appear in the tool until the submission window is open in 2021.

If you have questions about this process or other aspects of the MIPS program, email the CAP’s experts at mips@cap.org.

Medicare Physician Fee Schedule and the Quality Payment Program regulations on December 1, reinforcing its decision to cut pathology services’ payments by an average of 9% starting in 2021. While the cuts will decrease payment for nearly all pathology services, payment for the molecular interpretation service will more than double because of the CAP’s advocacy. The CMS released the relative value unit (RVU) files to calculate prices for physician services on the fee schedule on December 2. Download the CAP's impact table of the 2021 Medicare Physician Fee Schedule that shows the fluctuations in payment for pathology services between this and next year.

The CAP will host an exclusive webinar this Friday, December 11 at 3 PM ET/ 2 PM CT, where CAP experts will review regulatory changes that will impact payment for services, and pathologists’ participation in MIPS.

Webinar presenters will be the Chair of the Council on Government and Professional Affairs Jonathan Myles, MD, FCAP; Chair of the Economic Affairs Committee W. Stephen Black-Schaffer MD, FCAP; and Vice Chair, Economic Affairs Committee Diana Cardona, MD, FCAP.

During the 60-minute webinar, attendees will learn about the final 2021 Medicare Physician Fee Schedule and the Quality Payment Program regulations and its impact on pathologists. The CAP panel will also answer questions from attendees.

Register today

Take 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.

Take the December news quiz