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STATLINE

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February 7, 2017

In This Issue:

Pathologists must take action in 2017 in order to stop their Medicare payments from being cut in 2019 under the Merit-based Incentive Payment System (MIPS) program. The CAP has developed several resources, including a MIPS FAQ and an infographic, for its members to help them take action as they prepare their data in order to avoid penalties and potentially earn a bonus in 2019.

The Centers for Medicare & Medicaid Services (CMS) will use this 2017 calendar year as a performance period to determine whether or not physicians and group practices will face penalties of up to 4% in 2019. Individual pathologists or group practices can stop the penalty by reporting at least one quality measure in 2017.

The MIPS program is part of the CMS Quality Payment Program (QPP) and is the next evolution of three quality programs: Meaningful Use of electronic health records (EHR), the Physician Quality Reporting System (PQRS), and the Value-based Payment Modifier (VM). The QPP reforms Medicare by receiving and validating physician-submitted data, providing performance feedback, determining MIPS scores, and adjusting payments.

The CAP has developed eight quality reporting measures specifically for pathologists—helping CAP members avoid tens of millions of dollars in Medicare penalties every year. The CAP has secured the inclusion of these measures in the MIPS program.

In order to avoid penalties in 2019, practices must submit quality reporting data for 2017 no later than March 31, 2018. By submitting data on one quality measure, a physician can stop the Medicare penalty. A physician can also attest to participating in a clinical practice improvement activity to stop the penalty. The CMS has not yet provided details on attestation but the CAP will keep members updated.

Stay tuned for more MIPS related resources.

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The CAP, Association of Pathology Chairs, American Association of Medical Colleges, and about 50 other physician and medical society organizations, urged the Trump administration to reconsider the potential impact of a January 27 Executive Order (EO) restricting admission of certain foreign nationals and refugees into the United States. The groups listed their concerns about the EO in a February 1 letter to President Trump.

While recognizing the need to ensure national security, the CAP and other specialty groups said aspects of the EO will affect patient care, health education, and medical research. "Our organizations are dedicated to promoting a diverse and culturally competent health and biomedical workforce—at home and abroad—that supports improvements in health care, access to providers, breakthroughs in medical research, and equitable health for all patients regardless of their backgrounds," the letter said. "We urge the administration to provide additional guidance and to reconsider aspects of the executive order to avoid unnecessarily undermining our ability to fulfill these shared missions."

The groups offered to work with the administration to develop measured immigration policies that reflect the health care needs of the nation.

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The CAP will be conducting a short retirement and retirement planning study to find out more about retirement attitudes and age for most pathologists and how the changing demographics may affect the future job market for pathologists.

This short, five-minute online survey is being sent by email to board-certified pathologists, aged 60 to 85 years old and can be completed on a smartphone, tablet or personal computer. The survey asks the respondents about their current work status, workload and retirement plans and if they are practicing full or part-time. The survey will begin on Monday, February 13 and will end on Friday, February 24, 2017. The CAP will give away $150 Amazon gift cards to four lucky survey responders.

The CAP has previously conducted surveys that included questions about when pathologists expect to retire. However, those questions were part of larger surveys, and have not been conducted since 2014. This will be the first CAP survey to focus solely on retirement and retirement planning. Although it is far shorter than previous CAP surveys, it nonetheless will provide more detailed information about how pathologists expect to transition into retirement.

The results of the survey will enable the CAP to update its understanding of the workforce and future manpower needs for pathology. The CAP will also use retirement and retirement planning data so that we can help policy makers' efforts to assess and address specific needs across pathology specialties.

The results of this survey will be published in a manuscript later in 2017. If you have any questions, or have not received the survey and are eligible, please email practicesurvey@cap.org.

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State medical societies in Illinois and Washington have embraced the position of the CAP and state pathology societies in advocating for state legislation to require health insurance plan network adequacy for hospital-based physicians and to hold health insurance plans accountable for deceptive marketing claims regarding in-network hospitals.

Legislation introduced in both Illinois and Washington represent collaborative efforts across all hospital-based specialties and state medical societies to ameliorate the problem of out-of-network balance billing by addressing the actions of health plans that have engendered or otherwise exacerbated the problem for patient enrollees in their plans.

In addition to calling for legislation to address network adequacy requirements and deceptive trade practice legislation, the CAP and state pathology societies have urged state medical societies to protect patients by supporting safe harbor rules that would give physicians legal authority to waive charges for patients based upon patient economic duress and ensure that patient out-of-pocket costs are properly attributed by the health plan to the patient's maximum out-of-pocket expense.

Illinois Network Adequacy and Transparency

The Network Adequacy and Transparency Act (HB0311), introduced Jan. 25, would require an insurer to demonstrate to the Department of Insurance that it has a minimum ratio of full-time equivalent providers to plan beneficiaries, as well having met maximum travel and distance standards for beneficiaries. The bill is backed by the Illinois State Medical Society and an array of patient advocacy groups.

Specifically, the network plan must demonstrate, prior to approval, that it has contracted with physicians who specialize in pathology, emergency medicine, anesthesiology, radiology and hospitalists in sufficient numbers at any in-network facility or in-network hospital so that patients enrolled in the plan have reasonable access to these in-network specialists.

Under the bill, the Department of Insurance must conduct quarterly audits of all network plans to verify compliance with network adequacy standards. These audits must include surveys to be sent to plan beneficiaries and providers for the purpose of assessing network plan compliance. The measure, if approved, would take effect Jan. 1, 2018.

Washington Consumer Protection

SB 5654, introduced Feb. 1, provides for consumer protections from charges for out-of-network health services. Under the bill, which would take effect Jan. 1, 2018, a carrier must maintain in-network providers and facilities for each health plan in a manner that is sufficient in numbers and types of providers and facilities to ensure that, to the extent feasible, enrollees may access in-network options for all health plan services in a timely manner appropriate for the enrollee’s condition and the place of service. The bill is backed by the Washington State Medical Association and a coalition of medical specialty societies.

If a carrier has an insufficient number of type of in-network participating providers or facilities to provide a particular covered health care service, the carrier must ensure that the enrollee obtains the covered service from a non-network provider or facility within reasonable proximity and timely manner at no greater cost to the enrollee than if the service were obtained from in-network providers and facilities.

Importantly, a carrier may not state or imply in communications with or directed to enrollees or potential enrollees that a hospital is an in-network health care facility if the health care providers who provide the following specialty services to the hospital do not also participate in the carrier’s network: pathology, anesthesiology, emergency medicine and radiology.

In cases where a plan beneficiary must go to an out-of-network provider, the bill would require the health carrier to pay the out-of-network provider a reasonable rate—at a minimum at the 80th percentile of the geographically comparable charges as determined by a state entity that uses a reputable health care claims database. The charges must be benchmarked to 2016 rates and updated on an annual basis with the relevant health care consumer price index adjustor calculated by the Bureau of Labor Statistics.

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Jared Abbott, MD, PhD, FCAP

STATLINE regularly features one of the many the CAP members who have been champions for pathology in Washington and at the state level through our grassroots and PAC programs. If you would like to get involved, you can join PathNET, contribute to PathPAC, or join your state pathology society.

Name: Jared Abbott, MD, PhD, FCAP
Position: Pathologist, Iowa Pathology Associates, Chair, PathPAC Board

What advice would you give to someone who wants to be involved in advocacy?

The first step is to be engaged in the CAP because the CAP is the only pathology organization that really has full-spectrum lobbying and advocacy capabilities at the federal and state level. Step two would be to get involved in PathNET and PathPAC, as well as the HOD and the CAP committee structure. Finally, the third step is to get involved in your state society because the CAP facilitates state society efforts at a local level.

If you want a voice in what happens in medicine, advocacy is critical. For example, advocacy's role in preserving CPT code value and limiting the severity of cuts is as fundamental as it gets in terms of everyday life. Right now advocacy has a big role in trying to limit the power of Local Coverage Determinations (LCDs). That just affected me in Iowa. The immunohistochemical stains LCD that has been spreading across the country took effect here on January 1, and we;re not happy about it. If we're not participating in advocacy, we’re ceding control over our own future to someone else who may not understand what we do.

Do you have a favorite experience that stands out in your advocacy work?

I went to a fundraiser for my congressman and I got to meet him and his staff. That opportunity helped me to form a relationship that allowed for more effective influence and advocacy. The next time I had a meeting with him, he recognized me, resulting in a one-on-one in his office rather than meeting with a staffer. And to me, that was very formative and helped to illustrate the role of fundraisers in advocacy.

I hosted a lab tour for my congressman during the fight over the TC grandfather issue. I went through every step of how a specimen became a slide to a diagnosis. He viscerally understood that this isn’t a widget that can just be cut with the stroke of a pen.

What was your greatest concern about becoming an advocate for the profession before you got involved? Was your fear/concern justified?

My biggest fear was being lost in the noise of Washington. You realize how many different ways members of Congress and their staffs are pulled. But I've been fortunate to have legislators who took the time to understand the issue and built relationships that were useful in helping us to protect aspects of our practice. But on the flip side, there are always people who have the opposite opinion. That's why it's so important to use the power of advocacy and PAC fundraising to solidify relationships because everyone else is doing it, too.

Generally, I think it's becoming apparent that health care reform is going to be an ongoing political process. It's not just the repeal and replace of the Affordable Care Act. You have to have a seat at the table. Fortunately, this constant state of reform presents opportunities that only advocacy can grasp.

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Your membership in the AMA strengthens the College of American Pathologists’ (CAP) representation in the AMA House of Delegates (HOD)—the policymaking body of the AMA—which allows us to have a collective voice through which we can bring forth the perspectives and interests of our specialty.

Please activate your 2017 AMA membership today, visit ama-assn.org/go/join or call AMA Member Relations at (800) 262-3211. If you are currently a member, thank you.

AMA member benefits and resources include:

  • Unlimited access to The JAMA Network® which brings together JAMA and all 11 specialty journals with CME.
  • STEPS Forward™, the AMA's new practice transformation series designed to help physicians achieve the Quadruple Aim: better patient experience, better population health and lower overall costs with improved professional satisfaction.
  • Free 18-month trial of Dynamed Plus®, an evidence-based, clinical support tool that features thousands of images and provides immediate answers to clinical questions.

If you are a part of a group and want to learn more about the AMA’s Group Practice Membership discounts and benefits, please email raymond.helm@ama-assn.org.

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With a new presidential administration, the US government will pursue policies that are yet hard to predict. On February 21, 2017 at 1 PM ET/noon CT the CAP will present the A Seat at the Table—The Impact Only You Can Make on the Future of Pathology webinar.

If you ever had a doubt that your voice matters, this 60 minute webinar will present the facts and figures on the crucial impact you have on members of Congress. Learn how you can make a difference with data presented from Congressional Management Foundation surveys, the National Journal, and other reputable sources illustrating the importance of grassroots advocacy.

Get facts and figures along with down-in the-trenches insight from Joe Saad, MD, FCAP, the CAP Federal and State Affairs Committee Chair, and Michael Giuliani, CAP Advocacy Senior Director and former Hill staffer, on what drives members of Congress: who they listen to, how they make decisions, and the best ways to influence them.

Register now.

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With a theme of Protecting the Practice of Pathology and Our Patients, let your voice be heard at the 2017 CAP Policy Meeting. From April 24–26, CAP members can connect with government leaders and policy experts to discuss the impact of federal regulation on their pathology practices.

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