Advocacy Update

Read the Advocacy Update

January 12, 2021

In this Issue:

CAP Condemns Mob Attack on US Capitol

The CAP condemned the violence that took place in Washington, DC, on January 6 as a mob rioted the US Capitol during the certification of the 2020 presidential election results. In a statement sent to CAP members and the public, CAP President Patrick Godbey, MD, FCAP, said we stand with the nation in denouncing the assault on the constitutional process and on our values as a nation. As a leader in advocacy for practice of pathology and laboratory medicine, the CAP supports the Constitution of the United States and our democratic process.

Through the years, many of the CAP’s members have participated in advocacy grassroots efforts, Hill day visits, and engaging with our federal lawmakers in a cordial fashion in order to advocate for pathology.

“We regularly have members conducting business at the Capitol, walking those halls to lobby on behalf of pathologists and patients,” Dr. Godbey said. “Lack of access to the Capitol would be a detriment to our ability to serve them. Also, we have a CAP staff office near the Capitol building. Our personal connection to the people’s house makes this assault on it even more impactful.”

As pathologists, Dr. Godbey added, we are committed to healing, helping, and understanding the root of the diagnosis. At a time when our country is deeply divided, it is the right time to do our part to respect each other, to listen, and to seek understanding, he said. Let us support each other as we live our values and continue to improve the health of our patients.

2020 Transition: Who Will Lead Important Senate Health Care Committees in the 117th Congress

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 the 117th Congress took office in early January, Democrats will now be in control of both the House and the Senate, where they will now hold a slim majority. The Democrats gained control in the Senate with the addition of two Senators elected from Georgia on January 5. The Senate will be split with 50 senators caucusing with Democrats and 50 senators caucusing with Republicans, but Vice President–elect Kamala Harris will break ties on votes cast following political party lines. The CAP expects several leadership changes on key congressional committees overseeing Medicare, Medicaid, and health care that will be pertinent to the CAP's advocacy strategy in the Senate.

In the Senate Finance Committee, Sen. Ron Wyden (D-OR) will be the chair of the committee with Sen. Mike Crapo (R-ID) as the ranking member. In the Senate Health, Energy, Labor, and Pensions (HELP) Committee, the chair will be Sen. Patty Murray (D-WA) with Sen. Rand Paul, MD, (R-KY) as the ranking member on the committee.

Download the CAP’s Updated Impact Table on the 2021 Medicare Physician Fee Schedule

Because of the CAP’s advocacy efforts, pathologists will save up to $85 million in 2021. The CAP’s efforts reduced the -9% Medicare cut to approximately -2 to -3% to pathologists each year, amounting to between $76 to $85 million more for pathologists in 2021. Congress mitigated the cut by adding $3 billion to the 2021 Medicare Physician Fee schedule and delayed the implementation of a new evaluation and management add-on code for three years.

The CAP updated its the 2021 Medicare Physician Fee Schedule Impact Table based on the new rates. The original proposed a -9% Medicare cut to pathologists’ has now been drastically reduced.

CAP Agrees with Medicare Improvements to Address Burdens in Prior Authorization

In December, the Centers for Medicare and Medicaid Services (CMS) released a proposed regulation to improve the electronic exchange of health care data and streamline processes related to prior authorization. The CAP urged the CMS to move forward with changes that streamline prior authorization requests and ensure expedited prior authorization timeframes but expressed concern about the continued burden and challenges related to prior authorization for pathology.

In the January 4 letter to the CMS, the CAP asked that prior authorizations “should be targeted where they are needed most, and the burden on health care providers eased as much as possible.” Further, the CAP explained that specific to pathology, prior authorization can be especially complex, as pathologists generally do not have the information needed to complete required forms and are not in a position to appeal decisions. The CAP stated that “oftentimes when the specimens are received, there is not the time or availability to pause for prior authorization processes.” The CAP emphasized that utilization management policies that restrict, deny, or steer services for patients may disrupt coordination, add burdens, or lead to lower quality health care.

The CAP outlined other considerations that prior authorization processes or utilization management program must include:

  • Transparently based upon peer-reviewed, published evidence in medical literature;
  • Subject to routine and timely updating based upon accepted standards of medical practice and the most current medical knowledge;
  • Amenable to a physician's immediate over-ride in the ordering of pathology/laboratory services based upon the medical judgment of the physician regarding the patient; and
  • Prohibited from facilitating business conduct by a health insurance payer that would have an adverse claims impact upon a pathology/laboratory provider who receives an order for services from a health care provider by following the law.

The CAP has worked with the American Medical Association (AMA) to address programs requiring prior authorization because they can negatively affect patient access to necessary diagnostic tests, create inconsistencies with current clinical practice, and increase burdens on pathologists and laboratories.

AMA, CAP Urge the VA to Rescind Scope Expansion for Nonphysician Practitioners

The CAP has opposed a scope of practice change initiated by the Department of Veterans Affairs (VA) that would permit virtually all VA-employed nonphysician providers to practice without clinical supervision of physicians and without regard to state scope of practice law. The CAP is extremely concerned that this action has removed safeguards to protect patients and further allows nonphysician practitioners to practice outside the scope of their licenses.

In November, the VA published an interim final rule granting authority to “VA professionals” to practice health care. Previously, the CAP and other physician organizations urged the VA to not move forward with the rulemaking by citing risks to the patients the VA serves.

The CAP signed on to a January 7 letter led by the AMA opposing the change. While nonphysician practitioners are integral to physician-led health care teams, they cannot substitute for physicians when it comes to diagnosing complex medical conditions, developing comprehensive treatment plans, ensuring procedures are performed correctly, and managing highly involved and complicated patient cases. “Nowhere is this more important than at the VA, which delivers multifaceted medical care to veterans, including those with traumatic brain injuries and other serious medical and mental health issues,” the letter stated. “As such, our nation’s veterans deserve high-quality health care that is overseen by physicians.”

The AMA, CAP, and other signatories highlighted the following problems with the new VA regulation that jeopardize patient care:

  • The regulation inappropriately preempts state scope-of-practice laws.
  • The regulation does not adequately account for the differences in education and training that exist between physicians and nonphysician practitioners.
  • The regulation does not account for state licensing boards and inadequate oversight of nonphysician practitioners within the VA.

As veterans deserve the highest possible quality care, the CAP is urging the VA to rescind its new regulation.

Download Our New Fact Sheet on Sharing Test Results with Patients, Information Blocking

To answer questions pathologists may have about new federal regulations on sharing test results with patients, the CAP created a fact sheet summarizing key provisions of the regulation set to now take effect on April 5, 2021.

Download the CAP’s fact sheet on the regulations Arrow Right

In November 2020, the Department of Health and Human Services (HHS) pushed back the deadline for the regulations, which include information blocking, citing implementation concerns during the coronavirus pandemic. The rules will change how many physicians, including pathologists, pass along and receive electronic health information.

The CAP’s fact sheet provides background on the new regulations and how they could impact pathology practices. The CAP has advocated for easing administrative burdens tied to these regulations. The fact sheet provides answers to frequently asked questions such as “What is the practical impact of these new regulations?” and “Are there any exceptions to information blocking?”

With the new deadline to comply with the rules, which are required by the 21st Century Cures Act, pathologists and laboratories will have more time to become familiar with requirements. The CAP has noted that there are complex situations in which the administration will consider certain exceptions to information blocking that would warrant blocking the release of information. The American Medical Association has also created documents, Part I and Part II, with more information about these new regulations.

Ohio Pathologists, CAP Urged Governor to Veto Out-of-Network Legislation

The Ohio Society of Pathologists (OSP) and the CAP urged Ohio Gov. Mike DeWine to veto surprise bill legislation, which he signed into law on January 8. The OSP and the CAP had opposed this legislation as it pays for out-of-network services at 100% of the Medicare rate or the median in-network rate. Additionally, the legislation was negotiated and backed by the Ohio State Medical Association and the Ohio health insurance industry. The CAP’s partnerships with state pathology societies strengthen advocacy efforts at the state level.

In a December 24 letter to Gov. De Wine, Ohio Society of Pathologists President Sean Kirby, MD, FCAP urged the governor to veto the bill as it, “establishes out-of-network payment greater of Medicare or median in-network rates as determined by the payer without the use of a transparent database. Recently passed federal legislation (No Surprises Act) rejects the Ohio approach, recognizing that the use of HB 388 payment formula will be financially devastating to hospital and facility-based health care and will enrich the health insurance industry.” Unfortunately, Gov. DeWine signed the bill into law.

The new law will take effect nine months following enactment. The CAP and the OSP will seek to revise the law in the next legislative session.

Save the Date: 2021 Pathologists Leadership Summit May 1-4, 2021

The Pathologists Leadership Summit will be held from May 1 through May 4, 2021. This is a dynamic experience focused on helping CAP members advocate to protect the future of pathology and advance their leadership skillset to the next level of performance. Get updated on what you need to know today to effect positive change and make a bigger difference tomorrow. This meeting is exclusively available to CAP members including CME.

Breaking Advocacy News: Check out the Advocacy Twitter Channel

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.

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New Year, New Advocacy News Quiz

New year and a new Advocacy News Quiz. Last month, on average we had over 80 pathologists take the quiz. And in 2020, we had an average of 75 pathologists take the quiz each month. See how you compare against your fellow CAP members’ in the January News Quiz.

Take the January 2021 news quiz Arrow Right