January 2, 2018

In This Issue:

The Pathologists Quality Registry has been approved as a 2018 Qualified Clinical Data Registry (QCDR) by the Centers for Medicare & Medicaid Services (CMS) for the second consecutive year, solidifying the tool as an instrumental component for pathologists in fulfilling reporting requirements under Medicare's Quality Payment Program (QPP) Merit-Based Incentive Payment System (MIPS).

Developed by pathologists for pathologists, the Pathologists Quality Registry offers additional pathology-specific quality measures and attestation for improvement activities, helping pathologists demonstrate quality care while maximizing Medicare payment bonus potential. The CMS published information about approved registries for 2018 on its website on December 27.

The registry offers 17 quality reporting measures developed by the CAP and exclusively available in the Pathologists Quality Registry; eight are QPP measures in the public domain, and the remaining nine are specific pathology measures approved by the CMS in the last two years as QCDR measures. Through its measures development led by councils and committees of pathologists, the CAP has sought to improve quality of patient care and ensure pathologists can participate in new quality payment programs.

Read the full announcement sent to CAP members on December 28. Learn more about enrolling in the Pathologists Quality Registry for the 2018 MIPS performance year.

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In a December 29 letter to the CMS, the CAP has urged the Medicare agency to not increase requirements on pathologists for the second year of the Quality Payment Program (QPP) and Merit-based Incentive Payment System (MIPS) as clinicians adapt to the new payment program. One change the CMS will make for the 2018 MIPS performance period is increasing the low-volume threshold, which the CAP advocated for and supports.

At the same time, the CAP is urging the agency to provide clinicians with the choice to voluntarily opt-in to MIPS for those excluded from the program because of its low-volume threshold. In changes adopted by the CMS for the 2018 MIPS performance period, the CMS increased the low-volume threshold to exclude both individual eligible clinicians and groups that have Medicare Part B allowed charges less than or equal to $90,000 or provide care for 200 or fewer Part B-enrolled Medicare patients.

While the CAP backs the low-volume threshold change, the CAP also believes those excluded should be allowed to voluntarily opt-in to the MIPS program. "This is particularly true for those [eligible clinicians] who exceeded the low-volume threshold for 2017 but not for 2018," the CAP said. "Many clinicians have invested significant resources towards being able to comply with MIPS; they should have the opportunity to benefit from upward MIPS adjustments if they are high performers, even if they fall below the new low-volume threshold."

According to the CMS, there are about 8,200 pathologists eligible for MIPS in 2018. Of those eligible, the CMS projects 96.4% will either receive Medicare payment bonuses or remain neutral. Through the years, quality measures developed and maintained by the CAP have been used by pathologists to not just avoid Medicare penalties but also earn bonuses.

The CAP also continues to advocate that eligible clinicians who cannot be scored for cost or advancing care information categories as currently formulated should receive only a weighted median score—which would maintain a more even playing field as the CAP helps to develop equivalent alternatives that permit pathologists to participate equally across the full complement of MIPS categories.

Read the CAP's full comment letter on the QPP.

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Time is running out to report your 2017 data if you are included in the CMS Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS). Your 2017 data will determine how your 2019 Medicare payments will be adjusted up, down, or not at all. The deadline to enroll in the CAP's MIPS Reporting Solution is January 5, 2018.

If you are unsure of your MIPS reporting status, you can enter your National Provider Identifier (NPI) to check to see if you are included in an Alternative Payment Program (APM). If you are part of an APM, then you don't need to report for MIPS. If you are not part of an APM, then check your MIPS status to see if you are eligible for reporting. Clinicians who (1) enroll in Medicare for the first time in 2017; (2) bill Medicare for $30,000 or less; (3) have provided care for 100 Medicare patients or fewer; or (4) are not in a MIPS-eligible specialty, are exempt from the MIPS program.

If you do qualify to report for MIPS, it is not too late to use the CAP's 2017 MIPS Reporting Solution tool to manually enter quality measures data and/or attest to Improvement Activities to avoid the penalty and aim for a bonus. The enrollment deadline for the CAP's 2017 MIPS Reporting Solution is January 5, 2018.

If you have further questions about MIPS reporting for either of the CAP's MIPS reporting tools, please email

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Registration is open for the 2018 CAP Policy Meeting.

The CAP's annual Policy Meeting, which is scheduled April 30–May 2, at the Washington Marriott in Washington, DC, will connect CAP members with government leaders and policy experts to discuss the impact of federal regulation on their pathology practices.

New regulations are taking shape that will impact pathology reimbursements for years to come. Attendees at the CAP’s Policy Meeting will receive the latest information and analysis on the implementation of new Medicare and laboratory regulations. The CAP is actively engaged in the legislative and regulatory arenas on the critical issues facing pathology and laboratory medicine, including physician payment reform, reducing regulatory burdens, and improving health care quality.

The Policy Meeting will also include discussions with congressional offices during the CAP's Annual Hill Day on May 2, which is the specialty's opportunity to focus on the federal issues most important to pathologists now and in the future.

The Policy Meeting is a benefit of CAP membership. There is no fee to register.

Register for the 2018 Policy Meeting.

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The Wisconsin Society of Pathologists (WSP), with the support of the CAP, is calling for changes to draft network adequacy and balance billing legislation, saying it cannot support the draft concept bill in its current form, as developed by the Office of the Commissioner of Insurance. The CAP supports the WSP's proposed amendments to the network adequacy legislation and will support the state society in its opposition to this legislation, if introduced.

In a December 15 letter to the Wisconsin Office of the Commissioner of Insurance (OIC), the WSP said the proposal actually confers financial incentives for participating provider health plans that fail to build an insurance network to ensure enrollees have reasonable and timely access to facility- and hospital-based physician services. The WSP is proposing several amendments to the legislation.

The WSP opposes linking out-of-network (OON) payments to Medicare because Medicare amounts are derived for the purpose of reimbursing medical services for a specific population based on federal budgetary and regulatory constraints.

"The impact of using a Medicare fee schedule on out-of-network payment is likely to have a profound impact on in-network contracting to the detriment of health care delivery in Wisconsin," the WSP said, noting that a recent report from the RAND Corporation concluded that for the state of New Jersey an analogous payment rate for OON providers could reduce payment by between 6% and 10%.

Instead, the WSP supports use of the 80th percentile of the FAIR Health Inc. charge database for determining "usual and customary" rates. In addition, the WSP recommends that payment be made by the health insurance plan directly to the provider.

The WSP also argued the current OIC draft bill does not establish an explicit statutory mandate on the insurance commissioner to make a determination on approval of an access plan that includes consideration of a health plan’s network adequacy for hospital- and facility-based providers. "This lax enforcement allows health insurance plans to construct narrow networks that mislead enrollees into thinking that in-network facilities and hospitals provide reasonable access to in-network physicians in critical medical specialties," the WSP said.

The WSP recommended insurers be required to submit annual reports for each hospital that provides the percentage of physicians in each of the specialties of pathology, emergency medicine, radiology and radiation oncology, and hospitalists practicing in the hospital who are in the insurer’s network. The WSP also urged that when determining the adequacy of a proposed provider network, the commission consider whether the proposed access plan includes a sufficient number of contracted providers to reasonably ensure enrollees have in-network access for covered benefits at the in-network facility.

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