Advocacy Update

July 12, 2022

In this Issue:

In Case you Missed It: CMS Releases Proposed 2023 Medicare Physician Fee Schedule

On July 7, the Centers for Medicare & Medicaid Services (CMS) released its proposed 2023 Medicare Physician Fee Schedule signaling an advocacy win for the payment of pathology technical component services. The agency will restore the proper rank order of the clinical labor rates for histotechnologists and laboratory technicians in 2023. The CAP’s advocacy will lead to more accurate payments for the technical component of pathology services in 2023 if proposals are finalized later this year.

Proposed Regulation Impact on Pathology Payment

The 2023 proposed regulation, estimates indicate the overall impact to pathology payments from 2022 to 2023 would decrease by one percent. Specifically, the proposed 2023 conversion factor used for the fee schedule’s payment formula is $ 33.0775, representing a 4.4% decrease from the 2022 conversation factor.

This 4.4% decrease accounts for the expiration of the 3% increase fee schedule payments for 2022 as required by the Protecting Medicare and American Farmers from Sequester Cuts Act, and required budget neutrality adjustment to account for changes in relative value units. The CAP continues to aggressively lobby Congress to mitigate these cuts to pathologists for 2023.

Review the proposed pathology services changes in our proposed 2023 Medicare Physician Fee Schedule Impact Table.

MIPS Scoring Performance Threshold Remains at 75, Increases Achievement Complexity

As first reported on July 7, the CMS released its proposed 2023 Quality Payment Program (QPP) regulation which outlined more challenging performance thresholds for pathologists. The CMS also provided consistency in MIPS while they gain familiarity with MIPS Value Pathways (MVPs) and move toward accountable care and advanced alternative payment models. Though limited, the proposed changes to the MIPS program could significantly impact pathologists’ scores and payment bonuses.

In the proposed 2023 QPP regulation, the CMS will leave the performance threshold at 75 points. However, the CMS did increase the complexity to reach the scoring threshold, as measures that used to be worth between 3 and 7 points could be worth as little as 1 point. Because the pathology QPP measures are topped out, pathologists must achieve a near-perfect score to get 7 points. Otherwise, if a practice does not achieve a near-perfect score, the practice could receive only 1 point for that measure. Additionally, the exceptional performance bonus pool is no longer available.

In 2023, pathologists reporting MIPS will have to take action to avoid penalties that reduce future Medicare Part B payments for their services. For example, failing to reach the scoring threshold in 2023 could result in Medicare payment penalties up to 9% for payments in 2025.

With the proposed 2023 changes to scoring, it is likely that many small practices – especially those that rely heavily on the topped-out QPP measures – could see a reduction in their MIPS performance scores, leading to penalties. Billing companies alone are not able to avoid this problem for many practices.

The CAP will advocate for pathologists’ success in the MIPS program.

CAP Advocacy Win: AMA-CPT Releases CAP Developed Digital Pathology Codes

On July 1, the American Medical Association (AMA) CPT Editorial Panel released 13 new digital pathology add-on codes for 2023 that the CAP successfully advocated for inclusion.

The CAP worked with the AMA CPT Editorial Panel to develop these new Category III digital pathology digitization procedure codes. CPT codes 0751T-0763T will be used to report additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis. The CAP applauded the AMA for the public release of this information, and the CAP will provide resources throughout 2022 to inform CAP members about anticipated CPT changes. The new digital pathology codes will be effective on January 1, 2023.

Archives Features Research Revealing Strong Job Market for Pathologists

The CAP Archives of Pathology and Laboratory Medicine highlighted research that a strong demand for pathologists exists in the medical workforce. In the July 1, 2022, issue, an article authored by members of the CAP’s Policy Roundtable revealed a strong demand for pathologists within the medical workforce exists, with expectations of continued strength. This study updates that prior analysis using data from the 2021 Practice Leaders Survey.

The authors, who include David J. Gross, PhD (Director of the CAP’s Policy Roundtable); Stanley Robboy, MD, FCAP; Michael Cohen, MD, FCAP; Lori Vernon (CAP Staff); Jason Y. Park, MD, PhD; James M. Crawford, MD, PhD, FCAP; Donald S. Karcher, MD, FCAP; and Thomas M. Wheeler, MD, FCAP analyzed data from the 2021 CAP Practice Leader Survey. This paper summarizes results from 282 practice leaders about pathologist hiring in 2021, including the hiring of pathologists, the level of experience being sought, success in filling positions, and expectations for hiring in the next three years.

The research showed that among the 282 respondents who provided information about pathologist hiring in 2021,157 practices (55.7%) sought to hire at least 1 pathologist in 2021, up from 116 of 256 practices (45.3%) in 2017; the mean number of pathologists hired per practice also increased. In 2021, a total of 175 of 385 positions (45.5%) were to fill new positions, compared with 95 of 249 positions (38.2%) in 2017. Most practice leaders were comfortable hiring pathologists with less than 2 years of post-training experience. Practice leaders anticipated continued strong demand for hiring pathologists during the next 3 years.

The paper outlines that the demand in pathologist hiring is strong, and much increased from 2017. Combined with other job market indicators, the group concluded that demand may outstrip the supply of pathologists, which is limited by the number of trainees that has remained constant during the past 20 years.

CDC Releases Monkeypox Reporting Guidance

The Centers for Disease Control and Prevention (CDC) released new online guidance on reporting laboratory diagnostic test results for Orthopoxvirus, non-variola Orthopoxvirus, and Monkeypox virus on June 30. The new guidance includes information on who should report, what to report, how to report, how to use the standard terminology and assistance with electronic reporting.

This updated CDC guidance is in addition to the updated specimen collection guidance.

New Hampshire Pathologists and CAP Codifies Direct Access Precedent

On June 24, Gov. Christopher Sununu enacted the New Hampshire Society of Pathologists (NHSP) and the CAP’s amended House Bill 381 mandating direct-to-consumer (DTC) tests be subject to proficiency testing regardless of test complexity. The CAP advocates that patients are best served when laboratory tests are ordered by a qualified physician while ensuring appropriate safeguards are included for direct access testing.

New Hampshire is the first state to adopt the CAP’s longstanding policy in which all DTC testing, including waived tests, must be subject to proficiency testing to protect consumers from unreliable or unsafe testing.

In 2020, the NHSP and the CAP successfully amended the bill to include proficiency testing requirements for clinical laboratory testing provided without a health care practitioner’s order.

The bill will take effect on January 1, 2023.

Upcoming Webinar: CAP Update on LDTs and the VALID Act

Get the latest information on congressional efforts to enact legislation for a new comprehensive regulatory framework for clinical laboratory tests that includes laboratory-developed tests (LDTs). During this webinar, members will learn the key components of the Verifying Accurate Leading-edge IVCT Development (VALID) Act and how it would affect laboratories and pathologists if it is enacted into law.

On Tuesday, July 19 at 11 AM ET, CAP President Emily Volk, MD, FCAP, Council on Government and Professional Affairs (CGPA) Chair Jonathan Myles, MD, FCAP, and CGPA Vice Chair Joe Saad, MD, FCAP will discuss provisions of the VALID Act the CAP supports as well as areas where the CAP suggests the legislation and regulatory framework might be improved.

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Proposed 2023 Medicare Payment Regulations Webinar

On Monday, August 8 at 1 PM ET/ 12 PM CT, the CAP will offer this complimentary live webinar where CAP experts will review proposed regulatory changes that will impact Medicare payment for services and pathologists’ participation in the quality initiatives. Join us for a deep dive into the proposed 2023 Medicare Physician Fee Schedule and the Quality Payment Program regulations, including the Merit-based Incentive Payment System (MIPS).

Webinar presenters will be the Council on Government and Professional Affairs Chair Jonathan Myles, MD, FCAP; Economic Affairs Committee Chair Stephen Black-Schaffer, MD, FCAP; and Quality and Clinical Data Registry Affairs Committee Chair Diana Cardona, MD, FCAP.

Register now

Test Your CAP Advocacy Knowledge

Think you know CAP advocacy. Then take the July advocacy news quiz! Last month over 150 members took the quiz. See how you compare against your fellow CAP members and brag about your top scores on social!   

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