Advocacy Update

July 18, 2023

In this Issue:

In Case you Missed It: CMS Releases Proposed 2024 Medicare Physician Fee Schedule

On July 13, the Centers for Medicare & Medicaid Services (CMS) released its proposed 2024 Medicare Physician Fee Schedule outlining cuts to pathologists, independent laboratories, and other specialties to offset increases to primary care physician services. The CAP has strongly opposed these cuts and is actively lobbying Congress to mitigate the decreases before they take effect.

Proposed Regulation Impact on Pathology Payment

Briefly, here are the key topics included in the 2024 proposed rule:

  • The CMS proposed to implement evaluation and management add-on code, G2211, causing budget neutrality adjustments that negatively affect pathologists and other specialties throughout the physician fee schedule. Download the impact table showing the proposed changes to pathology services in 2024.
  • The CMS increases Medicare Quality Payment Program (QPP) requirements for 2024.
  • Learn more: Register for the CAP’s July 26 webinar providing a comprehensive overview of the proposed fee schedule changes to pathology services and the QPP.

In addition to the CAP, several physician associations said these continued cuts have negatively impacted physician practices in recent years and will have severe consequences in the long term. “These increasingly thin or negative operating margins disproportionately affect small, independent, and rural physician practices, as well as those treating low-income or other historically minoritized or marginalized patient communities,” American Medical Association President Jesse Ehrenfeld, MD, said in a statement. “Piling on more cuts is an unsustainable approach. Congress needs to turn its attention to fixing Medicare so we can preserve access for patients.”

The proposed regulation also included a request for information on histopathology, cytology, and clinical cytogenetics regulations under CLIA.

The request for information is soliciting feedback from the public on how to develop final regulations to achieve the following objectives:

  • Developing regulations around slide staining and tissue processing as a part of the wider CLIA regulations and certification
  • Making the public health emergency enforcement discretion permanent to allow pathologists to review slides remotely
  • Making the public health emergency enforcement discretion permanent that allows for cytogeneticists to review images remotely

The CAP will analyze in detail the provisions of the proposed regulation and submit comments during the agency’s 60-day comment period which is through September 11.

CAP Urges Senate Committee to Strengthen Laboratories for Future Pandemics

The CAP has asked a key health care committee in the Senate to make several changes to pandemic preparedness legislation to ensure laboratories can act swiftly to combat future public health emergencies.

First passed in 2006, the Pandemic and All-Hazards Preparedness Act is set to expire on September 30. The law’s authorities and programs serve as the country’s public health response, enabling the acceleration of medical public-private partnerships; a swift regulatory process to make tests, treatments, and vaccines available to Americans; and a strategic distribution and deployment of such medical products and supplies based on need. In March, the Senate Health, Education, Labor, and Pensions (HELP) Committee asked for input in the form of a request for information from public health officials, health care providers, and other stakeholders on policies they should consider, improve upon, and address during the reauthorization of the law. Therefore, on July 10, the CAP sent a follow-up letter in response to the HELP Committee’s request for feedback on the draft.

The CAP believes this is important as laboratories continue to prepare for future pandemics. Additionally, the letter urged the committee to:

  • Consider policies to standardize electronic laboratory reporting and authorize funding to enhance laboratory information systems. By establishing a uniform and standardized system for data sharing with public health agencies, Congress should ensure that burdens on data providers are manageable and streamlined given the critical role that such providers play during a public health emergency.
  • Strengthen the supply chain. The committee should clarify that clinical laboratory testing capacity is a critical part of the supply chain during a public health emergency.
  • Ensure a mechanism for adequate coverage and reimbursement of tests during a public health emergency. The reimbursement rates for COVID-19 tests ranged from $35 to $100, but those rates failed to account for the costs and resources necessary to bring testing online during the national public health crisis for laboratories of all sizes and localities. As a result, significant costs were incurred across the country as laboratories struggled with the crisis. The CAP called for established Medicare processes to determine clinical laboratory test prices are followed in the future and appropriate pricing is secured going forward.
  • Authorize funding to strengthen the laboratory workforce. The CAP urged the committee to mitigate the laboratory workforce shortage by providing funding to increase the availability and capacity of accredited laboratory training programs, fund and expand eligibility for federal scholarship, fellowship, and loan repayment programs and utilize federal resources to raise the visibility of careers in laboratory medicine.
  • Set Medicare reimbursement for clinical laboratory services on a sustainable path by adding the Saving Access to Laboratory Services Act (SALSA) to the reauthorization legislation as a permanent solution.

Read the CAP’s comments submitted to the Senate on July 10.

CAP Opposes the VA’s Proposed Use of ‘Cytologist’ for Cytotechnologists

The CAP is urging the Department of Veterans Affairs (VA) to avoid using the professional name “cytologist” for cytotechnologist interchangeably when defining roles in the clinical laboratory. In a July 14 letter, the CAP urged the VA to ensure professional titles and responsibilities in laboratories are clear to avoid confusion and align with education and training.

The VA is aiming to set national standards of care for members of the Veterans Health Administration workforce. These standards of care would establish clear and precise job descriptions which would allow for an individual employed in a given role in a VA health system to practice their profession at any facility within the VA system, regardless of the state licensure requirements.

Recently, the Department of Veterans Affairs published a request for information regarding cytotechnologists standard of practice and histotechnologists standard of practice. In response to the Department’s Request for Information. The CAP and the VA have opposing views on language, nomenclature and job descriptions pertaining to these two roles in the clinical laboratory. As a result, the CAP sent letters urging the VA to begin the process with clear and accurate names for the clinical laboratory workforce positions to which the standards of care will apply.

The CAP does not agree with VA that there is interchangeability between the term’s “cytotechnologist” and “cytologist.” The CAP said that to avoid confusion over professional licensing, scope of practice and assigned work between these two professions, a clear delineation of professional nomenclature should be maintained to avoid jeopardizing patient outcomes. This will also protect the clear distinction between education, training, and job responsibilities between the two professions.

The CAP has outlined to the VA that the correct nomenclature for a specialized medical laboratory technician who studies tissue samples is a histotechnologist. The VA used incorrect terminology referring to a histotechnologist as a histopathologist throughout the proposal. There is no non-physician profession categorized or referred to as “Histopathologist” in existence. The CAP further clarified that pathologists should always have direct supervision of histotechnologists in clinical laboratories and pertinent activities. As direct supervisors for histotechnologists, pathologists should retain full, unfettered authority to qualify clinical laboratory personnel as meeting personnel qualifications for histotechnologists.

The CAP requested that the VA use the accurate nomenclature for the roles in the laboratory workforce. Clarity in language pertaining to the variety of roles in the clinical laboratory is important as it potentially impacts government regulations, health care policy, as well as patients.

Read the CAP’s letters to the VA regarding cytotechnologists standard of practice and histotechologist standard of practice.

Register: Proposed 2024 Medicare Physician Fee Schedule Webinar

Do you know how much your Medicare pay will increase or decrease in 2024? Register in advance for our proposed 2024 Medicare Physician Fee Schedule webinar on July 26 at 1 PM ET/ Noon CT. During this session, you will learn the latest Medicare payment policies concerning individual pathology services and the Quality Payment Program next year.

Our expert presenters will also answer your questions. They are Jonathan Myles, MD, FCAP, chair, Council on Government and Professional Affairs; Diana Cardona, MD, FCAP, chair, Quality and Clinical Data Registry Affairs Committee; and Ronald W. McLawhon MD, PhD, FCAP, chair, Economic Affairs Committee. Secure your attendance for this complementary program today.

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