Advocacy Update

Read the Latest Issue of Advocacy Update

• July 25: Pathologists Day of Action on Surprise Medical Bills
• CAP Urges Anthem To Offer Clarification on Changes to Pathology Services
• Ohio Governor Vetoes Out-Of-Network Legislation Opposed By Pathologists
• 2020 Medicare Payment for Pathologists Webinar on July 30
• Can You Beat 80%? Take the July Advocacy News Quiz

On July 25, the CAP invites pathologists nationwide to participate in a day of action on surprise medical billing. Pathologists will send messages or call their members of Congress to advocate on out-of-network medical bills along with other physician societies across the country. The united advocacy effort before the August Congressional recess will ensure that legislators hear directly from physicians, and that health insurers should not be the only group to determine the value of physician services provided to patients.

During the morning of July 25, CAP members will receive an email directing them to our action center for engaging with Congress. In less than a minute, pathologists can use a form letter to email their representatives and senators. Members can further engage on social media with Congress after sending an email through the action center. The action center also provides telephone numbers and talking points if you wish to call lawmakers directly. 

Over the last few months CAP members have sent 10,167 messages through the action center to 474 elected officials on the surprise billing issue. Due to their advocacy and lobbying by the CAP and other physician associations, progress on surprise medical bills was achieved on July 17. Additional engagement by physicians before the August recess will further improve surprise medical bill legislation, so we deliver the best outcome for patients and pathologists.

CAP members who are interested in strengthening their voices on this issue can also make a donation to PathPAC—the CAP’s political action committee—which is the only such group that solely represents pathologists in Washington, DC.

The Energy and Commerce Committee marked up the No Surprise Act with amendments on July 17. An amendment by Reps. Raul Ruiz, MD (D-CA) and Larry Bucshon, MD (R-IN) added an independent dispute resolution, or appeals, process to the bill. The inclusion of an independent dispute resolution process is a necessary step to stop insurers from controlling patient access to medical services.

Other amendments adopted by the committee would require studies to assess the impact of the legislation on access to providers, network adequacy, premiums, and patient out-of-pocket costs. In addition, an amendment to the bill requires an audit of at least 25 health plans to assure that in-network median rates are being properly calculated. The CAP strongly supported the inclusion of these amendments.

While the CAP is still opposed to the bill and has several concerns—such as the high, arbitrary threshold of $1,250 that would exclude most pathology services from the appeals process, and a reliance on median in-network rates to reimburse out-of-network services—the Energy and Commerce markup of the No Surprises Act represented progress. In addition to the July 25 day of action, the CAP will be engaged as this bill moves to two other committees, where additional changes to the legislation may be considered.

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The CAP engaged with Anthem Blue Cross and Blue Shield (BCBS) to understand the insurer’s rationale for reductions to reimbursement for pathology services and expressed concern about policies that make it increasingly difficult for pathologists to continue to provide essential diagnostic services to patients. The CAP has been aware of Anthem’s implementation of fee schedule changes that resulted in reductions to pathology services. Moreover, the CAP continues to hear from concerned members regarding these cuts. 

In a July 16 letter to Anthem, the CAP highlighted several key issues, including concern and confusion over the new fee schedule changes, and the lack of clear communication and notification to pathologists. While there has been limited information publicly available, the CAP understands that Anthem’s new fee schedules will be substantially reduced from prior levels. Given the extent of this change, the CAP requested a comprehensive explanation of the reasons that led to the new rates, and clarification about how Anthem is valuing pathology services. Moreover, the CAP requested additional guidance and resources on exactly who is impacted by this change and where pathologists can go with concerns or questions.

Regarding communications to pathologists, the CAP stated its concerns with the process and short timeframe offered to providers to respond to the new rates. The CAP insisted that Anthem provide the appropriate information and time so that providers can understand and address the fee schedule changes in a fully educated manner.

While the CAP understands from a prior conversation with Anthem that providers may contact their regional network manager for additional information, that CAP asked that Anthem provide the response time, further contacts, and resources necessary for providers to make fully informed decisions on these changes.

The CAP will continue to communicate with members with any updates and communications on the changes from Anthem. For additional information and updates, go to our private health plans webpage.

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Ohio Gov. Mike DeWine vetoed provisions in the state budget that would have eliminated balance billing and tied physician payment for out-of-network services to the median in-network rates or Medicare reimbursement levels. The CAP had opposed these adverse budget provisions and, along with the Ohio Society of Pathologists (OSP), mobilized grassroots action by pathologists in the state to lobby against the legislation.

The budget bill provision, which had no public hearing or opportunity for physician testimony, also would have barred physicians from arbitration if the service was under $700 and did not address health plan network adequacy. The CAP and OSP strongly opposed these measures. Joint CAP-OSP grassroots action against the bill had generated approximately 500 emails from pathologists to legislative budget conferees.

Immediately following passage of the budget, the Ohio State Medical Association (OSMA) and the Ohio Hospital Association requested the Gov. DeWine to line item veto the provisions on out-of-network billing, noting: “We are extremely concerned that interested parties have not had ample opportunity to view the proposed policy to examine its potential impact upon how our state’s health care system functions. Unfortunately, because this is such a complex issue, we believe that should any proposed solution to surprise billing be enacted without the input of physicians, hospitals and other health care advocacy groups, it risks falling short of being the most effective solution for Ohio.”

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Due to a delay in the Centers for Medicare & Medicaid Services’ (CMS) release of the proposed updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations, the CAP rescheduled its webinar to Tuesday, July 30 at 1 PM ET/ Noon CT. However, if the CMS does not release the regulations by July 26, the CAP will cancel the webinar and work to schedule the program after the regulations have been published.

Webinar presenters will be the Chair of the Council on Government and Professional Affairs Donald S. Karcher, MD, FCAP; Vice-Chair of the Council on Government and Professional Affairs and Chair of the Clinical Data Registry Ad-Hoc Committee Emily E. Volk, MD, FCAP; and Chair of the Economic Affairs Committee W. Stephen Black-Schaffer MD, FCAP.

During the 60-minute webinar, attendees will learn about updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations and its impact on pathologists. The CAP panel will also answer questions from attendees.

If you are unable to attend the live event, a link to view an archived recording of the presentation will be sent to all registrants following the webinar. The recording can be viewed at your convenience.

We appreciate your flexibility and look forward to your participation during the webinar on July 30.

Register today for the webinar.

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Join over 100 of your fellow CAP members and test your advocacy knowledge with the new July Advocacy News Quiz. Of those members who took the quiz, they scored an average of 80%. See how you measure up against your fellow pathologists on this month’s quiz and share your results. Good luck!

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