Advocacy Update

Read the Latest Issue of Advocacy Update

• AMA, CAP, and Over 100 Medical Societies Advocate Against Medicare Cuts in 2021
• CAP: UnitedHealthcare Should Stop Cuts to Pathologists
• Florida Pathologists Reverse Hostile Medicaid Proposal
• Webinar August 5: 2020 Medicare Payment for Pathologists
• New Month, New Advocacy News Quiz
• Breaking Advocacy News? Check out the Advocacy Twitter Channel

The American Medical Association (AMA), the CAP, and more than 100 medical societies, called on the Department of Health and Human Services (HHS) to mitigate Medicare cuts that will adversely impact specialty physicians in 2021. The CAP has persistently asked the administration, as well as Congress, to stop the cuts, which will amount to a -8% Medicare decrease to pathologists next year.

In the July 1 letter led by the AMA, the groups said they’re “concerned that the financial instability created by this [COVID-19] public health crisis will be exacerbated by budget neutrality adjustments required when CMS implements a widely supported Medicare office visit payment policy finalized for 2021.”

In November of 2019, the Centers for Medicare and Medicaid Services (CMS) finalized a changes and payment increases to evaluation and management (E/M) services. These changes take effect in January 2021. Due to budget neutrality requirements, the change will reduce payments to non-E/M services beginning next year. The CMS decided that physicians, such as primary care doctors, should be paid more to reflect their work and the value they provide to patient care. To accomplish this and comply with budget neutrality requirements, the CMS will shift funds from specialists, like pathologists, who do not bill E/M codes.

“To impose cuts of this magnitude during or immediately after the COVID-19 pandemic, including steep cuts to many of the specialties that have been on the front lines in efforts to treat patients in places with widespread infection, is unconscionable,” the letter said. “For these reasons, our organizations strongly urge HHS to use its authorities and flexibilities under the public health emergency to implement the office visit increases and waive the requirement for CMS to adjust Medicare physician payments for budget neutrality.”

The CAP launched a summer campaign of virtual advocacy demanding that Congress delay, mitigate, or cancel the -8% Medicare cut for pathology services that will take effect on January 2021. Congress can stop this cut by waiving budget neutrality for Medicare E/M services. The CAP is asking its members to use this form to sign up for advocacy activities.

Congressional Calendar Compressed

During this election year, Congress is expected to spend fewer days in Washington prior to the November elections. Time enact legislation in Washington, DC, will be compressed to short timeframes in July, September, and a “lame duck” session post-election.

Be sure to look for opportunities, such as a virtual town hall, to engage with your representative or senators while they are in your districts. Reference our E/M Advocacy Toolkit to help amplify your voice!

With the COVID-19 pandemic causing great financial strains on pathologists and their laboratories, the CAP has urged UnitedHealthcare to cease implementation of fee schedule cuts, or reverse cuts that are already in effect, to pathologists practicing in Texas.

In a July 7 letter to the major health insurer, the CAP said new fee schedules sent by UnitedHealthcare to pathology groups in Texas included cuts to payment rates at a time when physician practices are in serious jeopardy across the nation. Such blanket reimbursement cuts would exacerbate this crisis and make it increasingly difficult to continue providing essential diagnostic services to patients.

“When UnitedHealthcare does not meaningfully take into consideration the range of activities within pathology services and the variation of associated costs and resources across different settings, it limits the ability for patients to continue to receive important diagnostic services,” the letter said. “In addition to ensuring that patients receive the right test at the right time with an accurate diagnosis, pathologists coordinate with and educate clinicians, utilize electronic health records, and stay abreast of the most recent advances in diagnostics.”

Read the full letter the CAP sent to UnitedHealthcare

In June, the CAP was alerted to recent UnitedHealthcare fee schedule changes in Texas. The CAP, as it has argued with other private insurers, believes these types of cuts will have adverse effects on pathology practices and the patients they serve. Given the current COVID-19 national emergency, the US health care system must adequately support pathology and laboratory services, including those of hospital-based pathologists, independent laboratories, and others.

Go to our website for more information about the CAP’s advocacy with private insurers

Under pressure from the Florida Society of Pathologists (FSP), and support from the CAP, the Florida Agency for Health Care Administration (AHCA) reversed its proposed Medicaid policy to eliminate professional component reimbursement for clinical laboratory services across an array of approximately 1,000 clinical laboratory (CPT) codes. The CAP supported the FSP’s efforts to restore the professional component of clinical laboratory services for those CPT codes for Medicaid payment.

On June 30, the AHCA restored many proposed cuts and only eliminated the professional component on 11 CPT codes, while reducing the professional component on seven codes and adding reimbursement for seven new COVID-19 codes.

The revised proposal is still pending a formal rule announcement from the AHCA. The FSP had worked with the Florida Medical Association to get this reversal as it would be detrimental for Florida pathologists.

Due to the COVID-19 pandemic's impact, the CMS is expected to delay the release of the proposed 2021 Medicare Physician Fee Schedule and the Quality Payment Program regulations. Therefore, the CAP has rescheduled its webinar to August 5 at 1 PM ET/ Noon CT.

Webinar presenters will be the Chair of the Council on Government and Professional Affairs Jonathan Myles, MD, FCAP; Chair of the Economic Affairs Committee W. Stephen Black-Schaffer MD, FCAP; and Vice Chair, Economic Affairs Committee Diana Cardona, MD, FCAP.

During the 60-minute webinar, attendees will learn about updates to the 2021 Medicare Physician Fee Schedule and the Quality Payment Program regulations and its impact on pathologists. The CAP panel will also answer questions from attendees.

Register today for the webinar

New month that means a new July Advocacy News Quiz. See how you compare against your fellow CAP members’ in the July News Quiz.

Take the July news quiz

Want up to the minute CAP Advocacy news? Then follow us on twitter @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.

Check it out and follow today