June 15, 2023
In this Issue:
Special Report: AMA Sets Medicare Pay Reform as Priority; Pathologists Influence Policy at AMA Annual Meeting
With a set goal of a predictable, sustainable, and fair physician payment system, the American Medical Association (AMA) House of Delegates declared Medicare physician payment reform an urgent advocacy and legislative priority for the AMA to address with a targeted campaign during its 2023 Annual Meeting in Chicago. Delegates representing the CAP at the meeting supported the measure as pathologists have fought against across-the-board Medicare cuts to all physicians for several years and, most recently, at our Pathologists Leadership Summit in April.
The CAP led the delegation of pathologists, called the Pathology Section Council, at the meeting. The section council includes American Society of Clinical Pathology, American Society of Cytopathology, the CAP, US and Canadian Academy of Pathology, National Association of Medical Examiners, and the American Society of Dermatopathology. In addition to Medicare payment reform, the Pathology Section Council engaged on a variety of topics concerning the specialty, including interventions to prevent human papillomavirus infection (HPV), blood transfusions, artificial intelligence, and noncompete clauses.
The Importance of AMA Membership
The entire house of medicine stood and applauded passage of new AMA policy to strengthen efforts to address deficiencies in Medicare’s payment system. Payment cuts and frozen rates have led to a 26% decline in Medicare physician payment since 2001 when adjusted for inflation, according to data from the AMA.
The AMA House of Delegates resolved to increase its lobbying budget to achieve Medicare payment reform that ensures physician pay is updated annually with a percentage increase equal to the Medicare Economic Index, a position also backed by the CAP in its advocacy efforts. The AMA Board of Trustees will also report back to the AMA House of Delegates at each annual and interim meeting on progress made to achieve payment reform.
The AMA has already dedicated significant resources for this cause, including its Fix Medicare Now campaign where physicians and patients can engage on the issue and contact lawmakers about the importance of this issue.
Interventions to Prevent HPV Infection and Associated Cancers
The AMA House of Delegates adopted a recommendation to modify existing policy concerning screening and treatment for breast and cervical cancer that the CAP and Pathology Section Council worked to amend. The Pathology Section Council supported efforts to prevent HPV through vaccination programs to people who are incarcerated. The recommendation also utilized more inclusive language on current policy on HPV screening and cancer treatment. The broader language offered by the Pathology Section Council clarified the recommendation and ensured that existing disparities in preventive services will not unintentionally increase.
Blood Transfusions/Blood Donations
On behalf of the Pathology Section Council, Jean. E. Forsberg, MD, FCAP and Cliff Sullivan, MD, offered testimony on a resolution on blood transfusions. The resolution primarily called for the AMA to undergo efforts that would discourage patient requests for blood products and components beyond current federal regulations or best-practice guidelines, including requests to exclude products from individuals who have received COVID-19 vaccines.
The section council supported the resolution but offered clarifying context and language to strengthen these efforts and support scientifically and medically supported transfusion best practices without any unintended consequences.
Residents and Fellows Section Delegate, Mary Clay Bailey, MD, provided testimony on ‘Support of Elimination of the Deferment Period for Blood Donation by Men Who Have Sex with Men (MSM)’ at the AMA Annual Meeting. As a member of the Residents and Fellows Section, serving on behalf of the CAP, she expressed support that the author of the resolution had brought to the forefront the issue calling for advocacy and support for the elimination of the three-month donation deferral policy for MSM. As implementation of new recommendations moves forward, the CAP and its members will be actively working with our AMA and other stakeholders to implement the individual, risk-based frameworks that ensure the safety of the nation’s blood supply.
Navigating Noncompete Clauses
The AMA House of Delegates approved a resolve to support policies that prohibits not-to-compete covenants for all physicians in clinical practice who hold employment contracts with for-profit or non-profit hospital, hospital system, or staffing company employers. The new AMA policy does not include private practices.
The AMA will oppose the use of restrictive covenants not-to-compete as a contingency of employment for any physician-in-training, regardless of accreditation status of the residency/fellowship training program. The AMA plans to further study the issue and report back on current physician employment contract terms and trends with recommendations to address balancing legitimate business interests of physician employers while also protecting physician employment mobility and advancement, competition, and patient access to care.
Artificial Intelligence and the Practice of Medicine
The AMA House of Delegates adopted a resolve that the AMA study and develop recommendations on the benefits and unforeseen consequences to the medical profession of large language models (LLM) such as, generative pretrained transformers (GPTs), and other augmented intelligence-generated medical advice or content, and that our AMA propose appropriate state and federal regulations. The AMA will work with the federal government and other appropriate organizations to protect patients from false or misleading AI-generated medical advice. The AMA will also encourage physicians to educate patients about the benefits and risks of consumers engaging with LLMs, including GPTs.
AMA Leadership Candidate Leadership Interviews
The AMA House of Delegates (HOD) elects officers and council members at each Annual Meeting. In interviews with the candidates, CAP leaders had an opportunity to engage on the specific, long-term AMA plans to address pending physician Medicare payment cuts given the impact of budget neutrality requirements and lack of an inflationary update. The CAP explained how pathologists are particularly impacted. While Congress has taken action to address some challenges continued leadership at the AMA will need to play a key role to implement needed changes. Workforce shortages were also a focus of our conversation and these challenges have been exacerbated by increased demand, medical education challenges, burnout, and the public health emergency.
Support Grows to Stop Medicare Cuts to Clinical Laboratory Services
The CAP recently teamed up with the American Clinical Laboratory Association (ACLA) to encourage Congress to enact the Saving Access to Laboratory Services Act (SALSA), which would stabilize Medicare’s payment system for clinical laboratory services. The CAP strongly opposes drastic cuts slated to hit clinical laboratory fees in 2024.
As part of ACLA’s Stop Lab Cuts campaign, they hosted an advocacy Hill Day on June 8, during which lobbyists from the CAP, ACLA, and other laboratory groups met with members of the House and Senate to encourage co-sponsorship and enactment of SALSA. The CAP further amplified this message during ACLA’s social media advocacy day on June 14.
SALSA would give the Centers for Medicare and Medicaid Services new authority to collect private market data through statistically valid sampling from all laboratory segments for the widely available test services where previous data collection was inadequate. By providing a gradual phase-in approach, the bill protects clinical laboratories, the Medicare program, and patients from the impact of dramatic rate increases or decreases.
How Pathologists Can Continue to Fight These Cuts
During the Pathologists Leadership Summit, CAP members advocated to support passage of SALSA. Pathologists can also encourage their representatives and senators to support the bill by signing into our Action Center.
CAP Supports Medicare Hospital Proposal to Pay Full GME Costs in Rural Areas
The CAP supported a Medicare proposal to pay rural emergency hospitals for resident training, noting concerns of shortages for pathology in these areas. The CAP’s support was highlighted in a June 8 letter to the Centers for Medicare & Medicaid Services (CMS) proposed regulation concerning inpatient hospital rates for 2024. The CAP engages with the CMS to protect the value of pathology services and advocate for favorable policies to the specialty.
In the June 8 letter addressing the proposed 2024 Hospital Inpatient Prospective Payment System, the CAP said it agrees with the 2024 proposal to pay rural emergency hospitals 100% of reasonable costs for indirect and direct graduate medical education. Additionally, the CAP urged the CMS to create opportunities and incentives to expand the pathologist workforce.
In other areas of the proposed regulation, the CAP supported increased payment for Chimeric Antigen Receptor (CAR) T-Cell and other immunotherapies for CAR T-cell cases. The CAP further urged the agency to continue to review the costs of CAR-T therapies and adjust the payments appropriately to ensure patient access to these lifesaving treatments.
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