Read the Latest Issue of Advocacy Update
June 18, 2019
In This Issue:
CAP Asks HELP Committee to Set Fair Pay Mechanism for Surprise Bills
As congressional committees debated proposals to legislate out-of-network surprise bills and other health care proposals, the CAP urged lawmakers to establish a fair arbitration process and payment formula while holding patients harmless when physicians’ services are unexpectedly provided out of network.
On June 18, the Senate Health, Education, Labor & Pensions (HELP) Committee was scheduled to hold a hearing on its legislative proposal, the Lower Health Care Costs Act. The Lower Health Care Costs Act is a bipartisan proposal that not only intends to combat surprise medical bills, but also addresses efforts to lower the cost of prescription drugs, improve health care transparency, improve access to personal health records, and lower the overall cost of health care delivery.
Through no fault of their own, patients are caught off guard when an insurer does not cover physician services, the CAP said in a statement to the committee. There is an agreement to hold patients financially harmless during these billing scenarios, but the CAP disagrees provisions in the HELP Committee bill that undermine the economic viability of health care delivery and impede access to hospital-based specialty physicians.
“The CAP believes that to protect patients from gaps in their health insurance coverage, insurers and providers should settle all payments without the patient’s involvement, including the use of an independent arbitrator to settle disputes,” the CAP said. “Network adequacy standards for health plans should be set, and at a minimum, there should be network standards for ensuring that an appropriate number of specialty physicians are available to provide medically necessary services at ‘in-network’ facilities.”
The CAP will continue to engage with the committee on its legislation as it moves forward with the legislative process.
Pathologists are urged to also remain engaged with their elected officials in Congress on the surprise medical bill issue. CAP members can contact their senators and representatives on this important issue through our grassroots action network, PathNET.
Health Care Reform, Artificial Intelligence Discussed at the Annual AMA Meeting
With the increased use of artificial intelligence (AI) in health care, physician delegates at the American Medical Association (AMA) adopted policy to advocate for the oversight and regulation of AI systems during the AMA Annual Meeting June 8-11. Delegates at the meeting, which included members of the CAP, also directed the AMA to study further the current medical education practices regarding the clinical use of pathology and laboratory medicine to identify potential gaps in training.
As a leading voice for pathologists in the AMA, the CAP led a delegation of pathologists to advocate for health care policies concerning its members. The CAP participated in several meetings, including interviews with AMA leadership, to urge action on policies concerning patient care, professional issues, regulatory oversight, and reimbursement. In addition to presentations by top health care officials in the Trump administration, the AMA made history by electing its first African-American female president.
The AMA Adopts Policy to Strengthen the ACA
The AMA House of Delegates adopted a new policy to boost its push for universal coverage by improving the Affordable Care Act (ACA) while maintaining its opposition to a single-payer approach to health system reform. The AMA aims to strengthen the current Affordable Care Act and not abandon it as it has made strides to help the uninsured
During the meeting, Seema Verma, the Administrator of the Centers for Medicare & Medicaid Services (CMS), highlighted the agency’s efforts to cut physicians’ regulatory burdens in a speech to the AMA House of Delegates. She also discussed the ramifications of a government-run health care system and assured the AMA that any health care reforms would have “patients and their doctors at the forefront because no one else should make decisions about patient’s health care,” she said during her keynote address.
Precautions with AI in Medicine
There was much discussion on the impact of augmented or artificial intelligence (AI). AI in health care is evolving rapidly, and issues regarding definitions of key terms, clinical effectiveness, and safety were addressed in AMA policy. The AMA heard testimony that “AI should be designed to enhance human intelligence and the patient-physician relationship rather than replace it.” The HOD adopted a new policy that further studies AI and its potential to benefit for doctors and physicians in training, including that medical specialty societies, like the CAP, should consider the production of specialty-specific educational modules related to AI.
Site of Service Policy
During the meeting, the CAP advocated to eliminate any site-of-service differential payments to hospitals for the same service that can safely be performed in a doctor’s office. The AMA decided to keep its current position on this policy as the association working with the CMS to address this matter.
Pathology in Medical School Education
Because of the CAP’s strong advocacy during the meeting, the AMA will study the current medical education practices regarding the clinical use of pathology and laboratory medicine information to identify potential gaps in training. The AMA will report back to the House of Delegates after studying the issue.
Female-Led Executive Team at AMA
Patrice A. Harris, MD, a psychiatrist from Atlanta, was sworn in as the AMA’s 174th president, at the AMA Annual Meeting. She is the first African-American woman to hold the office. Moreover, the AMA House of Delegates elected Susan R. Bailey, MD, an allergist and immunologist from Fort Worth, Texas, as the president-elect during the meeting.
Following a year-long term as president-elect, Dr. Bailey will assume the office of AMA president in June 2020. Dr. Harris succeeded Barbara L. McAneny, MD, who is now the AMA immediate Past President. This marks the first time in the association’s history that women have held all three president positions at the same time. The diversity at the top represents a turning of the tide for the AMA, as Dr. Harris said, “diversity within the AMA’s membership is its main strength,” during her inaugural address.
The CAP is an active member of the AMA House of Delegates and encourages pathologists to join the AMA or renew their AMA membership. A robust CAP delegation at the AMA can shape a health care system that best utilizes pathologists to deliver high-quality care and meet the evolving demands of patient care. The CAP and AMA work together on many of the health and medical policies that affect the way you practice and your reimbursements. Join or renew your AMA membership today.
CAP to Launch Survey for Upcoming RUC Meeting
The CAP will issue a physician work survey the week of June 24 to a random sample of CAP members to collect data on the pathologist’s work for code G0452 (Molecular pathology procedure; physician interpretation and report). The data collected will help the CAP, in concert with the RUC, recommend accurate relative values for physician work to the Centers for Medicare and Medicaid Services, and be presented at the AMA Relative Value Scale Update Committee (RUC) meeting later this year.
The survey will ask recipients to apply their clinical knowledge and expertise to time and value related to the service. The resulting data will be aggregated and analyzed to build value-based recommendations. Once recommendations are approved at the RUC meeting, they will be forwarded to CMS for review and finalization in the Medicare Physician Fee Schedule.
If you receive the survey, please complete it immediately. It’s critical to provide data-driven and evidence-based recommendations at the RUC meeting.
For more information on the RUC survey process, please watch the following YouTube video.
The CAP values your participation in this process. If you have questions, please contact Maurine Dennis at 202-354-7136.
Texas Enacts OON Legislation to Ban Balance Billing
The CAP worked with the Texas Society of Pathologists (TSP) on a new state law that bans balance billing for out-of-network services. The ban will include pathology and laboratory services unless the patient voluntarily selects the service. Out-of-network laboratory services are subject to the law regardless of the setting where the patient specimen is obtained.
The new law does not prescribe a payment formula, other than the usual and customary amount, which is not specifically prescribed in the bill, or an agreed upon amount. The law also establishes an arbitration system to resolve payment disputes between providers and health insurance plans.
The arbitrator’s determination must consider, among other factors: the 80th percentile of all billed charges for the service performed by a health care provider in the same or similar specialty provided in the same geographic area as reported in a benchmarking database. The determination must also consider the 50th percentile of rates for the service paid to participating providers in the same geographic area as reported in the database.
Given advocacy experience in other states on this issue, the CAP provided technical assistance to the TSP during legislative process. The prior Texas law allowed patients to mediate disputed balance bills. The new law, which effectively bans balance billing and removes patients from the billing dispute, goes into effect on September 1, 2019.
Take the June Advocacy News Quiz
The CAP has a new Advocacy News quiz for June, where you can test your knowledge and share your scores on social media. Last month more than 70 CAP members took the quiz and shared their results on social media. See how you measure up against your fellow pathologists on this month’s quiz. Good luck!