STATLINE

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In This Issue:

• Modernized AMA Ethics Code Retains Language Critical to Pathology Advocacy
• Pathologists Lead Blood Drive at AMA Meeting
• Read the CAP's STATLINE Alert on the PAMA Final Rule
• To Ensure Access to In-Network Pathologists, CAP Proposes Changes to TN Proposal
• Pathologist Assistant Licensure Bill Passes NY Legislature
• CAP Webinar: How Medicare's New Physician Payment Systems Will Affect Pathologists
• CAP Webinar: Key Concerns for Pathologists in the 2017 Proposed Medicare Fee Schedule

The American Medical Association (AMA) House of Delegates approved a modernized Code of Medical Ethics, which concluded two years of work and deliberation on the code, including input from the CAP.

The CAP represented pathologists at the 2016 Annual Meeting held in Chicago June 11-15 and provided comment on several issues concerning pathologists. The AMA House of Delegates adopted several policies during the Annual Meeting, which included modernizing the AMA Code of Medical Ethics and setting goals for alternative payment models (APMs).

Earlier drafts of the Code of Medical Ethics would have negatively impacted pathologists by deleting verbiage critical to CAP advocacy on appropriate billing for pathology services. The CAP and Pathology Section Council worked to change those provisions in order to retain ethics language critical to pathologists.

The CAP further engaged in the discussion and deliberation on the code of ethics at the 2016 AMA Annual Meeting. Pathologists supported the modernized code, which included prior language regarding direct billing, anti-markup and disclosure of charges for laboratory and pathology services. For instance, the approved new ethics policy continues to state: "A physician should not charge a markup, commission, or profit on the services rendered by others. A markup is an excessive charge that exploits patients if it is nothing more than a tacked on amount for a service already provided and accounted for by the laboratory. A physician may make an acquisition charge or processing charge. The patient should be notified of any such charge in advance."

In addition, the code continues to provide that a physician should charge only for "the service(s) that are personally rendered or for services performed under the physician’s direct personal observation, direction, or supervision."

The full code will be available on the AMA website in the near future.

The Code of Medical Ethics has been in place for 169 years. In 2008, the AMA Council on Ethical and Judicial Affairs launched a major project to review and update the code. The modernization project sought to improve:

• Relevance – the code has language that applies to contemporary medical practice.
• Clarity – the code has an improved structure and formatting to ensure that foundational ethical principles and specific physician responsibilities are easy to find, read and apply.
• Consistency – the code has harmonized guidance that consolidates related issues into a single, comprehensive statement.

AMA Sets Goals for APMs

As the Medicare program implements new payment pathways for physicians, the AMA adopted policy that recommends specific goals for alternative payment models (APMs). APMs are one of two new payment pathways under the Medicare Access and CHIP Reauthorization Act (MACRA) reform law.

Susan M. Strate, MD, FCAP, a CAP delegate to the AMA House of Delegates, urged the AMA not to leave any physicians behind in the development of APMs and physician-focused payment models and requested support for flexibility for pathologists, other specialty physicians, and rural physicians. Delegates at the 2016 Annual Meeting adopted policy that pursues the following goals:

• Provide resources to support the services physician practices need to deliver to patients
• Reduce burdens of health information technology usage in medical practice
• Promote physician-led, team-based care coordination
• Provide flexibility
• Limit physician accountability to aspects they can reasonably control
• Avoid placing physician practices at substantial financial risk
• Minimize administrative burdens
• Be feasible for physicians in every specialty and all practice sizes

AMA Adopts Guidance for Telemedicine

New ethical guidance adopted at the AMA Annual Meeting gives physicians guidelines when using telemedicine to treat patients.

The development of the new guidelines coincides with innovations in technology that are changing the ways in which patients engage with medicine. Pathologists are also providing telepathology services to patients. The evolution of telehealth and telemedicine capabilities offers increasingly sophisticated ways to conduct patient evaluations as technologies for obtaining patient information remotely continue to evolve and improve.

The AMA guidelines permit physicians utilizing telehealth and telemedicine technology to exercise discretion in conducting a diagnostic evaluation and prescribing therapy, within certain safeguards. In any model for care, patients need to be able to trust that physicians will place patient welfare above other interests, provide competent care, provide the information patients need to make well-considered decisions about care, respect patient privacy and confidentiality, and take steps needed to ensure continuity of care, the AMA said.

Dr. Riddle Appointed to AMA Young Physicians Section

Pathologist Nicole Riddle, MD, was elected to the AMA Young Physicians Section Governing Council. The section focuses on the concerns of physicians under 40 or within the first eight years of professional practice after residency or fellowship training. Dr. Riddle practices in Guntersville, AL.

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At the 2016 AMA Annual Meeting, the Pathology Section Council led a blood drive on June 10 that included several first-time blood donors and could save more than 150 lives.

Following the blood drive, Jean Forsberg, MD, FCAP, a CAP delegate to the AMA House of Delegates, thanked the AMA’s staff, board, and donors for their support, as well as LifeSource, the local blood bank which was a partner to the Pathology Section Council in this effort.

Dr. Forsberg also reflected on the horrific shooting in Orlando and the blood transfusions needed to treat the victims and save lives. "Whenever there is a tragedy in the US, people want to donate blood immediately. But we also need to encourage them to become regular donors because what is used during tragedies is the blood donated the week or month before."

The Pathology Section Council wanted to host an AMA event to highlight the pathologist's role in managing the nation's blood and to raise awareness about the importance of donations given that deferral guidelines are constantly changing. There is Food and Drug Administration guidance related to the Zika virus, and additional blood donation deferral guidelines are expected this summer.

Members of the Pathology Section Council are the CAP, American Society for Clinical Pathology, American Society of Cytopathology, National Association of Medical Examiners, and United States and Canadian Academy of Pathology.

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A final regulation filed on June 17 delayed until 2018 the implementation of new clinical laboratory fee schedule (CLFS) payment rates set forth under the Patient Access to Medicare Act (PAMA). PAMA will require applicable laboratories to collect and submit data on private payer reimbursements for clinical laboratory services, and the Centers for Medicare & Medicaid Services (CMS) will use the weighted median of these reimbursements to set fees for these services provided to Medicare patients.

The final rulemaking has been long delayed, published almost a year after the date required by statute. As a result, the Medicare agency not only delayed implementation of the reformed CLFS payment rates until 2018, but also data collection which will be based on the first six months of 2016 and data reporting until January 1–March 31, 2017.

The CAP sent a STATLINE Alert to members the night of June 17 with its initial analysis of the rule. In case you missed the alert, it is available to read in STATLINE's news archive.

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The CAP urged the Tennessee Department of Commerce and Insurance to require insurers to have adequate networks of hospital-based physicians available to patients enrolled in health plans operating in the state.

In a June 10 submission, the CAP joined the American Society of Anesthesiologists (ASA) and American College of Radiology (ACR) in calling on Tennessee insurance regulators to ensure health plans maintain sufficient access to in-network hospital-based specialty physicians. The state Department of Commerce and Insurance is considering urging adoption of model language on network adequacy developed by the National Association of Insurance Commissioners (NAIC). In the comment letter, the CAP, ASA, and ACR stated its strong opposition to the NAIC model’s regulation of out-of-network billing as it insufficiently ensures enrollees have reasonable access to in-network physicians at in-network facilities and hospitals.

"As a general statement of principle, we believe that when patients have no reasonable access to in-network physicians and are unable to access such physicians at in-network facilities and hospitals, it reflects the inadequacy and failure of the health plan," the letter said.

The CAP, ASA, and ACR outlined changes to the NAIC model legislation that would require state insurance commissioners to require health plans to have sufficient numbers of in-network, hospital-based physicians at in-network hospitals and facilities. When health plan enrollees do not have access to an in-network facility or hospital-based physician at an in-network facility or hospital, those enrollees cost-sharing should count toward maximum out-of-pocket limits, the letter said. Covered patients should also be allowed to assign any balance bill expense greater than the enrollees' in-network cost for services to the health plan, which would be responsible for such payments.

Earlier this year, out-of-network billing legislation to limit balance billing in Tennessee failed to gain support from state lawmakers after opposition from the CAP, Tennessee Society of Pathologists (TSP), and other physician societies in the state. At the time, the CAP and TSP also advocated for state regulators to require health plans to ensure patients at in-network facilities have reasonable access to in-network providers.

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The New York State Legislature passed a measure with CAP guidance to create a new licensure category for pathologists' assistants under state education law. The legislation, after clearing the state Assembly June 15 and the state Senate on June 14, is awaiting formal finalization and transmission to NY Gov. Andrew M. Cuomo for his signature.

The effort to pass the licensure for pathologist assistants was led by the Greater New York Hospital Association with support and technical assistance from the CAP and New York State Society of Pathologists (NYSSPATH). The New York State Department of Health had urged establishment of the new licensure category because certain laboratory limited licensure categories, under which pathologist assistants currently practice, may be sunsetting in September 2016. The bill, if signed into law, would ensure that pathologists' assistants have an appropriate licensure category to continue their practice in the state.

Under the bill, pathologists' assistants are supervised by licensed physicians who practice anatomic pathology. Moreover, according to the bill, the pathologists' assistants' scope of practice includes preparing gross tissue sections for pathology analysis, performing postmortem examinations, and other functions and responsibilities. The bill expressly denies pathologist assistants any authority to diagnose or provide a medical opinion.

Gov. Cuomo is expected to sign the bill into law.

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The CMS published its proposed regulation to implement Medicare payment reform under the MACRA. CAP leaders will review the proposed MACRA rule and discuss how it affects pathologists during a 60-minute webinar presentation on July 7 at 2 PM ET.

The MACRA regulation would set two payment pathways for physicians beginning in 2019: the MIPS and APMs. MIPS is expected to have an estimated $1.5 billion impact on payments to pathologists. Physicians participating in eligible APMs would not be subject to MIPS and would receive 5% Medicare payment bonuses.

The CMS is proposing to use 2017 as its first year to start measuring physician performance under the new payment system. Learn more about MACRA, MIPS, and APMs during this complementary presentation for CAP members. At the end of the presentation, our expert panel will answer your questions.

Register Today

Registration for this complementary presentation is available for CAP members and their staff. If you are unable to attend the live event, those who register will automatically receive an email link to an archive recording of the presentation by July 11.

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Throughout this hour-long panel discussion on July 14, CAP experts will explain the changes proposed by the CMS in the draft 2017 Medicare Physician Fee Schedule. The presentation begins at 2 PM ET.

Expected to be published by the CMS in early July, the proposed fee schedule contains reimbursement changes affecting pathologists. Under a new requirement, the CMS will provide additional detail on its intention to revalue certain pathology services targeted as potentially misvalued. During the webinar presentation, the CAP will review proposed changes, discuss how the rule affects Medicare reimbursement for pathology services, and the CAP's advocacy efforts to impact the CMS’ proposal prior to its finalization.

The second part of the webinar will be a question-and-answer session.

Register Today

CAP members are encouraged to register for this complementary presentation. If you are unable to attend the live event, those who register will automatically receive an email link to an archive recording of the presentation by July 18.

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