Advocacy Update

Read the Latest Issue of Advocacy Update

• CAP Launches Summer Advocacy Campaign to Stop E/M Cuts
• CAP Members Meet with Congressional Leaders, Call for Action on E/M Cuts
• CAP Advocates for COVID-19 Diagnostic Test Payment Increase at Medicare Meeting
• FDA Announces COVID-19 Asymptotic Test Screening Templates
• HHS Temporarily Suspends Provider Relief Fund Reports
• With Georgia Pathologists and CAP, State Legislature Passes Out-of-Network Legislation
• 2021 Medicare Payment for Pathologists Webinar is July 16
• Test Your Advocacy News Knowledge

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 changes to evaluation and management (E/M) services.

In November of 2019, the Centers for Medicare and Medicaid Services (CMS) decided to reduce payments to all non-E/M services effective in January of 2021. The CMS decided that physicians, such as primary care doctors, should be paid more to reflect the work they do and the value they provide to patient care. To accomplish this, the CMS will shift funds from specialists, like pathologists, who do not bill E/M codes to comply with budget neutrality.

Without significant engagement by CAP members with their respective members of Congress, getting this issue addressed before the end of the year is going to be a major challenge. Members of Congress need to hear directly from their physician constituents about the severe impact this -8% cut will have on the vital role pathologists have in health care. The recent pandemic has highlighted the important role of pathology.

Already, CAP members have called their Congress members to discuss the impact of the COVID-19 pandemic on pathology, and the critical role laboratories have played with testing. During these calls, CAP members asked to wave budget neutrality to fix these Medicare cuts because of the devastating consequences on their pathology practices. The CAP is asking for you to add your voice to this fight.

The CAP is specifically asking its members to use this form to submit the advocacy activities. Amplify pathology’s voice and help educate Congress to stop these devastating cuts before January 2021 by using the E/M Advocacy Toolkit.

Make sure you follow the CAP Advocacy Twitter account to get breaking legislative and regulatory news. If you’re on social media, please feel free to help us get the word out by using #stopthecutssummer!

During direct meetings with congressional offices and through work with a coalition of physician organizations, the CAP called on leaders on Capitol Hill to delay the proposed non-E/M cuts in 2021. In addition to working with pathologists to speak with staff working for leaders in the Senate, the CAP, together with a coalition of 48 health care professional groups, detailed how the pandemic has already stressed the health care community and further asked Congress to delay the budget neutrality requirement for the E/M cuts.

CAP Board of Governor Mary Elizabeth Fowkes, MD, PhD, FCAP, and CAP member Alvin W. Martin MD, FCAP participated in virtual meetings with Senate leadership to discuss the detrimental impact on pathology if the E/M cuts are implemented in 2021 without some needed relief. During the meeting with Senate Minority Leader Chuck Schumer’s (D-NY) staff, Dr. Fowkes, Director of Neuropathology and the Autopsy Service at the Icahn School of Medicine at Mount Sinai in New York City, spoke about the essential role of pathologists play in COVID-19 testing during this pandemic. As a medical examiner, Dr. Fowkes emphasized the importance of her role during the pandemic to provide a scientific understanding of what happened to patients who died from the virus. As a result of the pandemic and other financial pressures already impacting pathology, these cuts will have a severe impact on pathology and the health care community. Dr. Fowkes discussed the need to waive budget neutrality around the E/M changes to mitigate the effects on pathology and other medical specialties.

Additionally, Dr. Martin met with Senate Majority Leader Mitch McConnell’s (R-KY) staff to discuss the detrimental effects of the cuts and the impact on pathologists. Dr. Martin outlined how harmful the cuts would be on the health care continuum and would harm health care access.

In addition to mobilizing CAP members for political action, the CAP and 48 other health care organizations, in a June 18 letter to congressional leaders, asked Congress to waive the budget neutrality requirements for the E/M policy change. The group further requested that this issue be included in forthcoming COVID-19 legislative packages.

In light of the COVID-19 pandemic and the increasing demand for diagnostic testing, the CAP has sought to improve reimbursement for COVID-19 testing to ensure that laboratories are compensated fairly. On June 22, the CAP asked the CMS to increase payment for CPT code 87635, Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique at the Annual Clinical Laboratory Fee Schedule Public Meeting.

During the meeting, Michael O. Idowu, MD, FCAP, provided key testimony on behalf of the CAP regarding the 2021 Medicare Clinical Laboratory Fee Schedule. Dr. Idowu emphasized that the current CMS Medicare Administrative Contractor payment for CPT code 87635 does not reflect the present clinical labor, equipment, reagents, and supplies needed to perform the COVID-19 diagnostic assay.

The CAP will continue to work with the CMS on this issue to ensure that the agency provides adequate reimbursement for laboratories during the pandemic.

The Food and Drug Administration (FDA) announced an update in the screening of COVID-19 asymptomatic individuals, including increasing diagnostics testing templates for COVID-19.

In June 16 update, the FDA posted diagnostic testing for COVID-19 template update for molecular diagnostic testing for developers to assay for pooling patient samples or for screening asymptomatic individuals not suspected of having COVID-19. The templates will make it easier for developers to get FDA authorization for asymptotic individuals.

The FDA authorized molecular diagnostic tests for individuals suspected of having COVID-19, including symptomatic, pre-symptomatic, or asymptomatic. The individual primary care doctor can use their discretion to test asymptomatic individuals when necessary.

The FDA recognizes that organizations may want to conduct screening of asymptomatic individuals as part of a broader strategy to ensure the safety of their employees, patients, students, and others. In addition to these template updates, the FDA has made available FAQs with information regarding tests for screening asymptomatic individuals, and added the following questions and answers:

• Are EUA-authorized SARS-CoV-2 diagnostic tests limited to use in individuals who are symptomatic for COVID-19?
• Can an FDA EUA-authorized SARS-CoV-2 diagnostic test be used for surveillance for COVID-19?

For the latest COVID-19 news, check out the CAP webpage.

The Department of Health and Human Services (HHS) announced on June 13 that it would temporarily suspend the required quarterly reporting for recipients who have received at least $150,000 from the Provider Relief Fund.

According to the FAQ document, applicable fund recipients do not need to submit separate quarterly reports, as the HHS will develop and post all information necessary for recipients to comply with this provision. Data will be posted on the HHS Tracking Spending - Increasing Accountability website https://taggs.hhs.gov/Coronavirus/Providers.

However, the HHS clarified in its latest FAQ guidance that the agency would be requiring applicable recipients to submit future reports relating to the use of Relief Fund payments, the details of which would be communicated "in the coming weeks." Find the complete HHS FAQ document online here.

The CAP has developed a guide for pathologists with questions about the Provider Relief Fund. View the CAP guide online here.

The CARES Act allocated $100 billion for a Provider Relief Fund to help physicians and other health care entities that are responding to the coronavirus pandemic. Of that, $50 billion is allocated for general distribution to Medicare facilities and providers impacted by COVID-19, based on eligible providers' net patient revenue. The Paycheck Protection Program and Health Care Enhancement Act added another $75 billion to the fund.

The CAP has additional resources for pathologists and their practices facing financial difficulty on our COVID-19 webpage. Other questions or concerns can be emailed to smallbusiness@cap.org.

A multi-specialty coalition, expertly led by the Medical Association of Georgia (MAG), in which both the Georgia Association of Pathologists (GAP) and the CAP were integrally involved, approved of out-of-network legislation that is poised to become law soon. On June 17, the Georgia Legislature passed legislation (HB 888) that applies to out-of-network services at in-network facilities. Georgia Governor Brian Kemp is expected to sign the bill into law.

The legislation bans balance billing of patients and establishes out-of-network payment by health plans. The payments will be paid directly to providers at a rate that will be the greater than "the most recent verifiable amount agreed to by the insurer and the non-participating provider for the provision of the same services or the median contracted rate in 2017 paid by all insurers, excluding Medicare and Medicaid.

Once active, the amount will be adjusted annually by the consumer price index. The legislation requires that the calculation be "verifiable." In addition, the legislation for an arbitration process, initiated by either a provider or facility, in which the arbiter can consider the "complexity and circumstances of each case, including, but not limited to, the level of training, education, and experience of the relevant physicians."

Furthermore, health plans are required to notify providers if the plans are regulated under federal law, known as ERISA, and thereby exempt from state law. The state legislation would waive the billing and payment limitations of the contemplated law only when the patient orally and in writing consents to receive out-of-network services, after being furnished with a written estimate of such services.

Soon the CMS will issue its proposed updates to the 2021 Medicare Physician Fee Schedule and the Quality Payment Program regulations, including the Merit-based Incentive Payment System (MIPS). On July 16 at 1 PM ET/ 12 PM CT, the CAP will offer a complimentary live webinar where CAP experts will review regulatory changes that will impact payment for services and pathologists’ participation in MIPS.

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.

It’s June, and it’s time to test your CAP Advocacy News Quiz. Last month, over 100 pathologists took the quiz. See how you compare against your fellow CAP members’ in the June News Quiz. Take the June news quiz.