Advocacy News

• CAP talks with CMS about burdens in Medicare
• HHS, CMS, and insurers agree on prior authorization changes
• Physicians urge reinstatement of vaccine panel
• CAP calls for smarter health tech
• Survey deadline is now June 30

CAP leadership met with officials from the Centers for Medicare and Medicaid Services (CMS) on Monday to discuss payment, regulatory burdens, and other topics concerning pathologists and labs. 

Zoom in: The CAP previously outlined these issues in a letter to CMS Administrator Mehmet Oz, MD. The CAP had requested this meeting.

Discussion topics included: 

• Medicare payment system: The CAP emphasized retaining CPT and RUC processes to leverage physician expertise in Medicare nomenclature.
• Surprise billing and price transparency: The CAP supports patient protection but acknowledges the challenges associated with out-of-network payment disputes and compliance with good faith estimates.

Next steps: The CAP continues to work with CMS, the administration, and Congress to advocate for our specialty, to ensure that pathologists have the necessary resources to improve laboratory quality, and to safeguard patient access to tests.

Later Monday afternoon, health officials held a press conference to highlight a new pledge by the insurance industry to streamline prior authorization processes. 

The bottom line: Big insurers committed to six reforms aimed at reducing red tape, simplifying decisions, and improving transparency. These included:

• Standardized use of electronic prior authorizations with the Fast Healthcare Interoperability Resources (FHIR).
• Reduction in the number of services subject to prior authorizations by 2026.
• Ensuring medical professionals review all clinical denials.

The backdrop: Insurers have historically used tactics like prior authorization to interfere with patient care.

• CAP's recent report on insurer interference highlights how health plans narrow networks and reduce coverage.

What they're saying: "Insurers must reduce the delays to patient care and the growing administrative workload on physicians by targeting policies like prior authorization," said CAP President Donald Karcher, MD, FCAP. "We welcome the opportunity for continued dialogue to ensure that patient care is not delayed or denied."

What's next: More work is needed to ensure that patient care isn’t negatively affected, and that physicians can provide high-quality care in their communities.

The CAP joined dozens of medical organizations and state societies in calling for the immediate reinstatement of the Advisory Committee on Immunization Practices (ACIP) members. 

The joint letter signed on June 18 follows the termination of all ACIP members by HHS Secretary Robert F. Kennedy Jr. 

What they're saying: The letter underscores how changes to vaccine recommendations, and to the transparency of the recommendation process, may have severe consequences both for public trust and for access to immunizations.

• It also cites the ongoing measles outbreaks, underscoring the need for expert guidance on vaccines.

The CAP is urging the administration to improve interoperability and data accessibility to enhance workflow and patient care.

Background: Federal health agencies issued a request for information (RFI) on digital health products and data interoperability as they consider drafting new policies. The CAP responded with a letter on June 16. 

The CAP's recommendations include: 

• Increased incentives for hospitals to share data and address barriers for innovative applications.
• Collaboration to increase those incentives and to streamline the information blocking claim system.
• Positive incentives to encourage interoperability and to reduce the burden on pathologists. 

The CAP also signed a Physician Clinical Registry Coalition letter in response to the RFI, which highlighted the challenges registries face with data access. 

What's next: The responses to the RFI will guide government officials in advancing infrastructure and data availability for all stakeholders. 

• The CAP will continue to provide updates as new information emerges.

Did you miss your chance to take the 2025 Practice Leader Survey? Don't worry—the deadline has been extended until June 30!

Your feedback shapes the CAP’s advocacy efforts, empowering pathology’s message in Washington, DC. 

Act Now: Check your inbox for the survey invitation (or email PracticeSurvey@cap.org to request one) and submit your response by June 30.

• Already taken the survey? Encourage your fellow practice leaders to submit their responses.