Read the Latest Issue of STATLINE

June 27, 2017

In This Issue:

On June 22, the Senate released its version of the American Health Care Act (AHCA) renamed the bill the Better Care Reconciliation Act of 2017 (BCRA) that would reform the nation's current Medicaid program, make significant changes to Affordable Care Act's (ACA) insurance regulations and coverage mandates, and eliminate the majority of the ACA taxes.

The Senate will seek a vote on the BCRA bill later this week before Congress leaves for its Fourth of July recess, but the situation remains fluid. The nonpartisan Congressional Budget Office (CBO) estimates that the BCRA bill would leave 22 million more Americans without health insurance by 2026 compared to the Affordable Care Act and 1 million fewer people than under the House version. The CBO also estimated that 15 million fewer Americans would have coverage next year, compared with the current law. Finally, the CBO also estimated that the bill reduces the federal deficit by $321 billion over a decade.

The BCRA bill would reform the Medicaid program by phasing out its expansion over three years (starting in 2021) and overhaul the traditional Medicaid program. The BACA bill would change how traditional Medicaid is funded from the federal government to a block grant or giving states a per capita amount starting in 2021. The growth rate of how much money is given to the state in these two options would be slower than the AHCA bill starting in 2025. Moreover, 11 million Americans who gained health insurance through Medicaid expansion would lose their health care insurance.

The Senate bill repeals the ACA's 3.8% tax on investment income on people earning an annual income above $200,000, ends all ACA mandates and taxes, except the Cadillac tax, and repeals the individual mandate. The BCRA bill also proposes tax credits based on income level, age, and geography like the ACA and unlike the House version of the bill.

The BCRA bill would also make it easier for states to waive consumer protections in the ACA that require insurance companies to charge the same premiums to sick and healthy people and to provide a specific set of benefits. BCRA would keep funding ACA's cost-sharing subsidies for those purchasing insurance for 2018 and 2019 but then repeals them.

On June 26, the Senate released an updated version of BCRA that included a new "lock-out" provision that starts in 2019, which would impact individuals who do not have continuous insurance coverage for 63 days. Those individuals would be subject to a six month waiting period before coverage begins.

The CAP sent a letter to the US Senate Leadership outlining the CAP's health care reform principles and policy recommendations as the latest version of the health reform bill is currently in the Senate.

The CAP has adopted a set of policy principles as a framework for changes to the ACA and we urge Congress to consider these key components during deliberations to reform our current health care system. These principles are:

  • Any efforts to reform the health care system at the national, state or local levels should ensure that individuals with healthcare insurance can continue to access affordable insurance without interruption and take steps toward coverage and access for all Americans.
  • Maintain key insurance market reforms, such as pre-existing conditions, parental coverage for young adults, and elimination of annual and lifetime coverage caps.
  • Protect prevention and screening services that are currently covered.
  • Stabilize and strengthen the individual insurance market.
  • Reduce regulatory burdens on physicians implemented as part of the ACA and subsequent Medicare legislation that expanded upon the ACA.

The bill does not address the majority of the CAP's overarching principles for health care reform. The bill also would leave intact ACA provisions that have been harmful to pathologists. Fundamentally, the bill does not address regulatory burdens on physicians nor does it detail how it would pay for tax repeals.

The CAP along with the vast majority of the medical community including the American Medical Association, American College of Physicians, American Hospital Association, Federation of American Hospitals, AARP and patient advocacy organizations, oppose the legislation in its current form.

Stay tuned to STATLINE for further updates on health care reform.

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In a favorable conclusion of pathologist and patient advocacy over almost four years, the New York State Department of Health is proposing to remove the legal prohibition on pathologists responding to patient inquiries and contacting patients with test results in cases where critical values must be urgently communicated. In its proposed rule revision the Department acknowledged: "the importance of the pathologist-patient relationship as part of the spectrum of physician-patient relationships and its role in ensuring the delivery of safe, high-quality, patient care."

Although federal regulations took effect in 2014 permitting a laboratory to provide a patient access to completed test reports upon request by a patient or the patient's representative, New York State continued to prohibit pathologists from discussing test results with patients.

Under current rules, clinical laboratories and pathologists are prohibited from responding to patient inquiries on the meaning or interpretation of their test results. According to the Department of Health, the rule was originally put in place to prevent kickbacks or other payments from being given for referral of laboratory services. The rule required that laboratories direct a patient's inquiries regarding the meaning or interpretation of test results to the referring health services purveyor. The CAP had long urged the Department to remove the prohibition.

In its June 21, 2017, proposed rulemaking to void the prohibition for physicians, the Department of Health acknowledges that "direct communication between pathologists and patients regarding test results is not always needed, but in some instances, direct communication is crucial to providing safe, high-quality, patient-centered care."

The proposed regulation will add affirmative language to Section 34-2.11 of the Public Health Law to provide that, under specific circumstances, a licensed physician employed by a clinical laboratory may discuss the meaning and interpretation of test results directly with patients.

Specifically, the Department proposes the following language be added to a provision prohibiting a clinical laboratory from communicating to a patient the results of a clinical laboratory tests:

"Nothing in this section shall prohibit a licensed physician from communicating with a patient:

  1. When requested by the referring health services purveyor;
  2. When requested by the patient;
  3. When the referring health services purveyor, or other individual responsible for using the tests results, cannot be reached and a critical value needs to be communicated to the patient."

CAP President Richard Friedberg, MD, FCAP, reached out to a number of organizations thanking them for their support for the repeal. In a June 9 letter sent to numerous New York State and national patient advocacy groups that supported the CAP position, Dr. Friedberg said he was pleased to report that the Department of Health now recognizes the importance of the pathologist-patient relationship and is proposing to remove the legal prohibition on pathologist communication with patients.

The CAP will announce the date of enactment once this proposed rule is finalized.

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The clock is ticking away and the CAP wants to make sure that your practice is ready to participate in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This new law is changing the way physicians are paid under Medicare.

The CAP developed a MACRA-readiness checklist for pathologists to help pathologists successfully participate in the Quality Payment Program in 2017.

You can use this checklist to improve your performance in Medicare's Quality Payment Program.

You can download it from the Quality Payment Program web page.

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The Oregon Pathologist Association (OPA), the Oregon Medical Association and the CAP have successfully blocked state lawmakers' attempts to link the state's out-of-network (OON) physician payment formula to Medicare. House Bill 2339A, which passed the Oregon House on April 11, would have linked OON payment to 175 percent of Medicare for non-emergency services.

An amended bill, which passed the Senate June 8 and the House June 13, prohibits OON providers from balance billing patients for services provided at in-network facilities, effective March 1, 2018. Instead of tying OON payment to Medicare, the revised bill directs the Department of Consumer and Business Services to convene an advisory group that includes health care providers, insurers, and consumer advocates to develop recommendations for the reimbursement of services provided to enrollees by OON providers at in-network health care facilities. Governor Kate Brown is expected to sign the bill into law.

The advisory group is directed to provide its recommendations no later than Dec. 31, 2017.

The OPA and the CAP have long supported payment to OON physicians in accordance with usual and customary rates that reflect the market value of physician services based upon an independent database of charges that are determined by geography. They oppose tying OON payment to Medicare, arguing that it would limit what a health plan can pay to an OON physician, including pathologists, thereby devaluing certain physician services.

In addition, because the Medicare fee schedule was designed only for medical services rendered to persons over the age of 65, some medical services—including some pathology and some genetic screening services—are not covered by Medicare.

The CAP will continue to follow developments on recommendations from the advisory committee.

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In 2018, most pathologists will need to take action to stop penalties from reducing future Medicare payments for their services.

The CMS has issued its latest proposed rulemaking that implements provisions of the MACRA. On Wednesay, June 28 at 1:00 PM ET, the CAP will host a 60-minute webinar to discuss the CMS's proposals for participating in the 2018 Medicare Merit-based Incentive Payment System (MIPS) program, including options for preventing Medicare penalties.

Patrick E. Godbey, MD, FCAP, chair of the CAP's Council on Government and Professional Affairs; Jonathan L. Myles MD, FCAP, chair of the CAP's Economic Affairs Committee; and Diana M. Cardona, MD, FCAP, chair of the CAP's Economic Affairs Measures & Performance Assessment Subcommittee, will discuss how these proposed Medicare pay changes under MACRA will affect pathologists in 2018.

Register today.

By registering you will also receive a link to a recording of the presentation following the live event. Registrants will receive the link to the recording even if they are unable to attend the session on June 28.

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CAP Members from left to right, Patrick E. Godbey, MD, FCAP, Jonathan L. Myles MD, FCAP, and W. Stephen Black-Schaffer, MD, FCAP

On Monday, July 17 at 1:00 PM ET, the CAP will host "Pathology Payment - An Overview of the 2018 Proposed Medicare Physician Fee Schedule Webinar". Throughout this 60-minute panel discussion, CAP experts will review the proposed changes from the Centers for Medicare & Medicaid Services (CMS) 2018 Medicare Physician Fee Schedule. These proposed changes will include Medicare reimbursement and policy changes that will affect pathologists. The final fee schedule will be published by the CMS in the fall of 2017

Learn from Patrick Godbey, MD, FCAP, Chair of the CAP Council on Government and Public Affairs, Jonathan Myles, MD, FCAP, Chair of the CAP Economic Affairs Committee, and W. Stephen Black-Schaffer, MD, FCAP, Vice Chair of CAP Economic Affairs Committee on how the proposed changes to the physician fee schedule will affect pathology services. During the webinar presentation, CAP experts will also discuss the CAP's advocacy efforts to impact these changes.

Register today.

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Following the Independence Day holiday, STATLINE will next appear in your email inbox on July 11. Please continue to check the CAP Twitter and Facebook accounts for updates from the CAP.

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