Read the Latest Issue of Advocacy Update
June 30, 2020
In this Issue:
- Second Survey Confirms Laboratories Have More COVID-19 Testing Capability Despite Challenges
- CAP: HHS Must Recognize Barriers to COVID-19 Reporting Requirements
- CAP Objects to UnitedHealthcare Fee Schedule Cuts in Texas
- CMS Responds to CAP by Reducing MIPS Reporting Burdens; Details for Exceptions Need Clarity
- AMA, CAP Demand VA to Not Expand Scope of Practice During COVID-19
- Georgia Pathologists, CAP Strongly Support Two Out of Network Bills to be Signed Into Law
- Webinar Rescheduled to August 5: 2020 Medicare Payment for Pathologists Webinar
- Last Week to Test Your June Advocacy Knowledge
Second Survey Confirms Laboratories Have More COVID-19 Testing Capability Despite Challenges
The CAP resurveyed laboratory directors and confirmed what was stated in late April—that they expected their laboratories to ramp up their capacity and offer more tests in their communities in the weeks ahead. The CAP asked laboratory directors of CAP-accredited laboratories if the rate of COVID-19 testing had increased, key barriers to expanding testing, and the impact the pandemic has had on pathologists and other laboratory professionals.
The new June survey found substantial increases in COVID-19 testing capability, compared to the first survey, indicating that testing has increased and is available to patients despite ongoing issues with obtaining diagnostic supplies.
According to those responding to the survey:
- 76% of laboratories are providing COVID-19 testing as opposed to 60% in April
- 70% of the laboratories providing COVID-19 tests reported that they have the capacity for more testing than their current levels, as opposed to 80% in April
GAO Publishes COVID-19 Response Report
The Government Accountability Office (GAO) released its first bimonthly COVID-19 report as required by the Coronavirus Aid, Relief, and Economic Security (CARES) Act on June 25. According to the report, the federal government’s “absence of complete and consistent COVID-19 testing data … has made it more difficult to track and know the number of infections, mitigate their effects, and inform decisions on reopening communities,” the GAO also concluded. The GAO report is consistent with recent findings from the two surveys of CAP-Accredited laboratories, which also reported the lack of testing supplies and excess capacity for COVID-19 testing.
In the CAP survey, laboratory directors reported they could do more testing if they had all the necessary supplies. At the same time, laboratory directors indicated increased stress on pathologists and laboratory professionals due to burnout and the negative effects of furloughs and staffing shortages.
CAP: HHS Must Recognize Barriers to COVID-19 Reporting Requirements
On June 26, the CAP asked the Department of Health and Human Services (HHS) to describe the reporting burdens, and to clarify new requirements regarding the reporting of COVID-19 clinical laboratory test results and data elements. The CAP’s advocacy follows HHS regulations, released on June 4, that required laboratory reporting of COVID-19 test results along with other clinical data elements to health agencies.
Laboratories are required to report results from each COVID-19 test they provide to patients. In the June 26 letter to HHS Secretary Azar, the CAP urged the HHS to recognize the challenges that collection and reporting of the expanded data elements will create, especially since some of these data elements are not in many laboratory information systems currently. In the letter, the CAP stated how the “guidance significantly expands requirements for reporting of laboratory results with some new data elements that have not historically been required and may not be in many information systems currently... In addition, several data elements lack enough clarity with conflicting information regarding required vs. optional items for reporting.”
The CAP further pushed the HHS to relieve the reporting burdens on these laboratories. For example, “the 24-hour reporting requirement will be difficult to comply with as some data elements may have to be amalgamated from disparate databases, especially for employee health testing.”
To reduce the reporting burdens on clinical laboratories, the CAP wants the HHS to extend the implementation deadline of this regulatory guidance until further clarification is provided to clinical laboratories on required data elements. The CAP suggested delaying the reporting requirements until laboratories can effectively address their abilities to provide this data consistently during this national emergency.
The CAP will work with the HHS to reduce the clinical laboratory reporting burdens during this critical time.
CAP Objects to UnitedHealthcare Fee Schedule Cuts in Texas
In response to reports of new fee schedules in Texas by the health plan UnitedHealthcare that could lower payment rates for pathology services, the CAP will strongly object and urge the insurer to reverse the cuts.
The CAP is aware that several Texas pathologists received decreases to their UnitedHealthcare fee schedules in recent weeks. The CAP, as it has argued with other private insurers, believes these types of cuts will have adverse effects on pathology practices and the patients they serve. Given the current COVID-19 national emergency, the US health care system must adequately support pathology and laboratory services, including those of hospital-based pathologists, independent laboratories, and others. Go to our website for more information about the CAP’s advocacy with private insurers.
The CAP will report additional information regarding its engagement on this issue in future editions of Advocacy Update.
CMS Responds to CAP by Reducing MIPS Reporting Burdens; Details for Exceptions Need Clarity
For pathologists, physicians, and other clinicians who are unable to meet requirements for Medicare’s Merit-based Incentive Payment System (MIPS) in 2020 due to COVID-19, the Centers for Medicare& Medicaid Services (CMS) will allow you to request a hardship exception. The CAP has actively advocated for this MIPS reporting relief for pathology practices.
The CMS’ 2020 Quality Payment Program COVID-19 response includes MIPS reporting relief for practices for whom the “COVID-19 pandemic is preventing you from collecting data for an extended period of time.” The CMS requires practices to submit an extreme and uncontrollable hardship exemption application (by December 31, 2020). The CMS will review the applications on a case-by-case basis; for those practices with approved applications, the performance categories requested will be reweighted to zero. This means that if the CMS approves your application, you will have a neutral payment adjustment in 2022. Unlike for 2019, the CMS has not offered automatic neutral payment adjustment for clinicians who don’t submit data.
The CAP will work with the CMS on the details of this relief. For example, it is not clear how long it will take the CMS to provide decisions on hardship applications submitted in the 2020 reporting year, or on what basis decisions will be made.
If you have questions about this process or other aspects of the MIPS program, email the CAP’s experts at firstname.lastname@example.org.
AMA, CAP Demand VA to Not Expand Scope of Practice During COVID-19
The American Medical Association (AMA), the CAP, and several other medical professional societies are concerned about the administration’s desire to expand the scope of practice to include and increase responsibilities of non-physicians to care for US Veterans during the COVID-19 national emergency. The CAP continues to fight for pathology and laboratory medicine, especially during the COVID-19 pandemic, where accurate and timely diagnosis is critical in saving patients' lives.
In a June 24 letter to the Department of Veterans Affairs (VA), the group asked to change policy that undermines veterans’ health care by allowing “non-physician health care professionals ... to operate within the full scope of their license, registration, or certification, without physician oversight during the national emergency.” The group further demanded that the VA rescind their original directive.
The group is gravely concerned that the VA directive obstructs the state's scope of practice, allowing health care professionals to practice across state lines. The VA directive also establishes a new policy allowing VA health care professionals to operate within the full scope of their license, registration, or certification. The AMA, CAP, and others know that this will, “In effect, circumvents state scope of practice laws for the 32 health care professionals defined in the directive. Such a far-reaching expansion is overly broad, unnecessary, and threatens patients' health and safety within the VA system,” as stated in the letter.
Importantly the group emphasized that removing physician oversight of non-physician health care professionals is unnecessary during the COVID-19 pandemic, as lack of proper oversight threatens veterans and their families' health and safety.
Georgia Pathologists, CAP Strongly Support Two Out of Network Bills to be Signed Into Law
Two out-of-network bills backed by the Georgia Association of Pathologists (GAP) and the CAP have passed the Georgia State Legislature. The CAP has endorsed Georgia Governor Brian Kemp signing both bills into law.
The first bill, HB 888, applies to out-of-network services at in-network facilities. A coalition led by the Medical Association of Georgia (MAG), in which both the GAP and the CAP were integrally involved, approved of out-of-network legislation that is poised to become law soon. The second, HB 789 provides out-of-network balance billing protections for patients and an equal payment and arbitration provision for physicians.
Under HB 789, Georgia health plans will be required to indicate to enrollees if certain physician specialists are under contract at in-network facilities. Under the legislation, a health plan must divulge via a transparent checkmark rating whether the plan has in place at an in-network hospital a “Qualified hospital-based specialty group,” such as a medical group of anesthesiologists, pathologists, radiologists, or emergency medicine physicians. For the health plan, each specialty is assigned one checkmark in the four checkmark ranking system.
In a June 25 letter to Governor Kemp, the CAP urged to enact both bills. "These bills are critical to ensuring a robust health insurance plan market with equitable payments for physicians. Importantly, both bills ensure that Georgia patients can access in-network physicians, and should patients still lack access to in-network physicians, they will be financially protected,” stated CAP President Patrick Godbey, MD, FCAP, “These bills have the full support of the pathology community and merit your approval."
Rescheduled to August 5: 2020 Medicare Payment for Pathologists Webinar
Due to the impact of the COVID-19 pandemic, the CMS is expected to delay the release of the proposed updates to the 2021 Medicare Physician Fee Schedule and the Quality Payment Program regulations. Therefore, the CAP has rescheduled its webinar to August 5 at 1 PM ET/ Noon CT.
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.
Last Week to Test Your June Advocacy Knowledge
This is the last week to test your CAP Advocacy News Quiz. So far, over 50 pathologists took the June quiz. See how you compare against your fellow CAP members’ in the June News Quiz.