Read the Latest Issue of STATLINE

June 6, 2017

In This Issue:

On May 12 the Centers for Medicare & Medicaid Services (CMS) approved the Pathologists Quality Registry as a Qualified Clinical Data Registry (QCDR), making it an invaluable reporting option for pathologists with fulfilling reporting requirements under Medicare's Quality Payment Program (QPP). The Pathologists Quality Registry is the first pathologist-specific clinical data registry designed by pathologists to earn QCDR status from the CMS.

As a CMS-approved QCDR, the Pathologists Quality Registry will collect medical quality data from a pathologist or pathology group practice for physician quality reporting under QPP. The registry will send data directly to the CMS to track quality and foster improvement in patient care. This will also ease the reporting burden for pathologists and improve opportunities to increase Medicare reimbursements through the Medicare QPP. Getting QCDR status from the CMS is a strong indicator that the Pathologists Quality Registry will be able to meet QPP reporting requirements in the future.

The Pathologists Quality Registry is set to launch at CAP17, the CAP's annual meeting, so that CAP members can begin submitting 2018 data on January 1, 2018. The registry also provides access to quarterly benchmarking reports that enable practices to improve care provided to patients. The registry will include 14 measures, eight of which are the current Physician Quality Reporting System (PQRS) measures developed by the CAP.

"The designation by the CMS of the Pathologists Quality Registry as a Qualified Clinical Data Registry is a significant achievement for CAP members, our patients, and the pathology specialty," said CAP president, Richard C. Friedberg, MD, PhD, FCAP. "Our registry will allow pathologists to report directly to the CMS on current and future pathology-specific measures, thus fulfilling CMS reporting requirements while closely tracking the quality of their practices."

The CAP is working with FIGmd, the leading provider of clinical data registries to specialty societies, to develop the Pathologists Quality Registry. Designed specifically for the practice of pathology, this registry will ensure pathologists have a mechanism for quality improvement against the CAP-established standards, while complying with requirements under the Medicare QPP.

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On May 23, President Donald Trump released his federal budget proposal, which calls for $3.6 trillion cut in federal spending over the next 10 years while making major increases in defense spending and border security.

Even though the president proposes the budget for the federal government, Congress controls spending and must pass final appropriations funding legislation.

The proposed budget would cut funding to the National Institutes of Health (NIH) by $7.4 billion, or 21.5% in 2018.

The President's budget recommends that the Food and Drug Administration (FDA) be cut from $2.74 billion to $1.89 billion. To offset the reduction, user fees paid by manufacturers of drugs, devices, and other medical products, which now total $1.2 billion and cover nearly half the cost of all medical-product activities, would be increased by more than $1.1 billion. As a result, the agency's overall funding would increase by more $400 million.

STATLINE will report when Congress passes the final budget this fall.

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The Illinois Senate Insurance Committee has dropped from a network adequacy bill a provision that would ensure adequacy of hospital-based providers, including pathologist and radiologists.

The Network Adequacy and Transparency Act (HB0311), which passed the Illinois House on April 24, requires an insurer to demonstrate to the Department of Insurance that it has provided a minimum ratio of full-time equivalent providers to plan beneficiaries and maximum travel and distance standards for beneficiaries. Under the bill, the Department of Insurance would have to conduct quarterly audits of all network plans to verify compliance with network adequacy standards. The legislation also requires health insurers to provide adequate notice when their health care professional is no longer in their network and allow patients to change plans if this occurs.

Notably, the House measure as passed also contained a higher standard, requiring that network plans demonstrate sufficient inpatient services, including services by pathologists, emergency medicine, anesthesiology, and radiology. The CAP, the Illinois Society of Pathologists (ISP), and other hospital-based specialties had pushed for inclusion of the measure to counter efforts by insurance companies to limit and narrow their networks. However, facing political pressure, the Senate Insurance Committee removed this provision from the bill. The measure now goes to the full Senate for consideration.

The CAP opposes efforts to weaken the bill and supports the legislation in the form passed by the House. The CAP believes that any state-approved health insurance plan networks under state and federal insurance exchanges should be subject to plan adequacy requirements that include evaluation of the adequacy for in-network pathologist participation and the timeliness, proficiency, and scope of pathology services provided.

The CAP also believes that states should require health plans that fail to maintain an adequate network be responsible for paying out-of-network pathologist providers all billed charges and at no greater out-of-pocket expense to the patient as would be the case for an in-network provider of the service.

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Adapted and reprinted from AMA Wire

The CAP together with the American Medical Association (AMA), the National Association of Medical Examiners, Texas Medical Association, and Texas Society of Pathologists advocated for the practice of medicine and the protection of forensic pathologists rendering their medical opinions. The CAP, AMA, and physician organizations representing pathologists and Texas physicians submitted an amicus brief in support of immunity for a forensic pathologist and CAP member as a county-employed medical examiner in Texas.

Darshan R. Phatak, MD, FCAP, Harris County deputy medical examiner, followed the standard of care and acted in good faith in compiling an autopsy report on a woman who had died from a gunshot wound. His report concluded the cause of death was homicide. Following a criminal trial that resulted in a hung jury, the medical examiner's office changed the autopsy report to indicate the cause of death was "undetermined." The charges against the defendant were dropped, and the defendant filed suit against Dr. Phatak.

The CAP, the AMA, and other physician organizations representing pathologists and Texas physicians filed a friend-of-the-court (amici) brief asking the court to apply qualified immunity in Dr. Phatak's appeal to the United States Court of Appeals for the 5th Circuit court. The amici are "greatly concerned" the lower court's ruling will have a "significant chilling effect" on forensic pathologists and other government-employed physicians.

Qualified immunity protections are important because they allow medical examiners and other publicly employed physicians—including those publicly owned health care facilities and prisons—to fearlessly render medical opinions, and the 5th Circuit should uphold those protections, the amicus brief states.

The brief argues that the district or lower court improperly relied on the "plaintiff's alleged version of the facts rather than on the actual evidence."

For medical examiners, the brief indicates this fear of liability could play out in two ways:

"An examiner may practice defensive medicine and perform needless tests before classifying a death as a homicide or an examiner may avoid classifying anything as a homicide at all," the brief states. "Both ways hurt medicine and thus harm the public, medical professionals, and the integrity of the justice system."

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The Centers for Medicare & Medicaid Services (CMS) soon will issue its latest proposed rulemaking that implements provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). On 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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