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March 1, 2016
Pathologists Oppose Bill to Limit Balance Billing in Pennsylvania
The CAP and Pennsylvania Association of Pathologists (PAP) have opposed draft legislation prohibiting balance billing of patients by out-of-network physicians in Pennsylvania. Further, the CAP and PAP, in a February 19 letter, urged state insurance regulators to adopt network adequacy standards requiring sufficient numbers of in-network pathologists, including those practicing at in-network facilities.
The legislation, if enacted, would tip the equilibrium of payment negotiations between physicians and health plans in favor of the insurers, the CAP and PAP said. The legislation sponsored by the Department of Insurance effectively seeks to incentivize health plans to reduce or limit provider networks in order to secure economic advantage over physicians.
"We reject the approach of the Insurance Department which favors insurance interests," the letter stated. "We believe that Pennsylvania patients are best served when health plans are compelled by the State to undertake their fiduciary responsibility to their enrollees to ensure that patients at in-network facilities are able to have reasonable access to in-network providers."
The CAP and PAP urged the Department to not move forward with the legislation, and instead adopt regulation on network adequacy standards that:
- Require that health plans to document they have contracted with sufficient numbers of in-network physicians, including pathologists at in-network facilities in order to provide its enrollees with reasonable access to in-network physician services, including pathologists;
- Ensure enrollees are advised by health plans and network facilities of the financial risk in receiving out-of-network physician services for scheduled in-network facility procedures; and
- Ensure enrollees are advised by health plans of their options to obtain in-network physician services at in-network facilities before a scheduled procedure is to occur.
Advocate for Pathology at the 2016 CAP Policy Meeting
Registration is open for you to join your colleagues at the 2016 CAP Policy Meeting May 2-4 in Washington, DC. The annual event is the pathology specialty's opportunity to focus on the federal issues most important to pathologists now and in the future.
The 2016 Policy Meeting will feature guest speakers from Washington and pathology leaders from across the country. On May 4, pathologists will visit with their elected officials during the CAP's annual Hill Day. Meeting with your representative or senator is your chance to discuss the issues affecting pathology and the patients you care for every day.
Speakers and participants include:
- Renowned journalist David Gregory provides a firsthand analysis and running narrative of the Obama Administration, Congress and politics in America. David Gregory, former moderator of NBC News' Meet the Press, will share his insights on the latest Washington headlines, the current events facing our country and the upcoming 2016 race for the White House.
- Nationally recognized pollsters who will offer unique insights on the historic 2016 elections: NBC and Wall Street Journal pollster Peter Hart, whose work has been key in determining the future for some of the most influential politicians in the country; and Ed Goeas, President and CEO of The Tarrance Group, one of the most respected and successful Republican survey research and strategy teams in American politics today.
- Alberto Gutierrez, PhD, Director of the Food and Drug Administration (FDA) Office of In Vitro Diagnostics in the Radiological Health Center for Devices and Radiological Health, who will be part of a panel discussion on oversight of laboratory-developed tests (LDTs).
Collaborate. Advocate. Take Action.
Join your colleagues at the 2016 CAP Policy Meeting in Washington, DC. Focus on the issues most important to pathologists now and in the future. The CAP's Annual Hill Day will take place on May 4.
CAP Urges Congress to Support CDC's Harmonization of Test Results
The CAP joined laboratory medicine organizations to urge Congress to provide additional funding to harmonize the reporting of test results.
The CAP signed a letter with the laboratory medicine organizations supporting the Centers for Disease Control and Prevention (CDC) to continue and expand its efforts harmonizing test results so patients have access to comparable clinical laboratory test results. With health care delivery systems becoming more integrated, laboratory data will be the key piece of health information used to improve quality of care through clinical guidelines, performance measures, and electronic health records, the organizations said.
"When test results are not harmonized, the entire continuum of patient care can be affected in profound—but not always obvious—ways," the letter said. "For example, as medicine moves toward evidence-based guidelines as a way to ensure the best care for the population, often these guidelines are anchored in laboratory test results. However, if the test results do not align with the guideline, physicians may inadvertently misinterpret the results. Benefits from harmonization include fewer medical errors and lower healthcare costs by eliminating unnecessary follow-up diagnostic procedures and treatments."
The laboratory community, for example, had teamed up with the CDC and medical device manufacturers to harmonize some critical tests like cholesterol for heart disease and hemoglobin A1c for diabetes. In order to move the harmonization effort forward, the CDC requested $9.2 million for fiscal year 2017.
In addition to the CAP, the letter was signed by the American Association for Clinical Chemistry, American Clinical Laboratory Association, American Medical Technologists, American Society for Clinical Laboratory Science, Clinical Laboratory Management Association, Laboratory Corporation of America Holdings, Roche Diagnostics, and Siemens Healthcare Laboratory Diagnostics.