Advocacy Update

March 21, 2023

In this Issue:

CAP, AMA, and Others Ask Congress to Pass Inflation-Based Medicare Payment Fix

The CAP, the American Medical Association (AMA), and over 130 medical professional societies asked Congress to pass legislation that provides an annual inflation-based payment update based on the full Medicare Economic Index (MEI). The MEI index legislation would be an inflation-based update solution to the ongoing problems plaguing the Medicare Physician Fee Schedule (MFS) and ongoing Medicare payment cuts to all physicians. The CAP continues to fight for fair pay for the value pathologists provide.

In the March 15 joint letter, the groups representing over 900,000 physicians, urged congressional leaders in both the House and Senate to pass legislation providing an annual inflation-based payment update automatically, averting the ongoing problem currently facing all physicians. The groups noted that Congress has acted and provided measures to mitigate Medicare payment cuts and health care access to patients. However, medical practice costs have outpaced the past solutions passed by Congress.

The groups emphasized that “implementing an inflation-based update based on only half of the full MEI growth rate would be a missed opportunity to meaningfully address this perennial issue of Medicare physician underpayment that threatens stable access to care for millions of Medicare beneficiaries.” Congress must pass a permanent solution to this ongoing problem, the letter said.

The letter pointed to the March 15 release of the Medicare Payment Advisory Commission (MedPAC) report recommending for the first time that Congress increase the 2024 Medicare physician payment rate above current law with an inflation-based payment update tied to the MEI. However, MedPAC’s recommendation only solves half of the problem as the practice expense component does not cover all practice costs. “Therefore, an inflation-based payment update is equally warranted for physician work and other aspects of total physician payment, all of which could be addressed by finalizing an update that is tied to full, rather than half, of MEI.”

The CAP and the groups asked that congressional leaders address these systemic problems with the Medicare physician payment system by passing legislation providing physicians with an annual inflation-based update tied to the MEI.

CAP Asks Senate HELP Committee to Pass Health Care Workforce Fixes

On February 16, the Senate Health, Labor, and Pensions (HELP) Committee held a hearing on health care workforce shortages, and while the scope of this hearing spanned the entire health care workforce, Senators and witnesses primarily focused on shortages in relation to nursing. This hearing prompted HELP Committee Chairman, Senator Bernie Sanders (I-VT), and Ranking Member, Bill Cassidy, M.D. (R-LA), to circulate a request for information to industry stakeholders, including the CAP, to identify what we believe are the drivers of the workforce shortage and potential bipartisan solutions that could remedy it. Therefore, the CAP has urged Congress to recognize and address pathology workforce shortages.

Specifically, the CAP asked Congress to pass the soon to be reintroduced Resident Physician Shortage Reduction Act, which would address the physician shortage by providing 14,000 new Medicare-supported graduate medical education (GME) positions over seven years. Other recommendations included:

  • Draft and pass legislation that would reserve a certain number of Medicare-supported GME positions specifically for pathology;
  • Pass the Conrad State 30 and Physician Access Reauthorization Act (S. 665);
  • Pass the Specialty Physicians Advancing Rural Care Act (S. 705):
  • Draft and pass legislation establishing options for student loan repayment and greater physician visa waiver flexibility for forensic pathologists;
  • Pass the Resident Education Deferred Interest Act (S. 704/H.R. 1202);
  • Oppose legislation that would expand the scope of practice for non-physician practitioners; and
  • Establish a National Health Care Workforce Commission.

The CAP will continue to advocate on the health care workforce shortage throughout 2023, including at our April Hill Day. Stay tuned for more updates.

Illinois Pathologists, CAP Support Network Adequacy Reform

The Illinois Society of Pathologists (ISP) and the CAP issued support for Illinois State House Bill 2580 that would requires network adequacy of pathologists and hospital-based specialists. The CAP continually advocates for states to require that health plans have adequate networks of pathologists and hospital-based physicians.

In a March 6 letter to Illinois State Rep. William Hauter, ISP President Rohit Gupta, MD, FCAP said that “The proposed legislation protects against health carriers’ deceptive practices to advertise and offer inadequate health plan networks to Illinois patients, including misrepresenting hospitals and other facilities as in-network, without adhering to requisite and rigorous department of insurance oversight to ensure enrollees actually have access to in-network hospital-based specialists at such facilities.”

Illinois would join several states with similar CAP-enacted statutory requirements for hospital-based specialist network adequacy, including Louisiana, New Hampshire, Virginia, and Washington State. Hospital-based specialist adequacy at in-network hospitals and facilities would be assessed by the state insurance department, including, but not limited to, pathologists, radiologists, emergency physicians, and anesthesiologists.

The CAP will continue to monitor the legislation and additional opportunities for network adequacy reform.

Why Mitigating Risk of Cuts on Capitol Hill is so Important This Year

Next year, pathologists could face up to a 6.5% payment cut as Medicare implements payment increases to benefit primary care physicians. Understand the impacts of these looming policies by listening to Michael Giuliani, CAP’s Senior Director for Legislative and Political action, and Darren Fenwick, Director of Legislation and Political Action in this CAPcast.

Take action to educate legislators along with fellow colleagues at our Annual Hill Day, April 18.

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