STATLINE

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In This Issue:

• CAP Advocates to Remove Medicare Discounts to Pathology Services
• View the Recent CAP Webinars on 2016 Regulatory Changes, Download the Presentations
• Register Today for the 2016 CAP Policy Meeting
• View the Recent CAP Webinars on 2016 Regulatory Changes, Download the Presentations
• Register Today for the 2016 CAP Policy Meeting

After strong opposition from physician organizations including the CAP and Colorado Society of Pathologists (CSP), legislation to limit balance billing by out-of-network physicians failed a vote by a Colorado Senate committee and was postponed indefinitely on March 16.

The Colorado Senate Committee on State, Veterans, & Military Affairs defeated the out-of-network reform bill, entitled Notifications of Health Care Billing Charges for Covered Persons, (SB 152) by a vote of 2-3. CSP President Bryan Coffing, MD, FCAP, joined with the Colorado Medical Society to oppose the bill and encourage the committee to vote against it.

Pathologists are greatly concerned that health plans throughout the United States are refusing to contract with hospital-based physicians and are narrowing their health plan provider networks, Dr. Coffing said. He urged the legislature to press the Colorado Department of Insurance to require health plans to document they have contracted with hospital-based physicians, including pathologists, in sufficient numbers at any in-network facility.

"We think having this explicit obligation on health plans in the rules or laws that govern network adequacy will be a fundamental and important way for Colorado to ensure that its patients can access high quality and affordable health care that is within their health plan network," Dr. Coffing said.

Listen to Dr. Coffing's full testimony to the committee. Dr. Coffing's testimony begins at the 2:12:30 mark in the hearing.

Such rules or laws would address one of the problems underlying "surprise" bills sent to patients.

Tennessee Out-of-Network Bill

Out-of-network billing legislation to limit balance billing in Tennessee also has failed to gain support from state lawmakers after opposition from the CAP and Tennessee Society of Pathologists (TSP).

The legislation (HB 1861/SB 1782) would financially penalize physicians who provide services to patients regardless of the patient's insurance status. In a February 26 letter to the bill's sponsors, the TSP opposed the legislation and expressed concern that provisions of bill were impractical and benefitted health plans at the expense of physicians.

"Of significant note, a physician under provision (a) cannot bill a patient for out-of-network unless 'the provider or facility has disclosed to the consumer the anticipated amount to be billed to the consumer for such services prior to the services being rendered,'" the letter stated. "The inherent nature of pathology work makes it impossible for an out of network pathologist to provide patients with a written notice prior to the service being rendered. In some cases, it is only during the course of the procedure that the need for pathological analysis may be evident. Furthermore, the call for pathologist involvement may be urgent and immediate, for example, providing information or guidance to the surgeon while the patient is under anesthesia."

The TSP and CAP urged the sponsor instead to place an obligation on health plans to inform their enrollees with a: "disclosure or notice to indicate that the covered person may be subject to higher cost-sharing, as described in the covered person’s plan summary of coverage and benefits documents, including balance billing, if the covered services are performed by a health care professional, who is not in the covered person's plan network even though the covered person is receiving the covered services at a participating facility."

A similar disclosure provision has been adopted by the federal government to govern qualified health plans offered through the state and federal health insurer exchanges.

The CAP continues to oppose out-of-network legislation similar to the bills drafted in Colorado and Tennessee. The CAP advocates for state regulators to require health plans to ensure patients at in-network facilities have reasonable access to in-network providers.

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The CAP model legislation to require clinical laboratory advisory boards for accountable care organizations (ACOs) unanimously passed the Tennessee House Health Subcommittee on March 15.

The bill (HB 1100) would require an ACO to establish an advisory board to consider and recommend guidelines or protocols for clinical laboratory testing. An advisory board would have at least one physician who is a clinical laboratory director affiliated with the ACO. Similar laws requiring advisory boards have been adopted in Massachusetts and Illinois.

Before the Health Subcommittee's vote, Kathryn T. Knight, MD, FCAP, on behalf of the Tennessee Society of Pathologists, provided testimony in support of the bill. Dr. Knight, who is Vice Speaker for the CAP House of Delegates and practices in Nashville, stated the legislation would require advisory boards to make recommendations to ACO governance boards for guidelines or protocol adoption for laboratory testing and ensure appropriate use of testing.

"As legislators you can set ACOs on the right path. We, as pathologists within ACOs, recognize that we have to participate in that journey," Dr. Knight said. "If this legislation is enacted, I believe all physicians will be able to do their part and together we can achieve the best quality in patient care."

Watch Dr. Knight's full testimony. Discussion of HB 1100 begins at 1:24:00 of the video.

The bill now moves to the full House Health Committee for consideration.

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With Medicare officials drafting new regulation changing how pathologists will be reimbursed for patient services, the 2016 CAP Policy Meeting will feature a panel discussion with agency and health policy leaders on the new payment pathways stemming from the Medicare Access and CHIP Reauthorization Act (MACRA).

Registration is open for you to join your colleagues to receive the latest information and analysis on the implementation of the MACRA law and Medicare payment reforms at the 2016 CAP Policy Meeting May 2-4 in Washington, DC. The CAP Policy Meeting, which will include meetings with members of Congress during the CAP's Annual Hill Day on May 4, is the specialty's opportunity to focus on the federal issues most important to pathologists now and in the future.

Centers for Medicare & Medicaid Services (CMS) Medical Officer Lemeneh Tefera, MD, and Bob Berenson, MD, a fellow at The Urban Institute and former vice chair of the Medicare Payment Advisory Committee (MedPAC) will discuss MACRA and Medicare’s implementation of the law. Incentives for quality and value through the new Merit-based Incentive Payment System (MIPS) and eligible alternative payment models (APMs) offer opportunities to position the pathology specialty going forward. This session will provide CAP Policy Meeting attendees with unique insights into these new rules.

Other speakers and participants at the Policy Meeting include:

• Renowned journalist David Gregory provides a firsthand analysis and running narrative of the Obama Administration, Congress and politics in America. Mr. 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.
• Leading public opinion expert and NBC and Wall Street Journal pollster Peter Hart and Ed Goeas, who is 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).
• Marc Hartstein, the director of the Centers for Medicare & Medicaid Services (CMS) Hospital Ambulatory Payment Group, and Medicare law and policy authority Paul Radensky, MD, JD, of the law firm McDermott Will & Emery. Mr. Hartstein and Dr. Radensky will speak during a panel discussion titled: "Getting Ready for the New Protecting Access to Medicare Act (PAMA) Requirements for Laboratories."
• Harold D. Miller, the president and CEO of the Center for Healthcare Quality and Payment Reform, who will discuss how physician can provide leadership in future health care payment and delivery reforms.

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.

Collaborate. Advocate. Take Action.

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The CAP is fielding the 2016 Practice Leader Survey to gather data from individual pathology practices regarding their economics, demographics, and market trends. Data from the new survey will help CAP leaders determine which advocacy issues are most important to pathology practices and further assist the CAP on advocating on behalf of the pathology specialty.

The survey is targeted to practice leaders who can answer the questions for the whole practice. For some practices this will be one individual, while for others it will be multiple individuals. Practices with more than one practice leader should coordinate about how to best complete one survey for their practice. For a listing of the specific questions on the survey, please email practicesurvey@cap.org.

All responses are kept strictly confidential. Responses will be reported in aggregate form only. No individual practice information will be uniquely identified or shared.

Survey Emailed to Practices on March 21

Pathology practice leaders began receiving invitations to complete the survey on March 21. CAP members who complete the survey, which should take about 20 minutes to complete, will later receive an invitation to attend an exclusive webinar reviewing the survey results. A report on the survey will then be available for all CAP members.

Those completing the survey will receive early access to the results. The CAP will publish more details about this and other benefits for completing the survey.

Learn more about the 2016 Practice Leader Survey.

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The CAP participated in a March 18 FDA public workshop examining regulatory approaches to oversight of Prothrombin Time/International Normalized Ratio (PT/INR) in vitro diagnostic point-of-care devices and improved clinical management of warfarin therapy.

The FDA invited the CAP to participate in this workshop and present on CAP quality assurance programs including proficiency testing programs specific for point-of-care PT/INR testing. Russell Higgins, MD, FCAP, Chair of the CAP Coagulation Committee, represented the CAP during the workshop and participated in a panel discussion.

The FDA seeks to identify potential solutions to address the scientific and regulatory challenges associated with point-of-care PT/INR devices to ensure safety and effectiveness. In 2015, members of Congress raised the oversight issue with the FDA following published news reports of nursing home residents being hospitalized or dying after errors involving Coumadin or warfarin.

During Dr. Higgins presentation, he discussed limitations of the INR system and compared point-of-care and central laboratory methods. Dr. Higgins also reviewed proficiency testing performance and relevant labor atory accreditation issues.

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