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March 28, 2017

In This Issue:

On March 24, House leaders, with encouragement from President Trump, pulled the American Health Care Act from the floor before a vote could occur.

House Republicans lacked the 216 votes that are necessary from their conference seated in the majority to pass the bill. Democrats were also united against the bill.

Prior to the House action on March 24, the CAP's position was to not support the bill as it did not meet specific principles set for health reform. The bill also would leave intact provisions that are burdensome and harmful to pathologists.

The bill faced widespread opposition from physician associations and hospital and patient advocacy groups. The CAP did not support the AHCA legislation.

The CAP's policy principle framework for changes to the ACA are:

  • Ensuring that individuals can access affordable insurance without interruption and take steps toward coverage for all Americans
  • Maintain key insurance reforms (eg, pre-existing conditions)
  • Protect prevention and screening services
  • Stabilize and strengthen the individual insurance market
  • Reduce regulatory burdens on physicians

The failure to get this version of the bill through the House floor calls the future of health care reform into question. The CAP will continue to monitor issues related to health care reform.

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Bruce Scott, MD

With health care reform still unsure and the pending release of potential legislation impacting the practice of pathology and laboratory medicine, the 2017 CAP Policy Meeting will be an essential event for pathologists to advocate on behalf of their specialty and patients. The CAP is proud to announce that Bruce Scott, MD, vicespeaker, House of Delegates of the American Medical Association and Congressman Michael Burgess, MD, (R-TX) will be speakers during the conference on April 24-26, 2017 in Washington, DC.

Dr. Scott will speak on the panel titled Affordable Care Act (ACA) Repeal and Replace: Challenges and Opportunities in the Changing Health Care Landscape. Dr. Scott was first elected as vice speaker of the American Medical Association in June 2015 and re-elected June 2016. The CAP is excited have his viewpoint on this important panel.

Rep. Burgess, MD, will provide his insights on the future of health care and the political environment during the Evolving Health Care Landscape discussion. Rep. Burgess, MD, previously worked as an OB-GYN in Denton County, Texas, and currently is chairman of the House Energy and Commerce Subcommittee on Health.

Both speakers will discuss how the current health care landscape affects pathology reimbursement and how new regulations may have a further impact. Attendees at the CAP Policy Meeting will receive the latest information and analysis on the implementation of new Medicare and laboratory regulations. The CAP is actively engaged in the legislative and regulatory arenas on the critical issues facing pathology and laboratory medicine, including physician payment reform, reducing regulatory burdens, and improving health care quality.

Michael Burgess, MD, (R-TX)

The CAP Policy Meeting will also include meetings with members of Congress and their staff during the CAP's Annual Hill Day on April 26, which is the specialty's opportunity to focus on the federal issues most important to pathologists now and in the future.

The CAP Policy Meeting is a benefit of CAP membership. There is no fee to register.

Join your colleagues—register for the 2017 CAP Policy Meeting, April 24–26, in Washington, DC. Earn 5.25 CME credits.

Want to learn more about advocacy and how to get engaged before attending the CAP Policy Meeting? Register for our complimentary webinar, Essential Tools for Pathologists Engaging in Grassroots Advocacy, on Wednesday, April 5, at 2 PM ET.

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The CAP is joining with other laboratory groups in seeking a one-year delay in implementation of the new Medicare payment system for clinical laboratory tests scheduled to take effect Jan. 1, 2018. The CAP along with several lab groups believe that Centers for Medicare and Medicaid Services (CMS) and laboratories simply must need more time to address data collection concerns, collect and ensure accurate submission of all applicable data as this impacts the accuracy of final payment rates for clinical laboratory tests.

In a recent letter to Tom Price, secretary of the Department of Health and Human Services, from laboratory organizations in addition to the CAP including such as the American Clinical Laboratory Association (ACLA), National Independent Laboratory Association (NILA), and seven others, said they continue to have significant concerns about implementation of the Medicare clinical laboratory fee schedule (CLFS) reform as mandated by the Protecting Access to Medicare Act of 2014 (PAMA).

"While our organizations have worked closely with our members and the CMS toward PAMA implementation, we believe that under the current regulatory requirements, the new program will not reflect accurate private market rates for clinical laboratory services as required by PAMA," the groups write. "Given the significance of these ongoing concerns, we respectfully request The CMS delay the implementation of the CLFS reforms under PAMA for one year to resolve these significant issues."

The groups are concerned that the CMS's data collection system is not yet functioning at adequate capacity as many operational problems from the 2016 test phase appear unresolved and are hampering laboratory data submissions. Furthermore, problems with the data collection process are complicating the possibility of a smooth transition to the new payment system. The data reporting period for PAMA is scheduled to conclude on March 31, 2017, but many laboratories are still in the data collection phase as they struggle with the CMS regulatory requirements, note the singed laboratory organizations.

"The CMS and laboratories simply must have more time to address data collection concerns, collect and ensure accurate submission of all applicable data as this impact final payment rates," they write.

Among the other concerns the group conveyed is the regulatory definition of "applicable laboratory," which essentially excludes most hospital laboratories, argue the singed laboratory organizations. In fact, the HHS Office of Inspector General has estimated that only about 5 percent of all clinical laboratories will report data that will be used to establish the new payment rates.

"The exclusion of an entire laboratory sector, particularly hospitals operating large outreach laboratories, negatively affects the integrity of rate calculations under PAMA," write the groups. "The implications are immense and would ultimately threaten to reduce laboratory infrastructure across the country, and therefore, limit beneficiary access to laboratory test services that support patient clinical care management. The applicable laboratory definition should be redefined to appropriately capture the true laboratory market."

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Whether you are a seasoned Policy Meeting veteran or a first timer thinking about going to the CAP17 Policy Meeting, then the Essential Tools for Pathologists Engaging in Grassroots Advocacy webinar on April 5 at 2 PM ET is for you.

With new regulations taking shape that will impact pathology reimbursements for years to come, grassroots advocacy for pathologists is more important than ever. The Essential Tools for Pathologists Engaging in Grassroots Advocacy webinar will provide a foundational training for CAP members who are attending the CAP17 Policy Meeting by covering the basics of how Congress works, why grassroots advocacy matters, and the tools and resources the CAP provides for members. This webinar will help provide a general understanding of grassroots advocacy before you arrive in Washington.

During the webinar you will hear from experienced advocates Joe Saad, MD, FCAP, Federal and State Affairs Committee chair; Al Campbell, MD, FCAP, Grassroots Subcommittee chair of the Federal and State Affairs Committee; and moderator Michael Giuliani, advocacy senior director of the CAP.

Register today for the webinar.

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