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California officials codified network adequacy requirements to ensure patients at in-network facilities have reasonable access to in-network hospital-based physicians, including pathologists.

California Insurance Commissioner Dave Jones announced the stronger requirements for health insurers to maintain adequate networks in a regulation published on March 8. The regulations go into effect immediately because they address a number of critical problems consumers have faced with insurers when seeking timely access to care, according to a California Department of Insurance news release.

The regulations state a health plan "network includes adequate numbers of available primary care providers and specialists with admitting and practice privileges at network hospitals." Insurers are required to submit to the Department of Insurance network adequacy reports describing each "network hospital and percentages of physicians in specialties of emergency medicine, anesthesiology, radiology, pathology, and neonatology practicing in the hospital and are in the insurer’s network(s)."

The CAP advocates for state regulators to require health plans to ensure patients at in-network facilities have reasonable access to in-network providers. At the same time, the CAP continues to oppose out-of-network legislation, similar to the bills drafted in Colorado and Tennessee, to limit balance billing while failing to ensure patient access to in-network hospital-based physicians.

America's Health Insurance Plans (AHIP) had opposed the Department of Insurance's regulation on network adequacy and called for changes. Previously, AHIP stated there could be consequences for patients and hospitals in light of the new rules.

In AHIP's November 2015 comments to the draft regulation, the national organization representing insurance companies stated: "The requirement that an insurer's network have network providers at network facilities to be considered adequate is problematic, especially if certain providers at a network hospital are unwilling to contract with the insurer. This could lead to providers being allowed to unilaterally dictate the terms of a contract, knowing that the insurer is required to have network providers within their facility; it could also lead to an insurer having to terminate a hospital's contract if its hospital-based providers refuse to contract at any rates."

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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, which practice leaders receive an emailed invitation to take, is targeted to those 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

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

Reminders Emailed to Practices on March 28

Pathology practice leaders began receiving invitations to complete the survey on March 21 and reminders were sent on March 28. 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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Dr. Martin and Rep. Connolly

At a fundraiser for a Virginia congressman on St. Patrick's Day, pathologist Elizabeth Martin, MD, FCAP represented the CAP's PathPAC program and met with her representative in Congress.

Dr. Martin said she was eager to accept the invitation to again represent PathPAC at Rep. Gerry Connolly (D, Va.) at his fundraising event on March 17. Although Rep. Connolly is not her representative in Virginia, she used the event as an opportunity to solidify connections and awareness of PathPAC’s support for the congressman.

PathPAC is a political action committee established by the CAP solely representing pathologists. Through the PAC, the CAP provides direct support for federal candidates for Congress. The PAC also has a political education fund that supports the political education of our members through events like the annual Policy Meeting in Washington, DC.

"I was pleased that my Congressman Don Beyer was also at this function, and very pleased that he remembered me from the campaign events I attended two years ago," Dr. Martin said. "I think this contact from the event will also be useful when the need to advocate for pathologists' concerns arises."

Dr. Martin is planning to attend the 2016 CAP Policy Meeting, May 2-4, in Washington, DC. "I think all pathologists should attend this at least once to understand the importance of advocating for ourselves and our professional future," she said.

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Registration is open for you to join your colleagues to receive the latest information and analysis during the 2016 CAP Policy Meeting May 2-4 on the implementation of new Medicare and laboratory regulations. The CAP Policy Meeting in Washington, DC, 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.

Register for the meeting today. The CAP Policy Meeting is a benefit of CAP Membership. There is no fee to register.

Speakers and expert presenters at the Policy Meeting will include:

  • 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.
  • 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."

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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Each month, STATLINE will feature one of the many CAP members who have been champions for pathology in Washington and at the state level through our grassroots and PAC programs. If you would like to get involved, you can join PathNET, contribute to PathPAC, join your state pathology society, or register for the 2016 CAP Policy Meeting.

Name: Shelley Odronic, MD, FCAP
Position: Staff Pathologist, Lima Pathology Associates, St. Rita's Medical Center, Lima, OH

How did you first get involved in advocacy with the CAP?

I got involved with advocacy as a resident. During an annual CAP meeting, I attended the PathPAC reception. I met pathologists from all over the country and was introduced to CAP advocacy efforts. After that, I started making small annual contributions to PathPAC. I also attended my state pathology society meetings where I formed connections with pathologists that ultimately led to job opportunities. I think it is very important for residents to get involved early. As we start our careers, many of us have concerns about the future of the field. What will the role of the pathologist look like in 30 years? Becoming involved in advocacy enables us to shape that future and is the only way to bring about changes that we want.

What advice would you give to someone who wants to be involved in advocacy?

Advocacy does not look the same for everyone. We are all busy and have limited time, and we all have different levels of social comfort. But we are all able to incorporate advocacy into our lives at some level. It can be locally at your own institution, in your community, in your state, or on a national level in Washington. Whether speaking at tumor boards at your hospital, having a phone conversation with your hospital administration, donating to PathPAC, or talking to your neighbors at the community center, these small interactions can add up to make a large difference.

Pathologists are at a disadvantage because we are often not as visible in health care as some of our clinician peers. Consequently, we may be ignored when lawmakers or administrators makes decisions for all physicians. We must tell our stories and argue our cases on a personal level. And with the landscape of health care changing greatly right now, it is critically important for us to have our voices heard.

Do you have a favorite memory or experience that stands out in your advocacy work?

Absolutely, the CAP Policy Meeting! I went as a resident and it was an exhilarating and exciting experience. I was surprised to learn about all of the issues facing pathology and proud that the CAP was simultaneously working on so many of them for us. After two days of education and information, I was fired up and enthusiastically took my message to Capitol Hill. Meeting my Congressman was invigorating and I was thrilled to be a part of this process. It laid the foundation for a relationship with my lawmakers that I hope to utilize in the future. There are several CAP success stories of advocacy efforts making a huge impact when there is a personal relationship between a member of Congress and a constituent pathologist. I urge every pathologist to attend the CAP Policy Meeting at least once in his or her career.

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