Read the Latest Issue of Advocacy Update
November 10, 2020
In this Issue:
- Trump Administration, Biden Transition Team Hold COVID-19 Meetings
- CMS Must Include Transparency, Medical Experts in New Medical Device Coverage Policy
- The CMS Includes CAP-Backed Complexity in Insurer Price Transparency Regulation
- Survey Finds Pathologists Stress Level Increased Because of COVID-19
- Test Your Advocacy News Knowledge
Trump Administration, Biden Transition Team Hold COVID-19 Meetings
While the country awaits the certification of results from the November 3 elections, President Donald Trump’s Administration and the presidential transition team for former Vice President Joe Biden separately took actions aimed at stopping the spread of COVID-19 on November 9.
The White House COVID Task Force met on November 9 as members of the panel in recent days have urged states and communities to take actions that mitigate COVID-19. The CAP has engaged with members of the task force on solving persistent issues, such as shortages of testing supplies, throughout the pandemic.
Also on November 9, the Biden transition team announced members of a COVID-19 Advisory Board and its initial plan to counter the disease. Regarding testing, the plan includes measures such as the creation of a Pandemic Testing Board that is similar to a wartime production board. The board would focus on the production and distribution of tens of millions of tests.
More information following the outcomes of the November elections will be published in future editions of our newsletter.
CMS Must Include Transparency, Medical Experts in New Medical Device Coverage Policy
The CAP urged the Centers for Medicare & Medicaid Services (CMS) to ensure that the new Medicare coverage decisions will be by health experts through a transparent process based on medical evidence. The CAP is concerned that the new CMS coverage for innovative medical devices would establish regulations that would complicate or circumvent the current coverage determination process.
In the November 2 letter, the CAP supported the CMS’s proposal to classify the existing coverage determination policy definition of reasonable, including the proposed modification. However, predicating Medicare coverage policy on commercial insurance coverage will require increased transparency in developing national and local coverage determinations. The CAP asked the CMS to “ensure that adoption of even the least restrictive coverage policy of a commercial plan does not inadvertently limit coverage or impede appropriate access for Medicare patients.” Further, the CAP urged that the CMS work with public stakeholders “to improve the process for developing local coverage policy, which continues to deteriorate despite the CMS’ well-intentioned recent efforts to address long-standing concerns.”
The CAP will remain engaged with the CMS during the development of this new Medicare coverage process.
The CMS Includes CAP-Backed Complexity in Insurer Price Transparency Regulation
On October 28, the Department of Health and Human Services (HHS) issued a final regulation on health care price transparency where the CAP had urged HHS to consider the complexity of pathology practice as the agency implements changes. The final regulation requires most group health plans, including self-insured plans, and health insurance issuers to disclose price and cost-sharing information to patients. While the CAP supports patient access to appropriate price information, we are concerned about any changes that may unintentionally delay services due to difficulties in determining the cost of pathology services in advance.
The CAP agrees that patients should know the cost of health care services and understands how access to price information prior to services may be useful. However, the CAP is concerned about the patient harm risk from delays in determining the cost of pathology services in advance of services.
In addition to providing patients with personalized out-of-pocket cost information, the new regulation will require health plans, starting in 2022, to make available to the public detailed pricing information, including negotiated rates and historical payments. The HHS will also continue to evaluate access to quality reporting data and other information.
CAP Survey Showcases Increased Stress Levels for Pathologists
In the latest CAP survey, pathologists reported the most overall impact was increased stress because of the COVID-19 pandemic. Over 70% of board-certified pathologists nationwide reported a “much higher” or “slightly higher” stress levels than before the pandemic. Over 28% reported “much higher” levels of stress, while just nearly 42% said “slightly” higher levels of stress.
Reports of increased stress levels are somewhat higher among practice leaders than among non-practice leaders. Nearly 35% of practice leaders reported “much higher” levels of stress since the pandemic began, and slightly more than 40% of practice leaders reported “slightly higher” stress levels.
The CAP surveyed board-certified pathologists nationwide and 85% reported the COVID-19 pandemic has negatively affected pathologists. The CAP’s latest survey confirmed the pandemic’s ongoing adverse effects on pathologists as the United States has relied on COVID-19 testing throughout this national crisis.
Additionally, Thomas Wheeler, MD, FCAP, Chair of the CAP’s Policy Roundtable Steering Committee, spoke about the impact of COVID-19 on pathologists in a recent CAPcast.
The CAP, which routinely conducts socioeconomic surveys of its members to better inform its advocacy, fielded this survey from August 31 through September 11. The CAP received 811 responses, constituting a 5.5% response rate, making the sample nationally representative with a +/-3.4 margin of error.
Test Your Advocacy News Knowledge
It’s November, and it’s time to test your CAP Advocacy News Quiz. Last month, over 120 pathologists took the quiz. See how you compare against your fellow CAP members’ in the November News Quiz.