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In This Issue:

The CAP led a delegation of pathologists at the 2018 American Medical Association (AMA) interim meeting, to help set policy that affects the practice of medicine including, defending medical specialty societies’ right to protect specialty-developed quality measures, advancing appropriate “surprise” out-of-network policy, and ensuring opportunity and educational resources for physicians interested in accountable care organizations (ACOs).

The picture above shows the 2018 CAP AMA Delegation: William Harrer, MD, FCAP; CAP President-Elect Patrick Godbey, MD, FCAP; CAP President Bruce Williams, MD, FCAP; Susan Strate, MD, FCAP; Jean Frosberg, MD, FCAP; Valerie Lockart, MD, FCAP; Joe SanFrancesco, MD, FCAPJames Caruso, MD, FCAP; and Mark Synovec, MD, FCAP.

Mandatory Licensing Requirements for QCDRs Resolution Passed

The CAP led several medical societies to create AMA policy protecting specialty societies from forced, free licensure of measures as a requirement for Qualified Clinical Data Registry (or QCDR) status. A recent proposal by the Centers for Medicare and Medicaid Services (CMS) would have required QCDR measure owners, like the CAP, to enter into a free license agreement with the CMS. The free license agreement would permit any approved QCDR to submit data on the QCDR measure. 

The Pathology Section Council, which includes pathologists from the CAP, American Society for Clinical Pathology, United States and Canadian Academy of Pathology and other pathology organizations, successfully argued that the CMS cannot force licensure on quality measures created specifically for qualified clinical data registries (QCDRs). The CAP and Pathology Section Council urged the AMA to adopt a policy opposing forced, free licensure. Further, the CAP and others asked the AMA to create policy governing where QCDR measures are shared between the original measure owner and another QCDR.

Mark Synovec, MD, FCAP, Chair of the AMA Pathology Section Council and CAP delegate to the AMA House of Delegates, provided testimony in support of the policy. “The AMA should consider policy that actively opposes any CMS proposal that would require QCDR measure owners, as a condition of measure approval for reporting in MIPS and other Medicare quality payment programs, to enter into a license agreement with the CMS that would allow other QCDRs to use the owner’s measures without a fee or without a direct license with the measure owner,” Dr. Synovec said.

Out-of-Network Balance Billing

As the CAP supports current AMA policy on out-of-network care, the CAP sought to reaffirm AMA policy agreeing that current state laws that protect patients from out-of-network balance billing be immune from preemptive federal action.

AMA Policy Will Provide Physicians Guidance for ACO Participation

The CAP, along with members of the Pathology Section Council, asked the AMA to advocate for the continuation of upside-only risk Medicare Shared Savings Program ACOs, as well as for the AMA to develop educational resources to help physicians participate in and do due diligence for evaluating ACOs.

The CAP urged that AMA policy focus on increasing opportunity and incentives for specialty physician involvement in alternative payment models before unnecessarily pursuing increased risk. The reduction of the risk-free years is not in line with that objective. Changes to the Shared Savings Program that would discourage ACO formation and create unnecessary hurdles for pathologists. Keegan Lee, MD, FCAP, a delegate for USCAP, testified to the importance of increasing opportunities for specialists, including pathologists, in ACOs and other alternative payment models.

New policy directs the AMA to develop educational resources and business tools analytics to help physicians complete due diligence in evaluating the performance of ACOs.

Earlier in the meeting, it was also suggested that the AMA continue to work closely with the CMS on improvements to Medicare’s Merit-based Incentive Payment System (MIPS), including reducing reporting burden.

CAP Member Recognized for Outstanding AMA Advocacy Service

During the meeting, Susan Strate, MD, FCAP, was recognized as a leader in the AMA Inspirational Physician Recognition Program for her dedication and commitment to represent pathology at the AMA. Dr. Strate, a CAP Alternate Delegate to the AMA House of Delegates, is a strong voice in the Pathology Section Council and continues to advocate on behalf of the specialty. 

The CAP is a part of the AMA House of Delegates and encourages members to renew their AMA membership and work together to help shape a health care system that best utilizes pathologists to deliver high-quality care and meets the evolving demands of patient care. The CAP and AMA work together on many f the health and medical policies that affect the way you practice and your reimbursements. Join or renew your AMA membership today.

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The CAP published the 2018 Practice Leaders Survey Report, providing the latest socioeconomic data on pathology practices’ structure and ownership status, case volume and revenue mix, practice staffing, and problems they are incur with coverage and payment for services.

The 2018 Practice Leader Survey is the second biennial Advocacy survey targeting pathology practice leaders. The results contained in the report published on November 5 are exclusively available to CAP members.

Among the most notable findings from the survey, there was a significant drop in pathologist-owned practices to 38% in 2018 from 49% in 2016. Among other significant findings, the report shows:

  • 57% of survey respondents lead practices with five or fewer pathologists 
  • Nearly one-third of practice revenues, on average, come from commercial health plans and just under a quarter comes from Medicare
  • There seems to be a healthy job market for pathologists with practice hiring exceeding the number of retiring pathologists

The 2018 survey asked questions about practice demographics (including questions on practice structure, case volume, and staffing levels), case mix revenue and sources (including questions on both AP and non-AP services), hiring and staffing, and market and regulatory issues regarding coverage and payment for pathology services. 

Download the full 2018 Practice Leader Survey report (member login is required)

For questions on the Report, please email

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Reports for performance in the 2016 Physician Quality Reporting System (PQRS) will only be available to download from the CMS until December 31.

A pathologist can access his or her PQRS feedback report and Quality and Resource Use Report through a CMS portal, which requires using an Enterprise Identity Management system account. The CMS has additional instructions on signing up for an account and accessing the reports on its website.

The Quality Payment Program’s MIPS reporting track replaced the PQRS program.

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On November 1, the CMS finalized the 2019 Medicare Physician Fee Schedule and Quality Payment Program changes, and the CAP hosted a webinar on November 9 where CAP experts reviewed the policies that will impact Medicare pathology payment and services next year. You can still view the webinar and download the slides.

As part of our ongoing commitment to ensure pathologists can successfully participate in new and evolving payment models, the CAP continues to offer MIPS educational webinars.

Diana Cardona, MD, FCAP

The next webinar in the MIPS educational webinar series, Quality Measures that Will Improve Your MIPS Score, will take place on Tuesday, December 4 at 1 PM ET/ 12 PM CT. During webinar, Diana Cardona, MD, FCAP, will review specific quality measures that can help pathologists score the most points for their 2018 MIPS score. Register today.

The final webinar in the 2018 MIPS webinar series is still open for registration:

Steps to Take Before Reporting MIPS Data
Tuesday, January 8, 2019, 3 PM ET
Emily Volk, MD, MBA, FCAP
Discover ways of maximizing your scoring for 2018 before submitting results to CMS. REGISTER NOW

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Register and join us at the:

2019 Policy Meeting
April 29—May 1
Marriott Metro Center, Washington, DC

Make pathology’s impact on patient care heard in Washington.

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STATLINE will take scheduled breaks on November 20 and 27 in observance of the Thanksgiving holiday. You will receive the next edition of STATLINE in your email inbox on December 4. Please continue to check the CAP Twitter and Facebook accounts for updates from the CAP.

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