Advocacy Update

November 16, 2021

In this Issue:

Pathologists Urge Congressional Action to Change No Surprises Act Regulation

The CAP urged the Biden Administration to change the interim final regulation for the No Surprises Act to align the law’s implementation with the original legislation. Through strong grassroots action from CAP members and a broad coalition of physician specialties, the CAP urged 116 members of Congress to ask senior members of the Biden Administration to change the interim regulations to ensure a balanced process to settle payment disputes. The CAP has strongly opposed the interim federal regulations that give insurance companies the upper hand during what should be an impartial, independent dispute resolution (IDR) process as set in the No Surprises Act.

In response to the recently released regulations, congressional champions pledged to intervene with the administration to clarify the intent of Congress and urge reform to the interim final regulation. In a November 5 letter from Congress to the secretaries of the departments of Health and Human Services, Labor, and Treasury urged the Administration “to amend the [regulation] in order to align the law’s implementation with the legislation Congress passed.” The members of Congress asked that, “the parameters of the [independent dispute resolution] IDR process in the [regulation] released on September 30 do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes,” in the letter.

The interim final rule for the IDR process disregarded Congress’s intentions of creating a fair system where physicians and health insurers can resolve disputes without one single factor having more weight than another.

The Texas Medical Association (TMA) recently filed a lawsuit against the Biden Administration against the interim final regulation of the No Surprises Act. In the lawsuit filing, the TMA claims that the interim final rule “ignores congressional intent and unfairly gives health plans the upper hand in determining the final payment amount when a patient receives care from an out-of-network provider,” in terms of the IDR process.

However, there are some members of Congress who do support the current policy, such as Rep. Frank Palone (D-NJ), and Sen. Patty Murray (D-WA), who support the current interim final regulation of the No Surprises Act.

The CAP will remain engaged with the administration to address the regulations and ensure they follow the statute.

CAP Leads Pathology Delegation, Supports Efforts to Cover the Uninsured at AMA Special Meeting

The CAP led a delegation of the Pathology Section Council at the American Medical Association (AMA) Special Meeting of the House of Delegates (HOD) from November 12-16, 2021. The HOD virtual meeting delegates emphasized the importance of making health insurance coverage available to, and affordable for, uninsured individuals as well as the importance of preventing upcoming Medicare cuts to physician payment. Health equity issues in maternal health and access to care in rural health were also important discussions at the special meeting.

Nearly 700 physicians, residents and medical students gathered virtually to consider proposals across a wide range of clinical practice, payment, medical education, and public health topics. CAP member and Pathology Section Council Chair Mark Synovec, MD, FCAP, testified for the section council on the proper use of AMA CPT Codes and the harmful behaviors of the health insurance industry.

The CAP supported several initiatives at the AMA meeting, including expanding health care access to the uninsured. CAP members Susan Strate, MD, FCAP, and Council on Government and Professional Affairs Chair Jonathan Myles, MD, FCAP, were in the discussions on the final AMA resolution.

The Pathology Section Council also discussed some of the AMA top advocacy priorities including:

  • Opposing 2022 Medicare cuts and ensuring Medicare physician payments are sufficient to safeguard patient access to care
  • Strengthening public health systems
  • Bolstering the physician workforce in rural communities
  • Supporting efforts to allow Medicare to negotiate drug prices to bring down the cost of prescription drugs for patients
  • Enhancing privacy for people who use mail-order DNA testing kits

The Young Physician Section and Resident and Fellow Section also met virtually to discuss important issues such as:

  • Bereavement leave for medical students and physicians
  • Affirmatively protecting the safety and dignity of physicians and medical students as workers
  • Scope of practice
  • Preserving physician leadership in patient care

CAP Delegate to the Residents and Fellow Section Dana Martin, MD, was also elected as an Alternate Sectional Delegate from the Residents and Fellow Section to the AMA.

During the meeting, AMA President Gerald E. Harmon, MD, addressed the HOD and outlined ongoing challenges physicians are facing in the fight against COVID-19 pandemic. Dr. Harmon, who also spoke during CAP21, urged Congress to address the looming end-of-year Medicare cuts that could cut payments to physician practices by nearly 10% when they are already struggling due to the pandemic.

Learn more about AMA membership

Transition: Biden Nominates Robert Califf for FDA Commissioner

On November 12, President Biden nominated Robert Califf, MD, a cardiologist, as the Commissioner for the Food and Drug Administration (FDA). Dr. Califf was the FDA Commissioner for one year in the Obama Administration. If confirmed by the Senate, Dr. Califf would oversee an agency with regulatory influence over pharmaceuticals and medical devices, in addition to food safety and other areas of human health including vaccination research during the ongoing pandemic.

Dr. Califf is an internationally recognized expert in clinical trial research, health disparities, health care quality, and cardiovascular medicine. He would bring nearly four decades of experience as a doctor, researcher, leader, and public servant, including previous service as the FDA Commissioner from 2016-2017.

Currently, Dr. Califf is a professor of medicine at the Duke University School of Medicine, where he previously served as Vice Chancellor and founded the Duke Clinical Research Institute, and also works as Head of Clinical Policy at Verily Life Sciences, a life sciences research organization.

CMS Will Apply MIPS Automatic Extreme and Uncontrollable Circumstances Policy for 2021 Reporting

The CMS will apply the Automatic Extreme and Uncontrollable Circumstances Exception Policy for the 2021 MIPS performance year in response to the ongoing COVID-19 Public Health Emergency. The exception policy will apply to eligible clinicians who are allowed to participate in MIPS as individuals. It will not apply to groups, virtual groups, or alternative payment model (APM) entities. The CMS is applying the policy to help physicians as they face challenges during the pandemic.

However, if your practice is well on its way to submitting MIPS data, the CAP recommends that you proceed as planned.

If a physician participates in MIPS as an individual, they don’t need to take any action to have the automatic exception policy applied to them. The CMS will automatically identify and re-weight all four MIPS performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless the physician submits data in two or more performance categories, or has a higher final score from group or APM Entity participation.

The CMS has more details on the exception process on its website.

Rep. Ami Bera Joins PathPAC Members for a Virtual Reception

PathPAC events are a valuable tool for building relationships in Congress and advancing the CAP’s overall advocacy efforts. Earlier this month, Rep. Ami Bera, MD, one of only 17 physicians serving in the 117th Congress, joined PathPAC members for an engaging conversation on health care policy topics and the recent elections.

At this PathPAC-hosted event, members were able to thank Rep. Bera for being a strong champion of pro-pathology legislation, including his introducing the bipartisan legislation that helped provide relief from the proposed 9% cut to non-evaluation and management codes for 2021. Rep. Bera also co-sponsored last year’s legislation on surprise medical bills, and he continues to urge against the harmful Medicare payment cuts to physicians proposed for 2022.

The group discussed a variety of topics, from the implementation of surprise medical billing legislation, to the recent election results in Virginia and New Jersey. They touched on the role of telemedicine in pathology and shared policy solutions that could expand the physician workforce. Rep. Bera, as a physician, is uniquely qualified to lead on the policies that advance the pathology profession and improve overall patient care.

For all participants, this opportunity to connect with Rep. Bera provided an important reminder of the need to stay engaged with lawmakers, especially as they deliberate major pieces of policy in these final months of the year. PathPAC will continue to facilitate these opportunities to keep CAP connected to Capitol Hill.

Webinar on December 3 – Final 2022 Medicare Payment Regulations Impact on Pathology Services

The Centers for Medicare & Medicaid Services (CMS) released the final 2022 Medicare Physician Fee Schedule and the Quality Payment Program regulations, including the Merit-based Incentive Payment System (MIPS). On Friday, December 3 at 1 PM ET/ 12 PM CT, the CAP will offer a complimentary live webinar where CAP experts will review the final regulation that will impact payment for services and pathologists’ participation in the Quality Payment Program.

Webinar presenters will be the Council on Government and Professional Affairs Chair Jonathan Myles, MD, FCAP; Economic Affairs Committee Chair Stephen Black-Schaffer MD, FCAP; Economic Affairs Committee Vice-Chair Ronald McLawhon, MD, FCAP, and Quality and Clinical Data Registry Affairs Committee Chair Diana Cardona, MD, FCAP.

Register today

75th Anniversary Featured in November Advocacy News Quiz

It’s the CAP’s 75th anniversary and members get a special prize taking the quiz. Last month, over 100 pathologists took the quiz. See how you compare against your fellow CAP members’ in the November News Quiz, and brag about your top scores on social!

Take the news quiz