Advocacy News

• Physicians want to delay AI prior-authorization model in Medicare
• Anthem policy threatens patient care
• AMA adopts new policies for IMGs and student loans
• Get your Medicare fee questions answered
• Ways to keep advocacy going this holiday season
• Your pathology news delivered daily

The CAP, along with other physician organizations, is urging Congress to prevent traditional Medicare fee-for-service from implementing a prior authorization pilot program.

Background: In July, the Centers for Medicare & Medicaid Services (CMS) announced the Medicare Wasteful and Inappropriate Service Reduction (WISeR) Model. 

• WISeR would use AI and machine learning, along with human clinical review, before paying for select items and services.
• This pilot model would begin January 1 in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. 

In a letter to the House Appropriations Committee, the physician organizations commended the committee for approving an amendment pausing the WISeR Model rollout.

• This delay would allow time to address design flaws and implementation concerns, ensuring patient care isn't compromised by administrative burdens.

The big picture: The WISeR Model raises the same concerns over problematic prior authorization programs in Medicare Advantage.

• Stakeholders, including physician groups, were not initially involved in the model’s development.
• The CAP joined other groups in identifying additional recommendations to ensure any adoption will be least disruptive to physicians and patients.

What's next: The CAP and other physician groups urge continued collaboration with the CMS to refine WISeR and avoid a repeat of past missteps in health care reforms.

Medical organizations are speaking out against a potentially harmful policy proposed by Anthem Blue Cross and Blue Shield targeting nonparticipating care providers. 

• The proposed plan would penalize hospitals with a 10% reimbursement cut for using out-of-network physicians.
• Hospitals might pass these cuts onto physicians, pressuring them to join networks or become employees.

The policy has sparked significant concern among physician organizations, who warn it could disrupt independent practices and limit patient access to care.

The big picture: The policy further threatens to undermine reforms in the No Surprises Act, which protects patients from unexpected medical bills.

• The Act ensures patients pay in-network rates for out-of-network care at participating hospitals.
• Anthem's move is seen as sidestepping this bipartisan policy, raising concerns over patient care and costs.

What's next: In a joint letter, physician groups urge Anthem to rescind the policy and consider alternatives that better support physician networks and patient care.

Last week, we reported that the CAP had attended the American Medical Association (AMA) House of Delegates Interim Meeting and worked with the Pathology Section Council to secure passage of new AMA policies. 

• The measures are against health plan steering tactics and deceptive advertising by training programs. 

Additional topics covered at the meeting 

Supporting international medical graduates

What they're saying: Testimony at the meeting underscored the important role that international medical graduates (IMGs) have in the US health care system, especially in underserved areas. 

• The AMA adopted a new policy calling for a viable, expedited, and distinct pathway for physicians to obtain permanent residency.
• The AMA will also advocate to ensure that physicians are exempt from unreasonable increases in H-1B visa fees and to create a dedicated visa pathway specifically for physicians.
• The CAP and the AMA opposed the new $100,000 H-1B visa fees introduced by the Department of Homeland Security.

Student loan advocacy 

Delegates also raised concerns about recent federal policy changes that affect medical school costs, particularly for students from low-income backgrounds. The policies include eliminating loan programs and imposing caps on student loans.

In response, the AMA adopted policies calling for continued advocacy to:

• Ensure federal student loan limits accurately reflect the actual cost of graduate medical education.
• Preserve a variety of beneficial repayment options, including favorable income-based repayment plans for medical graduates.
• Protect the Public Service Loan Forgiveness Program, which remains a vital tool for physicians serving in public and nonprofit health settings.

Other news: Mehmet Oz, MD, MBA, administrator of the Centers for Medicare & Medicaid Services, also addressed the crowd, encouraging attendees to "be curious, be courageous."

With Medicare policy shifts set for 2026, the CAP is making sure pathologists are prepared.

Next month's CY 2026 Medicare Physician Fee Schedule and Quality Payment Program Webinar will unpack what these changes mean for you and your labs.

Hear from our experts: Joe Saad, MD, CPE, FCAP; Ronald W. McLawhon, MD, PhD, FCAP; and Gregary Bocsi, DO, FCAP will share guidance and insight.

When: December 5 at 3:00 PM ET

Added context: Explore how CAP advocacy efforts helped steer important improvements in Medicare payment policy.

Register Today

The holidays may be approaching, but there's still time to make your voice heard for pathology. Here are quick, meaningful ways you can advocate right now.

Use our Action Alerts to ask Congress to:

• Support the RESULTS Act to stabilize laboratory services, stop harmful Medicare payment cuts, and establish a new payment framework.
• Fix the Medicare payment system by advancing long-overdue reforms that strengthen physician practices.

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