STATLINE

Read the Latest Issue of STATLINE

• It's Not Over—The Senate May Try ACA Repeal in 2018
• Despite Calls for Delay, Medicare Releases 2018 Clinical Laboratory Fees
• New CAP17 Advocacy Timely Topic Session – Network Adequacy in Health Plans: The Financial Implications for Pathologists (STA007A*)

On September 30, the Senate failed to have enough votes to repeal portions of the Affordable Care Act (ACA), but the Senate fiscal year 2018 budget resolution suggests the chamber could still use it to repeal key parts of the current law in 2018. The budget resolution includes a reserve fund, just in case the committees decide they want to tackle some elements of repeal.

All proposed legislation to repeal and replace the ACA did not align with the health reform objectives set forth by the CAP. The CAP developed high-level policy principles that we want to see in any repeal and replacement package. These principles included ensuring that individuals with insurance can continue to access affordable coverage without interruption while the health care system takes steps toward coverage and access for all Americans; maintaining key insurance market reforms that protect patients (eg covering pre-existing conditions); protecting prevention and screening services that are currently covered; stabilizing and strengthening the individual insurance market; and reducing regulatory burdens on physicians.

The American Medical Association, the American Hospital Association, American’s Health Insurance Plans, the Federations of American Hospitals, the American Academy of Family Physicians, BlueCross BlueShield Association, the American Society of Clinical Oncology, AARP and many other consumer groups expressed opposition to the past proposed legislation.

The CAP continues to monitor the situation.

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On September 22, the CAP sent out a STATLINE Alert when the Centers for Medicare and Medicaid Services (CMS) published the new 2018 clinical laboratory fee schedule (CLFS). The new CLFS schedule used the new methodology based on private payer rates for tests collected from a small segment of providers. However, the CAP and other industry groups have called this collection process flawed and continued to urge the CMS to delay of the implementation of the new fee schedule.

A 2014 federal law mandated changes to the CLFS and the CMS has since worked to implement the law.

The CAP analyzed the impact of the top 100 Healthcare Common Procedure Code System (HCPCS) CLFS codes by volume, which represent 80% of total CLFS spending. Download the 2018 CLFS Impact Table.

The CMS reports that the preliminary private payor rate-based CLFS payment amounts are estimated to be a loss in $670 million of Medicare Part B payments in 2018. According to the CMS, approximately 10% of the HCPCS codes on the CLFS receive an increase based on the weighted median of the private payor rates over the 2017 CLFS rates.

The CAP is currently evaluating the draft rates and will provide the CMS with comments on the 2018 Medicare CLFS rates by the agency's October 23, 2017 deadline. The CMS is expected to publish the final rates in November.

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Provider network adequacy and balance billing influence the market value of pathology services, regardless of whether a pathologist is an employee or an independent contractor. The CAP has strongly advocated for state regulators to protect patients from health plans with inadequate networks of pathologists and other hospital-based physicians. During this 60-minute informative session on Monday, October 9 at 1 PM ET, you will learn more about the CAP's state advocacy strategy and how you can get involved.

Registration is still open for this and other key CAP policy and advocacy courses and roundtable discussions important to the pathology specialty during CAP17 at the Gaylord National Harbor from October 8–11, 2017.

In recent years, state regulators have failed to ensure health plans maintain robust networks of physicians as insurers created narrow and "ultra-narrow" networks of providers. Led by Joe Saad, MD, FCAP, Chair of the Federal and State Affairs Committee (FSAC), and David Gang, MD, FCAP, FSAC Vice-Chair, attendees will learn about network adequacy and balance billing issues facing pathologists and the financial impact on pathology practices.

Additional CAP advocacy courses and roundtable discussions are also available at CAP17:

• M1596: How is My Payment Determined for Pathology Services?
• R1690: My Surgical Pathology and Cytopathology Coding Dilemmas
• R1691: Current Payment Policy Challenges in Pathology Practice
• S1620: Medicare's New Quality Payment Program and the Physician Fee Schedule
• STA007C: Results from the 2017 CAP Practice Characteristics Survey.

Check out the full list of Advocacy courses offered at CAP17.

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