Advocacy Update

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In a recent letter to committee members, the House Ways and Means Committee Chairman Richard Neal (D-MA) proposed a different approach to end surprise medical bills through the regulatory rulemaking process. The CAP is engaged and in contact with the committee to understand the scope and intent of the proposal.

The negotiated rulemaking approach consists of representatives from the departments of Health and Human Services, Labor, and Treasury, and affected interest groups to negotiate the terms of an administrative regulation. Recommendations from the group would then be published in a proposed rule. The CAP will engage with the committee to raise concerns on how this process and the role the agencies would have in developing and implementing the regulation.

In the meantime, the CAP supports other legislation, the Protecting People from Surprise Medical Bills Act, because it includes an independent arbitration process that will financially protect patients and reduce out-of-network cost. The process is based on the successful model that New York State implemented almost five years ago, which has led to lower premiums, lower health care costs, and agreement between insurers and providers that the process is working well. Currently, the legislation has 96 co-sponsors.

Pathologists are urged to remain engaged with their elected officials in Congress on the surprise medical bill issue. CAP members can contact their senators and representatives on this important issue through our grassroots action network, PathNET.

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The CAP has asked the Centers for Medicare & Medicaid Services (CMS) to abandon cuts to pathology payments in the proposed 2020 Medicare Physician Fee Schedule. In a September 13 letter to the CMS, the CAP opposed a proposed 8% pay cut to pathologists stemming from changes to evaluation and management (E/M) services planned in 2021. The CAP also met with the CMS in early September and submitted official written concerns early, so that the Medicare agency has time to react and mitigate the proposed cuts. The CMS will release the final regulation by early November.

The 2021 proposed payment cuts to pathology are part of the CMS’ plan to redistribute $7 billion from medical specialties to primary care physicians due to restructuring and revaluation of E/M office visits. The proposed policy would greatly benefit some physicians but penalize many, including pathologists, who rarely bill for E/M services. Due to budget-neutrality requirements, pathologists are forecasted to have large payment reductions to offset the costs of those physicians who deliver office visit-based services, like primary care physicians.

In the proposed fee schedule released in July, the CMS had agreed to implement changes in 2021 developed by the American Medical Association (AMA) E/M workgroup. The agency then went beyond the workgroup solution and proposed an add-on payment for E/M services, which redistributes an additional $2 billion, accounting for 3% of the cuts proposed for pathologists if this provision is finalized. The CAP, AMA, and other medical specialties joined the CAP in opposing this additional redistribution of funds.

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Try your advocacy luck and take the October Advocacy News Quiz. See how your scores compare to your fellow CAP members and share on social media.

Last month, over 100 of your fellow CAP members tested their advocacy knowledge. See how you stack up against your fellow pathologists on this month’s quiz and share your results. It’s easy, so good luck!

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