Advocacy Update

Read the Latest Issue of Advocacy Update

September 22, 2020

In this Issue:

Calling All CAP Members: Fight Medicare Cuts to Pathology Services

The CAP needs all pathologists to fight upcoming Medicare cuts by contacting your federal legislators. The CAP had launched a summer campaign of virtual advocacy demanding that Congress mitigate the -9% Medicare cut to pathology services that will take effect on January 2021. The fight is not over. Our virtual campaign to advocate against these pending Medicare cuts will continue and we need your help.

Already, hundreds of CAP members have contacted, called, and virtually met with many Congress members to educate them on the impact these cuts will have on patient access to care and reimbursement. Only Congress can stop the cuts and we are asking CAP members to ensure their representatives and senators know how destructive these drastic decreases in payment to pathologists will be to their constituents back home.

Go to the CAP’s action center to send a message to your representatives in Washington, DC.

To learn more, watch an on-demand training webinar explaining everything you need to know about this issue and how you can best engage.

Make sure you follow the CAP Advocacy Twitter account to get breaking legislative and regulatory news. If you’re on social media, please feel free to help us get the word out by using #fightthecuts!

CAP Advocacy in Action: CDC Reverses COVID-19 Testing Guidance

On September 18, the Centers for Disease Control and Prevention (CDC) reversed guidance criticized by the medical and scientific community, including the CAP, about who should be tested for COVID-19. The CDC updated its recommendation to include testing asymptomatic patients who have been in close contact with someone diagnosed with COVID-19.

The CAP had asked the CDC and the Department of Health and Human Services (HHS) to provide the scientific rationale for changes the administration made to federal COVID-19 testing guidance in late August. In a statement issued on August 27, the CAP said now was not the time to recommend halting COVID-19 tests for asymptomatic patients.

On August 24, the CDC had revised its guidance to “focus on testing considerations” and removed previous statements recommending testing for asymptomatic individuals who have close contact with COVID-19 patients.

FDA Releases COVID-19 Comparative Performance Data for Diagnostic Tests

On September 15, the Food and Drug Administration (FDA) released comparative performance data for some authorized COVID-19 molecular diagnostic laboratory-developed tests (LDTs). The data published provides laboratories and pathologists a new resource on the relative performance of available tests.

The FDA published information that shows the Limit of Detection (LoD) of more than 55 authorized molecular diagnostic COVID-19 tests against a standardized sample panel provided by the FDA.

The FDA provided this reference panel to test laboratory developers who are required to assess their test’s performance against this panel (or other FDA-recommended reference materials) as a condition of their Emergency Use Authorization (EUA).

The FDA will continue to update the table as it receives additional results.

Medicare Panel Reviews Clinical Lab Fees as CAP Advocates for Accurate Reimbursement Rates

On September 3, the Medicare Payment Advisory Commission (MedPAC) convened a public meeting to discuss the methodology the CMS uses to set private payer-based rates for laboratory tests under the Protecting Access to Medicare Act (PAMA). MedPAC is an independent federal group that periodically produces reports and nonbinding recommendations to Congress on the Medicare program. During the meeting, MedPAC reviewed the clinical laboratory fee schedule (CLFS) rate' changes under PAMA, discussed trends in utilization and Medicare spending, and outlined next steps.

The CAP had met with MedPAC leadership earlier this year and advocated for improvements to PAMA to ensure more accurate reimbursement rates and continued access to laboratory tests for Medicare patients.

In preparing the report, which is mandated by Congress and due in June 2021, MedPAC stated they would refine PAMA spending and utilization analysis from 2017 to 2019, evaluate private-payer rates from the first round of reporting, and look at the revised data reporting requirements for the second round of reporting in 2022. Additionally, the group will report on the feasibility of using a representative sample as some stakeholders are concerned the current data collected is overly burdensome and not representative of the market.

PAMA requires applicable laboratories to report private payer rates for clinical laboratory services to the CMS, using the data to calculate Medicare reimbursement rates for tests on the clinical laboratory fee schedule. As a result of recent legislation, the next reporting period is required to begin January 1, 2022.

Take the September Advocacy News Quiz

Take the new September News Quiz. Last month over 100 CAP members took the August news quiz. See how you compare against your fellow CAP members’ by taking this month’s quiz.

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