The CAP led a delegation of pathologists at the virtual 2021 American Medical Association (AMA) Special House of Delegates (HOD) Meeting to set policy affecting the practice of medicine from June 11-16. The AMA special HOD meeting focused on the COVID-19 pandemic and the role physicians played like heroes, rising to the challenge to guide the nation’s health care during this unprecedented pandemic. Additionally, the AMA House of Delegates virtually welcomed the new AMA President Gerald E. Harmon, MD, a family medicine physician from Pawleys Island, SC, and President-elect Jack Resnick, MD from northern California. During the meeting, the CAP’s advocacy included addressing the sustainability of the rural health care system, voicing concerns about information blocking requirements for pathologists, relaxing Centers for Medicare & Medicaid Innovation Center (CMMI) regulations, and fighting for scope of practice protections.

Addressing Rural Health Care’s Challenges

The CAP has engaged in addressing rural populations' health needs and support efforts to further this work with the AMA. In response to the challenges facing the rural health system, the HOD adopted policy advocating for public and private payers to take the following actions “to ensure payment to rural hospitals is adequate and appropriate.”

In the new policy, delegates said payers should:

• Create a capacity payment to support the minimum fixed costs of essential services, including surge capacity, regardless of volume.
• Provide adequate service-based payments to cover the costs of services delivered in small communities.
• Adequately compensate physicians for standby and on-call time to enable very small rural hospitals to deliver quality services in a timely manner.
• Use only relevant quality measures for rural hospitals and set minimum volume thresholds for measures to ensure statistical reliability.
• Hold rural hospitals harmless from financial penalties for quality metrics that cannot be assessed due to low statistical reliability.
• Create voluntary monthly payments for primary care that would give physicians the flexibility to deliver services in the most effective manner, expecting that some services will be provided via telehealth or telephone.

ONC and Information Blocking

The CAP and the Pathology Section Council asked AMA to urge the Office of the National Coordinator for Health Information Technology (ONC) to consult with relevant stakeholders about unintended or unforeseen consequences from the 21st Century Cures Act information blocking regulations. The CAP has been engaged on this issue and believes providing patients with direct and immediate access to laboratory and pathology reports has advantages. Still, there are genuine barriers, challenges, and potential safety issues with the current ONC regulations. Additionally, the group directed the AMA to urge the ONC to broaden and relax its Patient Harm Exception through regulatory revisions that would include patients’ emotional and mental distress to the current and narrow definition of this exception. The CAP urged the ONC to consider a broader ability for pathologists and ordering physicians to make exceptions to the immediate release requirement. The CAP will continue to work on this important issue to get the additional time and compliance flexibility needed for pathology. The CAP will continue to work on this important issue to get the additional time and compliance flexibility needed for pathology.

Relaxing Pathology CMMI Reporting Regulations

The CAP and the Pathology Section Council supported efforts to oppose mandatory Center for Medicare & Medicaid Innovation (CMMI) payment model demonstration projects. Instead, the pathology delegation directed the AMA to ask the Office of the National Coordinator for Health Information Technology (ONC) to relax their current regulatory requirements and seek innovative payment delivery model ideas from physicians and medical specialty societies to guide the Physician-Focused Payment Model Technical Advisory recommendation Committee (PTAC). Additionally, the group asked that the CMMI propose demonstration projects that are voluntary and appropriately tested.

Lessons Learned from COVID-19 and Global Vaccine Distribution

The HOD discussed at length the lessons learned by the medical community from the COVID-19 pandemic and continuing needs, including personal protective equipment (PPE) supplies, pandemic treatment procedures, and vaccine distribution. The CAP and the AMA support efforts to distribute COVID-19 vaccines to health care agencies globally that are scientifically tested and approved by the US Food and Drug Administration. The HOD discussed sending and administering vaccines to other countries where the pandemic is at its height, like India and Vietnam. Additionally, the AMA and the CAP advocated for improvements to PPE and supply chain issues and increased distributions for future health emergencies.

The CAP is an active member of the AMA House of Delegates and encourages pathologists to join the AMA or renew their AMA membership. A robust CAP delegation at the AMA can shape a health care system that best utilizes pathologists to deliver high-quality care and meet the evolving demands of patient care. The CAP and AMA work together on many of the health and medical policies that affect the way you practice and your reimbursements. Join or renew your AMA membership today.