Win at the AMA: Pathology seeks to end health plan 'steering' tactics

The American Medical Association (AMA) House of Delegates adopted a CAP-introduced resolution to ensure pathology and lab referrals are made based on the physician's medical judgment for optimal patient care.

The impact: The resolution, which is now AMA policy, aims to stop health plan in-network steering of pathology and laboratory services. 

• In recent years, health plan payers are limiting lab referrals and patient access through steering and similar tactics in insurance products like Medicaid managed care health plans.
• They're enforcing policies that restrict physicians’ medical discretion, requiring physicians to refer to “preferred” in-network labs, sometimes only one designated lab.

The resolution says that the AMA will support state and federal efforts to prohibit steering by insurers. 

• It also says the AMA will advocate along with state medical and specialty societies to protect ordering physician discretion to refer specimens to any in-network pathology or lab provider.

Coalition effort: The CAP appreciates the collaboration and support of the members of the Pathology Section Council to get this issue raised at the AMA and AMA policy approved.

• The Pathology Section Council includes AMA HoD delegates and alternate delegates from the American Society of Cytopathology, American Society for Clinical Pathology, American Society of Dermatopathology, CAP, and National Association of Medical Examiners.

CAP at the AMA Meeting

The AMA hosts two meetings a year to debate and adopt policy. Its 2025 Interim Annual Meeting is taking place at National Harbor, Maryland, November 14–18.

Representing the CAP at the meeting were President Qihui "Jim" Zhai, MD, FCAP; President-Elect Kalisha Hill, MD, FCAP; delegates James L. Caruso, MD, FCAP, Joe Saad, MD, CPE, FCAP, Susan Strate, MD, FCAP, and Mark Synovec, MD, FCAP; and alternate delegates Diana Marcella Cardona, MD, FCAP, Jean Forsburg, MD, FCAP, and Joseph Sanfrancesco, MD, FCAP.