In November 2019, the Centers for Medicare and Medicaid Services (CMS) finalized a Medicare policy to increase reimbursement for evaluation and management (E/M) services. In 2020, Congress temporarily mitigated the impact of these changes on non-primary care physicians, including pathologists. The 2021 Omnibus bill passed at the end of 2020 included $3 billion to lower the E/M cuts by 3.75% and a 3-year moratorium on the introduction of a new primary care add-on code (G2211). The add-on code represents approximately 3% of the expected overall 9% cut. In short, instead of a 9% percent cut, the cut was reduced to 2.25% in 2021. In 2022, because of Congressional action at the end of 2021, the cut was reduced to 3%.
Absent congressional action, pathologists will face a 3.4% cut to all pathology services in 2023. These cuts, combined with the pending threat of a 4% PAYGO reduction, the termination of the 2% sequestration moratorium in July 2022, and the lack of an inflationary update to the Medicare Economic Index represents significant negative financial factors to the practice of pathology. Therefore, the CAP is asking Congress to pass legislation before the end of the year to mitigate the impact of these cuts. The CAP continues to work with Congressional leaders, the AMA, and other groups on broad payment reform. Until that process is complete, however, continued relief is needed.
The current pandemic has brought to the forefront the vital role of pathologists and the value that they bring to medicine. Laboratory workforce shortages have been exacerbated by increased demand, pipeline issues, burnout, and the COVID-19 public health emergency. As people leave the laboratory system, the strain felt by those left behind reaches a breaking point leaving pathologists and other laboratory staff unable to keep up with the demand for necessary and essential diagnostic services.
Pathologists continue to handle huge volumes of COVID testing, in addition to the millions of other tests that must be run, processed, and analyzed for patients every day. From wellness visit check-ups to other non-COVID related diseases such as diabetes, heart failure and cancer, and now monkeypox, laboratories are a critical component of ensuring the health of all Americans.
While Congress has made generous investments in testing, vaccines, and economic support to physicians and their patients to address the impact of the pandemic, the instability caused by the pandemic exposed fissures in our nation’s laboratory infrastructure, including high-cost equipment, staffing, and the need for critical supplies. In short, with workforce shortages, addressing the current pandemic, preparing for future pandemics, and inflationary pressures, now is the time to invest in our nation’s laboratory infrastructure, not erode it.
As such, the CAP remains committed in the fight against further cuts to pathology services and we need your help. Send an email to your member of Congress today.
Latest E/M Asks to Congress
Articles by Pathologists on the Need to Mitigate Impacts of Medicare Cuts
- Congress needs to protect physicians from Medicare cuts, by Patrick Godbey, MD, FCAP
- Stop Medicare cuts to pathologists during a pandemic, by Samuel Caughron, MD, FCAP
- Safeguarding Physician Services and Medicare Patients Post COVID-19, by Eric Loo, MD, FCAP
- Cuts in Medicare Payments are Hurting Physicians and Access to Healthcare, by Anthony Simonetti, MD, FCAP
- Medicare Cuts Would Sink Labs, by Sang Wu, MD, FCAP