Prevent Medicare Cuts for Pathology Services

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 beginning in 2021. To offset the increase and maintain budget neutrality, the CMS reduced payment for non-E/M services.

At the end of 2022, the CAP successfully lobbied Congress to mitigate the cuts by 2.5% in 2023 and 1.25% in 2024. Despite this relief, absent congressional action, pathologists face Medicare payment cuts of 2.75% in 2024 even with the 1.25% conversion factor adjustment Congress provided physicians at the end of 2022. These cuts combined with the lack of an inflationary update to the Medicare Economic Index represent significant negative financial factors.

While Congress has taken action to address some of these fiscal challenges by mitigating some of the recent Medicare Physician Fee Schedule (MPFS) cuts, payment continues to decline. According to an American Medical Association analysis of Medicare Trustees data, when adjusted for inflation, Medicare payments to clinicians have declined by 22% from 2001–2021. Additionally, the MPFS lacks an annual inflationary update, even though clinicians — many of whom are small business owners — contend with a wide range of shifting economic factors, such as increasing administrative burdens, staff salaries, office rent, and purchasing of essential technology when determining their ability to provide care to Medicare patients. The absence of an annual inflationary update, combined with statutory budget neutrality requirements, further compounds the difficulties pathologists face in managing resources to continue caring for patients in their communities.

The CAP remains committed to the fight against further cuts to pathology services.

Without significant engagement by CAP members with their respective members of Congress, getting this issue addressed before the end of the year is going to be a major challenge. The CAP has asked its members to contact their members of Congress on the Medicare cuts. You can contact them here. For more information, review our issue brief.

The CAP has urged Congress to provide further economic assistance to pathology practices by writing letters to congressional leaders with members' concerns regarding E/M services cuts.

• April 25, 2023
• May 9, 2023
• June 15, 2023
• August 8, 2023