CAP Review and Forecast: Advocacy 2025/2026

Dr. Joe Saad: 
It really is refreshing to experience going to the Hill and meeting with your elected representatives. They will listen to you. You're a constituent. They care about what you think, and they can care about their constituents back home.

Nancy Johnson: 
Welcome to a series of conversations featuring council chairs from the College of American Pathologists. They highlight the successes of 2025, look ahead to 2026, and give us a window into who they are and why they're passionate about the work they do. I'm Nancy Johnson and I'll bring you their stories. Dr. Joe Saad chairs the Council on Government and Professional Affairs and is a member of the Board of Governors. He says the CAP has been successful in pushing for safeguards in multiple states that delay the release of certain diagnoses to protect patients.  

Dr. Joe Saad: 
Now we know that a cancer diagnosis can be very, very traumatic to a patient, and we don't want a patient to learn of their breast cancer diagnosis through an electronic portal. We believe that it's best when a physician communicates directly and is able to be there to discuss and answer questions about their diagnosis. So we've been successful in a number of states, I think seven states till now, in passing laws that would allow a 72-hour delay between the time a result is released and the time that a patient has access.  

Nancy Johnson: 
Dr. Saad leads the charge for pathologists to go to Capitol Hill to advocate for the profession and patients. For example, a short-term increase in Medicare reimbursement is being overshadowed by a new efficiency adjustment. Dr. Saad and other pathologists are pushing Congress to hit the pause button.

Dr. Joe Saad: 
So this is a brand new bill, and we're going to urge our members to support this bill.

Nancy Johnson: 
Another key issue is that Medicare could cut payments for lab tests by as much as 15% in a single year. Those steep cuts make it harder for labs to operate, especially smaller or hospital-based labs. The RESULTS Act would prevent those sharp drops by capping changes at about 2.5% per year, making payment adjustments more gradual and predictable.

Dr. Joe Saad: 
Fortunately, the continual resolution that was passed the end of January, beginning of February delayed that cut until 2027. Short of congressional action, by either passing the Results Act or again delaying the cuts, on January 1, 2027, we'll be facing a fifth, potentially up to 15%, cut on the clinical laboratory fee schedule. That will be another one of our Hill Day asks is to once and for all pass the RESULTS Act and end this ludicrous cycle of uncertainty for our laboratories and for our patients.

Nancy Johnson:  
Behind the scenes, decisions about what Medicare will and won't cover are happening every day through a process called local coverage determination. And Dr. Saad says the process needs serious reform.

Dr. Joe Saad: 
This is the way the Medicare administrative contractors determine what services will be covered and not covered. And you know, we need to reform the way that's done. It needs to become more transparent. There needs to be a way to appeal if a service, a laboratory test isn't covered.

Nancy Johnson: 
Another critical issue is the pathologist workforce shortage. Not enough pathology residents are graduating to meet the demand. Expanding the Conrad 30 program would keep internationally trained physicians practicing here in the U.S.

Dr. Joe Saad: 
This would allow our international medical graduates that want to stay in this country to get a waiver from the two-year home requirement and stay here and practice. The pathway to that is usually through an intermediate visa called the H-1B visa. Now, you may have heard in the news last summer that the administration imposed a $100,000 application fee on the H-1B visa. This is very detrimental to our workforce. It hits particularly hard in rural and underserved areas where many international physicians take advantage of the H-1B visa to go to those areas while they're serving out their requirement to waive their visa.

Nancy Johnson: 
Dr. Saad is an international medical graduate who grew up in Lebanon and attended university there and went to medical school at the American University of Beirut.

Dr. Joe Saad: 
Yeah, you know, I was actually rather fortunate because, you know, my parents were American, and so I didn't have any visa issues. You know, I was an American citizen. I didn't have any visa issues, but a lot of my classmates did, and they had to go through this J1 visa and get a waiver in order to stay here. The vast majority that came and trained in the U.S. decided to stay in the U.S. Now, a few of them did go back immediately, some of them practiced for 10, 20 years and then went back to Lebanon, but most of us are still here.

Nancy Johnson:  
Read the full annual report to learn more and be sure to check the show notes. In the days ahead, we'll visit with other council chairs to learn about their work and what's coming up this year. For the College of American Pathologists, this is Nancy Johnson. Have a great day.