September 2021 Advocacy Recap

Alec Bose:

Hello and welcome to the CAP Advocacy Recap, a monthly podcast dedicated to catching you up on the top news for pathologists. I'm Alec Bose. Later we'll have a conversation with Dr. Kathryn Knight about the CAP's annual meeting and the Advocacy Town Hall she moderated. To find details on everything we cover, be sure to subscribe to our weekly Advocacy newsletter, and follow us on Twitter at CAPDCadvocacy. Now, without further ado, let's jump into the September Advocacy Recap.

The US Food and Drug Administration approved the College of American Pathologists for admission to its network of experts. The CAP will provide the agency with additional expertise on pathology and laboratory medicine issues such as those concerning the pandemic and artificial intelligence. Former CAP President, Dr. Patrick Godbey, praise the FDA's approval in a statement, "As the world's largest organization of board certified pathologists, the CAP stands ready to lend its knowledge to laboratory diagnostic testing and all other pathology issues to the FDA. The CAP has expertise on a wide range of issues concerning pathology. This includes those involving leading edge and digital healthcare technologies. We look forward to participating as part of the network of experts and answering clinical questions from the FDA as they arise."

September also featured a week of action to fight Medicare cuts. During the week of September 13th, the CAP called on its members to join a grassroots effort in contacting their federal legislators to extend the relief provided in the Consolidated Appropriations Act of 2021 for the next two years. With the extraordinary challenges pathologists have faced during the pandemic, the CAP is seeking an extension of the Relief Congress passed last year. As such, the CAP and its members called on Congress to appropriate an additional 3.75% funding, or roughly $3 billion to extend the current relief and provide sufficient time to develop a longer term solution. We will continue to keep you updated on this as we move forward.

Meanwhile, other advocacy efforts are shaping up in Congress with regards to the Reconciliation Bill. In a letter to house leaders, the CAP also asked the elected officials to stop upcoming cuts to pathologist's Medicare payments, and address physician shortages throughout the United States, "Without continued relief, pathologists face an additional payment cut of 5% in 2022, on top of the 2.25% cut they received in 2021.

These cuts are in addition to other economic shifts adversely affecting pathology practices." The CAP also stated its support for a pluralistic system that increases access to care for patients and stabilizes the healthcare system. This includes $7 billion to support healthcare infrastructure activities, and another $10 billion in grants to increase capacity and update medical facilities and hospitals. Visit PathNET for more details and learn how to get involved in this advocacy.

And we end this month's Recap with the CAP's annual meeting. One session at the event was the Advocacy Town Hall with CGPA Chair, Dr. Jonathon Myles, and CAP President, Dr. Emily Volk, where they discussed some of the most pressing policy issues facing pathologists today. Here to talk with us about that is moderator of that discussion, CAP House of Delegates speaker, Dr. Kathryn Knight. So Dr. Knight, again, thank you so much for joining us today. We really appreciate it.

Dr. Kathryn Knight:

It's my pleasure, Alec.

Alec Bose:

So jumping right into it, what were some of the main points discussed during the panel?

Dr. Kathryn Knight:

Well, as you know, Alec, the town hall was held during CAP CAP21, and the panelist involved were our new president, Dr. Emily Volk and Dr. Jonathon Myles, who is a member of the Board of Governors and chair of the Council and Professional and Governmental Affairs. So, we had two real experts in the area of advocacy participating. We had both an in-person and a virtual audience, so this was a bit new for us, but we were able to take questions from both of those audiences. Really, the topics that came up in discussion were items like how the CAP has pivoted in a new administration, and what's been done in this last year? Obviously, questions regarding payments, whether certainly focused on Medicare and what we're dealing with from a federal government perspective, but a bit also on the state reimbursements relating to the private payer sector. And then also, the threats to the profession. Foremost of those were scope of practice issues. So, those off the top were, I would say, the primary items discussed.

Alec Bose:

Yeah, I remember hearing a lot about the threats, especially when we talk about some of those key policy issues that threaten some of the payments of pathologists. So, speaking about some of those pathologists, what were some of the key advocacy interests or concerns that the attendees had in the audience? Can you speak a little bit about that?

Dr. Kathryn Knight:

Well, and I'm taking audience to mean both virtual and in-person.

Alec Bose:

Absolutely, yeah.

Dr. Kathryn Knight:

I would really focus on the ones that I just mentioned, and I can go into a little more depth on each of those, if that's helpful?

Alec Bose:

Please.

Dr. Kathryn Knight:

Looking back at a new administration, and I think that's always one of the challenges that folks may forget, that each administration comes with its own agenda. And the agenda that we were dealing with last year may not be the agenda we're dealing with this year. So, under the Biden administration, we have really, in the CAP, sought to make sure that we were at the table as policies affecting pathologists are discussed, and as those may change. And one of the particular areas that we're focused on, in our pandemic environment in particular, is strengthening our ties with agencies such as the Food and Drug Administration and the Centers for Disease Control.

So in a plus, really for the CAP, the CAP is now part of the network of experts recognized by the FDA, because we have managed to be so engaged with the administration. And then obviously, with this past year and dealing with the pandemic, we have engaged with these federal agencies on issues such as laboratory supply shortages. The other aspect of the Biden administration is that there's a new focus on healthcare equity and health disparities, and really we have no problems addressing those issues, because the CAP and our member pathologists are truly focused on serving our patients. So, we are already very much involved in issues like the Foundation Sea, Test & Treat Program, our Lab Inspection Program, and we're closely following the bills that are in Congress right now that reflect dealing with healthcare disparities.

Alec Bose:

We spoke a little bit earlier in this Advocacy Recap about that FDA network of experts. Is there any way you can touch a little bit on that, maybe a little bit more how important that is that the CAP is involved in this network of experts?

Dr. Kathryn Knight:

As we attempt to advocate for our specialty in DC, that we have to keep in mind the fact that there is legislative advocacy, but there's also regulatory advocacy. And to be able to be recognized by the FDA and therefore be heard by the FDA, allows us to influence, hopefully in a very positive way for our patients, the policies of the FDA. And that can be, we can overlap into discussions of laboratory developed tests, or other aspects where the FDA may have control or may be influencing what happens in those areas. So, I'm answering your question perhaps somewhat vaguely, but I'm trying to focus on the fact that a partnership, a recognized expert in an area which we are now with the FDA, puts us in a position of advantage as we work for our member pathologist.

Alec Bose:

Right, and that may be a little bit vague as well, just coming from that position of a consultation role, not necessarily a role that is 100% definitive. There's just a lot of things that I feel the administration will be coming to you, and there will be problems and issues that are unforeseen perhaps.

Dr. Kathryn Knight:

Well, I think that's absolutely true. Again, as we advocate on behalf of our members, it really is all about relationship building. And if that's in a legislator's office, if that's in the State House, if it is with a governmental agency, the relationships you build and the trust that comes from those relationships has everything to do with how successful you are in your advocacy.

Alec Bose:

Great point. You talked a little bit about State Pathology Societies during the annual meeting and at that town hall, and how that advocacy was crucial in creating some policies, but now we're seeing some of these issues with Cigna. Can you talk about how those State Pathology Societies are important in working to reverse or in fact advocate for some of these key policies?

Dr. Kathryn Knight:

Now, thank you for asking that, Alec. I really can't overemphasize how important the work of the State Pathology Societies and our individual memberships in those states is. We have at the CAP had increasing effort put into strengthening our relationship with State Pathology Societies and our State Pathology Society Initiative chaired by Dr. Ned Fody, has really over the past few years, done a lot to elevate some of the State Pathology Societies that needed assistance. And I can't think of a better way that that important relationship between the CAP and the States is demonstrated than in the effort that was put into dealing with the threat from Cigna, our private payer segment, regarding payment of the professional component of clinical pathology services.

And we did that very successfully earlier this year. Just this week, we're hearing that Cigna may be coming back to this, and we're going to have to suspect, get back in the saddle, so to speak, and go after this again. But beyond just the Cigna issue, we have to be able to advocate not only at the federal level, but at the state level, and CAP is really working to strengthen those partnerships. I think we will see that becoming more and more important in the future.

Alec Bose:

Finally, just to wrap everything up, what were a few big takeaways that you had from this town hall or the annual meeting overall?

Dr. Kathryn Knight:

I think the very fact that we are the... And I hope our members know this, but that we are the only pathology organization that's a 501(3)(c) organization, and that can truly advocate for our pathologist. In saying that, we've been working hard on addressing Medicare cuts. In this past year, we had a big success in going from what was a 9% cut to a 2.5% cut, but that fight continues. We're looking at scope of practice issues that are affecting not only our profession, but all medical specialties, and the CAP is at the forefront of trying to stay on top of scope threats. We have all of these things that are going on right now.

We also are looking at really strengthening our State Pathology Societies so that we can advocate at the state level through our State Pathology Societies and that partnership. But at the end of the day, we have 30 employees, I think, in the DC office, where advocacy takes place. But the ability to advocate comes down to our members, and it really is one of those things where participation by our CAP fellows is truly critical.

We need as individual pathologists and members of the CAP, to not only be dependent on the great folks that we've got in DC and on our terrific CAP leadership, but to recognize the fact that we have individual accountability to speak out for our profession. And we can do that through joining PathNET, responding to advocacy alerts, giving to PathPAC, attending the PLS, which is coming up April 3rd through May 2nd next year, I believe, starting with the House of Delegates meeting on Saturday. We need to be involved because our voices matter. I think at the end of the day, that's the takeaway on advocacy in general. The CAP is speaking up for you as a CAP fellow and as a practicing pathologist, but you need to be involved.

Alec Bose:

Definitely hammering the point home about that importance of being involved. Thank you so much, Dr. Knight, for joining us. We really appreciate it.

Dr. Kathryn Knight:

It has been my pleasure, Alec, and just encourage everybody to get involved. Thank you so much.

Alec Bose:

That's all for the September edition of the CAP Advocacy Recap. Thank you so much for listening. Be sure to read our weekly newsletter and follow us on Twitter at CAPDCadvocacy. Once again, I'm Alec Bose, and we'll see you next month.

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