Advocacy Update

• Pathologists go to the Hill: Urge Congress to Stop Medicare Cuts and Solve Workforce Issues
• CAP, AMA, and 120 Medical Societies Ask Congress to Stabilize Medicare Payments
• The 2023 Practice Leaders Survey Is Open—And We Need Your Participation
• CMS Proposes New Rules Promoting Health Equity in Hospital Care
• ASP-CAP Amended Prior Authorization ‘Gold Card’ Bill Enacted by Governor
• Last Week to Test Your April Advocacy Knowledge

On April 18, CAP members met with their federal lawmakers and advocated to protect the value of pathology services. Pathologists discussed how Congress can mitigate Medicare cuts to physicians, set limits on future clinical laboratory fee cuts, and increase the medical workforce to address current shortages during meetings with 145 offices in the Senate and House of Representatives.

CAP members confidently made their cases while speaking with legislative staff and received positive responses during the CAP’s annual Hill Day, which concluded the 2023 Pathologists Leadership Summit. The four-day hybrid meeting included more than 600 of pathologists attending the House of Delegates, educational courses, and advocacy sessions.

Without additional relief, pathologists will receive a Medicare cut of 6.5% in 2024 and some Medicare fees for laboratory tests will be slashed by 15%. The CAP has worked with a coalition of other physician organizations to stop or mitigate cuts in recent years.

Pathologists also reviewed the looming medical workforce shortage and encouraged legislators to increase Graduate Medical Education (GME) funding to increase residency slots, which is key to address critical shortages of pathologists in the coming years.

Looking to Help Us on these Issues?

If you couldn’t attend the Pathologists Leadership Summit Hill Day, please visit the CAP’s advocacy action center to support our advocacy. It’s easy and takes little time to advocate on the issues impacting how you practice and your ability to provide patients with quality care.

The American Medical Association (AMA), CAP, and 120 national medical professional, health, and state medical societies have urged congressional leaders to pass the bipartisan Strengthening Medicare for Patients and Providers Act (HR 2474). The legislation would provide financial stability to physician practices by including an annual inflation update for Medicare payments that’s tied to the Medicare Economic Index (MEI). The CAP advocates for fair payment for the value of pathology services.

In an April 19 letter, the coalition thanked Reps. Raul Ruiz, MD, (D-CA), Ami Bera, MD (D-CA), Larry Bucshon, MD (R-IN), and Mariannette Miller-Meeks, MD (R-IA) for introducing the legislation that should be part of comprehensive and meaningful Medicare physician payment reform.

According to an AMA analysis of Medicare Trustees data, when adjusted for inflation, Medicare payments to clinicians have declined by 22% from 2001-2021. The failure of the Medicare Physician Fee Schedule to keep pace with the actual cost of providing care, combined with year-over-year cuts resulting from the application of budget neutrality and a lack of available alternative payment model/value-based care models, clearly demonstrates the Medicare payment system is broken. Overall, adding an inflationary update would provide constancy to the health care system as physician practices deal with shifting economic factors, such as increasing administrative burdens, staff salaries, office rent, and purchasing technology.

The CAP will provide updates on this legislation and other Medicare reform bills.

The 2023 Practice Leaders Survey is open, and practice leaders are asked to share critical, first-hand data from their practices regarding demographic changes and market trends.

This important survey assists in shaping CAP’s advocacy priorities as it captures and quantifies changes in the practice of pathology. The survey will provide important information to support advocacy efforts by giving the CAP a better understanding of pathology group’s needs, trends, and practices. The results will be published and shared with our members to inform and guide pathologists’ decisions regarding their practices.

The survey should take about 20 minutes to complete. The CAP recommends that the person who has the most knowledge about the business aspects of your practice should complete the survey. It includes a function that allows you to resume the survey if there is a need to stop and restart. And, if some questions should be answered by another individual in your practice, you can have them use your access code to complete the survey. In appreciation for your efforts, upon completion of the survey, all participants can receive a $20 gift card of your choice to either Amazon, Starbucks, or Mastercard.

All board-certified pathologists with at least five years in practice should have received a reminder email about the survey from the CAP on Monday, April 24. The email contained a unique access code to the survey. If you are not the person with the most knowledge about the business aspects of your practice, please urge that person to open their email and take the survey. If you need assistance, didn’t receive or lost your access code, or have any questions, please email us at: PracticeSurvey@cap.org.

Complete your survey soon before it closes on April 28.

On April 10, the Centers for Medicare & Medicaid Services (CMS) issued the proposed 2024 Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System regulation. The 2024 proposed inpatient regulation aims to advance health equity and support underserved communities. The CAP advocates for health equities and combats health care disparities.

The proposed regulation will update Medicare payments and hospital policies and hospital quality measures to foster safety, equity, and reduce preventable harm in the hospital setting, according to the CMS. The CMS also proposed to recognize homelessness, a social determinant of health, as an indicator of increased resource utilization in the acute inpatient hospital setting, which may result in higher payment for certain hospital stays.

The proposed regulation would also make health equity adjustments in the Hospital Value-Based Purchasing Program by incentivizing hospitals to perform well on existing measures and those who care for high proportions of underserved individuals, as defined by dual eligibility status. In addition, the CMS requested comments on how to further support safety-net hospitals.

The CMS also proposed that rural emergency hospitals could be designated as graduate medical education training sites. As a result, more medical residents would be able to train in rural settings, which can help address workforce shortages in these communities.

On April 11, House Bill 1271, previously amended by the Arkansas Society of Pathologists (ASP) in collaboration with the CAP and the Arkansas Medical Association, was enacted into law. The CAP partners with state societies to ensure pathologists and clinical laboratories are not subject to denials or reductions to payment because they fail to utilize a laboratory benefit management program or utilized a waiver for prior authorization in the ordering of a laboratory service.

The groups successfully inserted an amendment to the legislation that protects against adverse claims impacts on pathologists and patients. The CAP’s statutory payment safeguard legislative language, as included by the American Medical Association (AMA) in model prior authorization legislation, ensures health carriers cannot deny or reduce payment for health care providers involved in the rendering of a health care service subject to a prior authorization “gold card.”

The legislation establishes a prior authorization “gold card” waiver for providers who have received a 90% or higher approval rate for prior authorization requests for a particular health care service.

The law permits health care providers to obtain “gold cards” beginning on or after January 1, 2024.

It’s the last week to test your knowledge with the April Advocacy News Quiz. See how you compare against your fellow CAP members and brag about your top scores on social!

Take the news quiz