Advocacy Update

• CAP Calls on Cigna to Rescind Policy to Deny Pay for Professional Component of Clinical Pathology
• CAP Urges Passage of Bill to Eliminate Taxes on Provider Relief Funds
• Tennessee Pathologists Oppose Repeal of Corporate Practice Medicine Law
• Arizona Pathologists Protect Scope of Practice
• Missouri State Medical Association Publicly Recognizes Lab Testing Personnel
• Last Chance to Register for the 2021 Pathologists Leadership Summit!
• Last Chance to Take the April Advocacy News Quiz

The CAP strongly urged the health insurer Cigna to rescind a new payment policy to deny claims when the professional component (modifier 26) of clinical pathology is billed. In a letter to Cigna on April 23, the CAP urged Cigna to continue paying for the professional component of clinical pathology services for all pathologists. The CAP further engaged with the presidents of state pathology societies and state issue advisors on the Cigna policy and gathered feedback on how the change will affect pathologists in their states.

Cigna announced the change on April 12 and the denials will take effect July 11. The change would affect pathologists in several states.

The CAP maintains the professional component of clinical pathology (PC of CP) services are critical to the reliable and accurate diagnosis and treatment of patients. For Cigna to discontinue reimbursement for these services will prove detrimental to patients, and to the integrated delivery of care to which laboratory diagnostic services are central.

“The PC of CP services are critical to the reliable and accurate diagnosis and treatment of patients, particularly in delivery systems increasingly reliant upon care coordination, integration, and population management,” the CAP letter said. “The CAP’s Policy on Pathologist Professional Component Billing for Clinical Pathology Services describes the nature and type of professional services provided by the physician director of a clinical laboratory. As set forth in that policy, pathologists as directors of hospital laboratories spend a significant amount of time and effort fulfilling their responsibility for quality laboratory services to their patients and their fellow practitioners.”

The CAP will keep its members informed on this issue as new developments are available.

The CAP joined a coalition of health care groups urging federal lawmakers to pass legislation that would eliminate taxes on funds provided to health care professionals as part of COVID-19 relief. The coalition asked Congress to provide financial relief to pathologists who have worked tirelessly during the pandemic.

In 2020, Congress allocated $175 billion in financial relief to health care professionals through the Public Health and Social Services Emergency Fund (PHSSEF). Without this vital funding, many health care practices would have closed due to financial pressures. In an April 19 letter to Reps. Cindy Axne (D-IA), Neal Dunn, MD, (R-FL) and Brian Fitzpatrick (R-PA), co-sponsors of HR 2079, the Eliminating the Provider Relief Tax Penalties Act, the PHSSEF assistance is taxable, resulting in a 21% or more reduction to the benefit for taxpaying providers as compared to non-taxpaying providers, according to the coalition.

“The negative impact penalizes those who care for our nation’s most vulnerable,” the group writes. “The passage of HR 2079 would remove the negative tax implications for PHSSEF recipients by ensuring that all Provider Relief Fund assistance is not taxable while maintaining that expenses tied to this assistance are tax-deductible. The programmatic change is essential to continuing to support our members and their employees during this unprecedented national health crisis.”

The bill was introduced on March 19 and will be considered by the congressional committee and the full House before being sent to the Senate for consideration. The CAP joins more than 20 other medical associations in supporting the measure.

The Tennessee Society of Pathologists (TSP) and the CAP partnered with the Tennessee Medical Society (TMA) to adamantly oppose an amendment to Senate Bill 1568, repealing Tennessee’s Corporate Practice of Medicine Law. With support from the CAP, the TSP effectively ran a grassroots campaign to oppose the repeal of the Corporate Practice of Medicine Law in the Senate Commerce and Labor Committee to protect medical integrity and independent medical decision-making from corporate financial interests.

The TSP supports the current law, which prohibits corporate employment of hospital-physician specialists, including pathologists, radiologists, anesthesiologists, and emergency physicians. The TSP effectively argued against the law’s repeal, as physician specialists could face adverse impacts to employment arrangements and endanger patient care. Without the protection of the law, physicians could incur threats or coercion into employment arrangements that can threaten physician judgment and the well-being of patients. With collective voices of opposition, the sponsor deferred Senate Bill 1568 for committee consideration to 2022. The sponsor will hold legislative meetings over the summer with industry stakeholders to find resolve.

The TSP and CAP look forward to engaging in future conversations to safeguard the corporate practice of medicine and ensure quality health care in the state of Tennessee.

The Arizona Society of Pathology (ASP) and the CAP successfully protected pathologists’ scope of practice by advocating to amend state legislation regulating non-medical testing. Arizona Gov. Doug Ducey signed the amended legislation on April 20. The CAP works with state pathology societies to protect pathologists and laboratories from increased regulatory burdens.

The CAP coordinated with the ASP, industry partners, and direct-to-consumer genetic testing companies to include favorable language exempting “biological samples that are obtained or genetic data that for the purposes of an individual’s medical screening, treatment or diagnosis.”

The final amended bill was primarily based on the Coalition for Genetic Data Protection (CGDP)’s model legislation after collaborative efforts between stakeholders. The legislation mandated that non-CLIA regulated, direct-to-consumer genetic testing companies must provide clear information and require consent from consumers on the collection, use, and disclosure of genetic data.

Additionally, the newly enacted law includes comprehensive consent requirements that comply with federal policy to protect human research subjects. The law also provides enhanced security program features to prevent unauthorized access, use, or disclosure of genetic data. The new law also contains the CAP’s original amendment to ensure the mandate designating genetic testing as the exclusive property of the person tested does not apply to the federal health insurance portability and accountability act of 1996. With the strong advocacy of the ASP and CAP, Arizona pathologist’s scope of practice was preserved and increased consumer safety in non-regulated medical tests.

Praising laboratory staff for their dedication and hard work during the COVID-19 global pandemic, the Missouri State Medical Association (MSMA) House of Delegates on April 17 unanimously approved a resolution recognizing lab testing personnel at the group’s annual meeting. The resolution was introduced by Missouri Society of Pathologists President Chakshu Gupta, MD, FCAP.

Clinical laboratory scientists and pathologists have performed testing and delivered results for millions of patients during the pandemic, “putting in long hours under stressful conditions, dealing with resource constraints and personal health concern from handling COVID-19 samples,” says the resolution. “The Missouri State Medical Association publicly recognize and express gratitude to clinical laboratory scientists for their untiring, dedicated and overall outstanding services and to clinical pathologists for their invaluable medical services to patients” during the pandemic.

During the meeting, 27 physicians submitted comments in support of the resolution, including Douglas Miller, MD, PhD, FCAP, representing the Department of Pathology and Anatomical Sciences at the University of Missouri School of Medicine.

“I strongly support this resolution,” he wrote. “Pathologists and laboratory scientists and technologists stepped up, set up high-throughput COVID testing laboratories, and ran them sometimes without adequate PPE. They continued the essential laboratory diagnostic work (including autopsies) necessary to keep clinicians informed about their patients’ test results and so guided therapy.”

Natalie Webster, MD, FACP, added that laboratory personnel are often underrecognized, but that they have “been the backbone of COVID testing.”

Passage of the resolution came just before the start of Medical Laboratory Professionals Week, which takes place the last full week of April and is celebrating its 45th anniversary this year.

Don’t miss your chance to strengthen your leadership skills and learn more about issues impacting pathologists. Select session recordings will be available for review after the meeting, but you must be registered in advance of the meeting in order to access the archived recordings.

If you registered for the Summit, its not too late to register for Hill Day meetings and meet with your Federal legislators and let them directly know the value of pathology medicine in patient care.

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It’s the last week to take the April Advocacy News Quiz. Already over 40 pathologists took the quiz. See how you compare against your fellow CAP members’ in the April News Quiz and brag about your top scores on social!

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