Advocacy Update

• Halting Medicare Cuts to Pathologists Will Top the CAP’s Agenda for Hill Day
• White House Budget Proposal Calls for Increased Funding for Pandemic Preparedness
• CAP Urges Congress to Act on Social Determinants of Health During National Minority Health Month
• AMA, CAP Urge HHS to Extend COVID Physician Relief Reporting Period
• Advocacy Win: ASP-CAP Amended Pathologists’ Assistant Legislation Signed into Law
• CAP Calls on CMS to Rescind Rule on Billing for Split Visits
• Test Your Advocacy News Intelligence

Stopping looming Medicare cuts, addressing workforce shortages, and passing a major pandemic preparedness bill will be the top issues pathologists will ask Congress to support during the upcoming the Pathologists Leadership Summit. Join us on our virtual Hill Day on Tuesday, May 3 to help pathology raise its voice on these key issues impacting the specialty.

The pandemic has been a once in a lifetime disaster. For many, this meant long grueling hours, staffing shortages, and supply chain disruptions that continue to be problematic. At the same time, the value of pathology and laboratory medicine was brought to the forefront. The CAP is calling on its members to seize this moment and engage with Congress on the issues below.

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• Looming Pay Cuts
  Without congressional action, pathologists will face another 3% cut in all pathology services in 2023 to pay for increases to evaluation and management services. While Congress contemplates a long-term fix to this problem, temporary relief is needed for 2023. Congress needs to hear from you to motivate them to act before the cut takes effect at the end of the year.
• Workforce Shortages
  The COVID-19 pandemic highlighted the crucial role pathologists play in our health care system. It is important we have an ongoing supply of new pathologists entering the workforce as we move forward. Expanding the number of Graduate Medical Education (GME) slots is key to helping address critical shortages of pathologists in the coming years. Without the funding and commitment to expanding GME slots this serious shortage will only grow.
• Pandemic Preparedness
  As Congress works on proposals to prepare for future outbreaks key areas must be addressed. Congress must work to modernize and strengthen the supply chain, improve genetic surveillance and viral sequencing, and develop strategies for epidemic forecasting and outbreak analytics. The pandemic is not over, and we need to ensure we are better prepared for the next one.

Pathology needs your voice in Washington—it cannot be done if we don’t come together as one.

President Joe Biden’s 2023 budget proposal requested increased federal funding for health care programs, including support for the nation’s response to the pandemic and several other priorities. The president’s budget recommendation to Congress asked for $1.6 trillion for appropriated spending in fiscal year 2023, which begins September 1, including $873 billion for domestic programs. In addition, the budget requests $127 billion in discretionary funding for the Department of Health and Human Services (HHS), a $27 billion increase from current levels.

The CAP has engaged with the administration on its budget proposal through the years. For example, the budget document includes a legislative proposal that would allow the HHS secretary to temporarily waive or modify specific CLIA requirements during public health emergencies. The administration states that during the COVID-19 pandemic, it used enforcement discretion to allow pathologists to interpret slides remotely. The CAP lobbied heavily to achieve this action in 2020. Amending CLIA statute would give the government the ability to apply consistent criteria when granting a waiver to specific CLIA requirements.

Even though the president proposes the federal government's budget, Congress controls spending and must pass appropriations funding legislation.

The budget includes $81.7 billion in mandatory funding over five years across the Office of the Assistant Secretary for Preparedness and Response (ASPR), the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Food and Drug Administration (FDA) to support the President’s plan to prepare for and respond rapidly and effectively to future pandemics and other high consequence biological threats. As part of the plan, the ASPR would invest $40 billion to conduct advanced research and development of vaccines, therapeutics, and diagnostics for high priority viruses; scale-up domestic manufacturing capacity for medical countermeasures; and expand the public health workforce. Other investments in pandemic preparedness include:

• $975 million for the ASPR Strategic National Stockpile to sustain and expand current inventory (an increase of $130 million above 2022 enacted)
• $828 million for the ASPR’s Biomedical Advanced Research and Development Authority to support life-saving medical countermeasures and antimicrobial development (an increase of $83 million above 2022 enacted)
• $292 million to the ASPR Hospital Preparedness Program (an increase of $11 million above 2022 enacted).
• $842 million for the CDC’s domestic preparedness (level with 2022 enacted).
• $1.6 billion in new spending for the FDA to expand and modernize regulatory capacity, information technology and laboratory infrastructure to respond to any future pandemic or high consequence biological threat.

For National Minority Health Month this April, the CAP has urged Congress to pass legislation that addresses social determinants of health in the United States. The CAP will also join with federal agencies and communities across the country by raising awareness for the importance of vaccines and booster shots as vital tools against the COVID-19 pandemic.

“As physicians and stewards of laboratory medicine, the CAP and its members are committed to achieving health equity and addressing disparities in care to ensure quality, accessible patient care for everyone,” said CAP President Emily Volk, MD, FCAP. “Access to services like preventive care, cancer screenings, and treatment for chronic illnesses are essential for communities of color, rural communities, and other underserved populations. Unfortunately, various social determinants contribute to people not getting the recommended health care services they need.”

Over the last several months, the CAP has supported legislation to enable a better understanding of the social determinants that drive health care disparities in the United States. For example, the CAP supports the Social Determinants Accelerator Act to improve health care data collection between federal agencies and establish a federal council to develop plans addressing determinants plaguing beneficiaries in the Medicaid program. The Act will provide needed grants and assistance to state, tribal, and local governments to deploy strategies addressing determinants in their own communities.

Reducing Vaccine Hesitancy Among Communities of Color

The 2022 National Minority Health Month theme is Give Your Community a Boost, which focuses on the importance of COVID-19 vaccination. Racism and discrimination can contribute to mistrust in the US health care system. Misinformation about vaccines and boosters further serve as barriers to obtaining vaccine and booster shots.

Watch this CAP video to learn more about building trust about vaccines in the Black community.

The American Medical Association, the CAP, and more than 30 medical professional organizations asked the Department of Health and Human Services (HHS) to extend its Provider Relief Fund (PRF) reporting period for 60 days. The CAP kept its members informed of the PRF resources and deadlines, but also understood that the HHS rules for reporting were challenging for physicians to meet.

In the March 31 letter, the groups asked the Health Resources and Services Administration (HRSA) to reopen the reporting period for at least 60 days for applicable PRF recipients who did not report through the HRSA PRF Reporting Portal by the November 30, 2021, deadline. The HRSA is trying to recover as much as $100 million in pandemic aid from thousands of health care providers that did not comply with the reporting rules.

In the letter, the group outlined how many physicians conveyed “their serious concerns about the Period 1 funding they received being recouped and have provided greater insight into the many reasons why reporting by the deadline did not occur.” The group also offered their assistance to work with the HRSA to communicate with health care professionals who have not reported.

The group also noted that the initial wave of COVID-19 relief funds authorized through the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was deposited in some providers’ accounts without their knowledge or request, leaving them unaware of the reporting rules and deadlines. The government’s terms and conditions, which providers didn’t necessarily have to sign to get the money, required facilities that received more than $10,000 to report how they spent the funds by September 30, 2021.

On March 29, Arizona Gov. Doug Ducey signed House Bill 2197 into law, which authorized pathologists’ assistants to assist with the performance of forensic autopsies under the direct supervision of licensed forensic pathologists. In coordination with the CAP, the Arizona Society of Pathologists (ASP) and the National Association of Medical Examiners (NAME) successfully worked to protect pathologists’ scope of practice in forensic pathology. The CAP advocates to protect pathologists’ scope of practice from encroachment from non-physician allied health professionals.

The ASP, the CAP, and the NAME successfully amended the bill, prior to introduction, to ensure pathologists’ assistants are under the direct supervision of a licensed physician who is board certified in forensic pathology under procedures adopted by the county medical examiner or alternate medical examiner. Additionally, the new law expressly precludes pathologists’ assistants’ from having authority to certify a cause of death or independently performing autopsies. Within the original legislation, the ASP, CAP, and NAME were concerned that pathologists’ assistants were placed on equal scope footing with medical students, residents, and fellows in pathology training for purposes of autopsy performance.

The bill was advocated by the County Supervisors Association of Arizona, seeking to address forensic pathology workforce shortages, and mitigate administrative burdens on Arizona county medical examiner offices adversely impacted by the COVID-19 pandemic and the opioid crisis.

The CAP joined with more than 45 other medical groups to urge the Centers for Medicare and Medicaid Services (CMS) to rescind a rule on billing for split or shared visits when elements are performed by both a physician and a qualified health care professional. The CAP advocates to ensure adequate representation for coverage and reimbursement issues facing pathologists in the regulatory landscape.

Under the 2022 Medicare Physician Fee Schedule, beginning in 2023, only the physician or the qualified health professional who performs more than 50% of the time of the total visit can bill the split or shared visit. According to a March 29 letter the groups sent CMS Administrator Chiquita Brooks-LaSure, the policy would drastically disrupt team-based care and interfere with the way care is delivered in the facility setting.

The letter notes that the organizations support physician-led, team-based care, and patients benefit from the collaboration of physicians and qualified health professionals who care for patients in hospitals, skilled nursing facilities and other facilities, where they work hand-in-hand. Billing based on who performs more than 50% of the total time of the visit will disincentivize the continuation of these care relationships, the organizations argue. They added there is significant variability in how much time it takes to perform elements of the visit based on the level of training and expertise of the physician and the qualified health professional.

“CMS should not move forward with this policy and, instead, we urge CMS to propose an alternative policy in the CY 2023 Medicare Physician Payment Schedule proposed rule that allows physicians or QHPs to bill split or share visits based on time or medical decision-making,” write the groups. “Doing so will allow CMS to seek public comment from physicians and QHPs to ensure that the revised policy does not have any unintended consequences for team-based care and patients.”

The CAP will continue to follow this issue and keep members updated in future advocacy updates.

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