Advocacy Update

• New CAP-AAMC Study Reveals Pathologists Workforce Undercounted by Nearly 40%
• Resources for Pathologists Affected by Change Healthcare Cyberattack
• 2024 HOD Back the PAC Competition Update
• CAP Urges Pathologists to Respond to AMA-Mathematica Physician Practice Expense Survey, Deadline Extended
• CSP and CAP Support Pathology Remote Review and Sign Out Bill in California
• Take Our News Quiz for April

A new study published by Health Affairs Scholar uncovers an undercount in the workforce of pathologists as a result of omitting subspecialized training over several years. In this paper, “Re-evaluation of the Methodology for Estimating the U.S. Specialty Physician Workforce,” the authors from the CAP and the Association of American Medical Colleges (AAMC) suggest revisiting methodologies and definitions responsible for tracking the physician workforce as similar undercounts may exist in other physician specialties.

The Physicians Specialty Data Reports of the AAMC are a key source of standardized, consistently published estimates of physician supply in the United States. The AAMC’s specialty-specific physician workforce estimates serve the workforce research community, physician specialty societies, and policymakers seeking detailed data on how many and what types of physicians are in practice, and thus how many more may be needed to meet the nation’s medical care needs. By 2020 AAMC’s report for pathologists was undercounted by 39%.

“The CAP appreciates the collaboration with our colleagues from AAMC to revisit this issue and outline solutions to better ensure an accurate count of pathologists in the workforce,” said Donald Karcher MD, FCAP President of the CAP and study coauthor. “The data produced from workforce counts influences decisions on multiple levels, including decisions to allocate resources by the federal government. Ultimately, it’s important that we get this right, so we ensure we are training enough pathologists to meet the demands of the US patient population.”

Read the press release.

On February 21, Change Healthcare experienced a cybersecurity attack that resulted in disruptions in claims processing, delayed prior authorization requests, and other major impacts on physician practices. The CAP has continually monitored the impact the attack has had on pathology practices and laboratories and continues to share resources to assist pathologists managing the fallout. Most recently, the Department of Health and Human Services (HHS) compiled information, resources, and tools from health plans and payers for providers in need of assistance – find that document online here. The following are additional resources to help pathologists navigate these ongoing issues:

Change Healthcare

Change Healthcare has created a website with resources that include:

• Funding relief for providers
• An impacted applications status dashboard including updates for Chief Information Security Officers (CISO) and other stakeholders about products and services, as well as uptime and support availability
• Help with third-party documentation
• Client services assistance
• Up-to-date reconnection status information
• Frequently Asked Questions

MIPS Exception

The Centers for Medicare and Medicaid Services (CMS) has reopened applications for Extreme and Uncontrollable Circumstances exceptions for submission of 2023 MIPS data. The applications will be open until the end of an extended data submission period: April 15, 2024, at 8 PM ET. The applications will be accepted at the QPP website but only for disruptions related to the Change Healthcare cyberattack. Applications for other reasons will not be accepted.

HHS/CMS Payments

On March 5, the HHS and the CMS said they would help providers and hospitals negatively impacted by the Change Healthcare cyberattack. To help address cash flow and related problems, the HHS and CMS said they would provide accelerated and advance payments in amounts representative of up to thirty days (30) of claims payments to eligible providers and suppliers. Read more.

AMA Information

The American Medical Association (AMA) has a dedicated website with updates, additional resources, and advocacy efforts around this issue.

The CAP will continue to provide updates and resources as the issue progresses.

To enlarge the map, click here.

The CAP’s political action committee, PathPAC, and the CAP House of Delegates (HOD) are thrilled to partner for the third-annual Back the PAC competition, which has been underway since mid-March. This year’s Back the PAC continues the tradition of friendly competition between regional teams of the HOD to raise funds for the PAC in the lead up to the Pathologists Leadership Summit (PLS).

The competition’s goal is to increase the level of PathPAC support and engagement from HOD members while providing Delegates with more in-depth education on PathPAC’s important role in advancing the CAP’s advocacy agenda.

The five regional teams (all with an equal number of Delegates) will go head-to-head until Saturday, April 13, and the winning team(s) will be determined by:

1. Highest overall team participation rate (%)
2. Most PathPAC funds raised ($)

Winners will be announced on Saturday afternoon, and PathPAC supporters from the winning team(s) will be invited to an offsite reception taking place on Monday, April 15 with a special congressional guest, Representative Kim Schrier, MD (D-WA). PathPAC supporters who participate in PLS and are not in the House of Delegates will also have an opportunity to compete in a Back the PAC raffle to attend the prize reception with Rep. Schrier.

Check out the current team standings here or below:

Total $ Raised:

1st: Midwest Team ($8,350)
2nd: Coastal Team ($7,724)
3rd: Frontier Team ($7,350)
4th: Pacific Team ($6,892)
5th: Appalachian Trail Team ($2,550)

Participation Rate (%):

Coastal, Frontier, and Pacific teams are all tied for 1st place in participation with 16%.

PathPAC is the only political action committee representing pathologists at the federal level—the PAC is crucial in facilitating opportunities to educate Congress on the issues most important to pathologists. Learn more about PathPAC and its work to represent a strong, united voice for the specialty on Capitol Hill here.

The CAP is one of more than 170 health care organizations supporting a national study by the AMA and Mathematica that will collect representative data on physician practice expenses. The aim of the AMA Physician Practice Information Survey is to better understand the costs faced by today’s physician practices to support physician payment advocacy.

Pathologists and their practices must watch for invitations to complete the survey. Invitations and reminders about the costs survey will come from PPISurvey@mathematica-mpr.com. Invitations and reminders about physician hours worked will come from PhysicianHoursSurvey@mathematica-mpr.com with the subject line: “Please help to update accurate physician payments.” Your input will ensure future pathology payment rates are accurate.

The study will serve as an opportunity to communicate accurate financial information to policymakers, including members of Congress and the Centers for Medicare & Medicaid Services (CMS). The survey has been extended through at least June 2024.

Physicians will be randomly selected to participate. If contacted, you will receive a $100 stipend for participating in the survey and your individual practice data will be kept private. Participation is voluntary but critical to the success of efforts to support accurate resource-based physician payment.

Again, the CAP strongly urges all physicians who are selected for the surveys to respond as soon as possible. If pathologist participation rate is low, the specialty will not be accurately represented regarding the costs of the practice of pathology. If costs aren’t represented, reimbursement may suffer relative to other specialties. For more information read the Physician Practice Information Survey Methodology Report.

The California Society of Pathologists and the CAP strongly support Assembly Bill 2107 authorizing pathologists and laboratory personnel to remotely review clinical laboratory data, digital results, and digital images under CLIA.

In a March 20 letter, the groups stated: “Amid the COVID-19 pandemic and the unique challenges it posed, the Center for Medicaid & Medicare Services (CMS) utilized enforcement discretion to ensure pathologists could review slides and sign out remotely so long as the primary site or laboratory had a CLIA certificate. The CAP advocates for the continuation of this waiver to preserve quality, ensure continuity of care for patients, and provide necessary flexibility as needed for clinical laboratories and pathologists.”

California is one of the only states that does not recognize the CMS’ continued enforcement discretion for pathology’s remote waiver. Bringing California into alignment with federal guidance would allow pathologists in California the flexibility to sign-out remotely as they can in other states. As workforce constraints continue to be a challenge, this flexibility is key to ensuring timely review of tests and the quickest diagnosis possible, benefiting not only pathologists but California patients across the state.

The bill was further amended on April 3 and passed the Assembly Business and Professions Committee (16-0 vote) clarifying that clinical laboratory’s remote review will be on a temporary or intermittent basis under a primary site’s CLIA certificate and details the scope and review of ‘digital materials.’

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