Advocacy Update

• Advocacy Works—But Only If You Are at The Table
• The AMA, CAP and Others Support Proposed Prior Authorization Reforms
• Washington State Pathologists Support Forensic Pathology Loan Repayment Bill
• Test Your Advocacy Intel

Legislators don’t care to listen to advocacy staff if they don’t hear from their constituents, too.

In 2023 pathologists’ payments are being threatened to decline by another 3% in 2024. We all must take action to make sure that the rules focus on quality patient care and assure that pathologists can get paid fairly. Hear Jonathan L. Myles, MD, FCAP explain how pathologists’ payments are being threatened and why your voice is critical.

Register now and join us in person at the 2023 Pathologists Leadership Summit, April 15-18. Let’s go to the Hill and ensure our voice is heard.

The American Medical Association (AMA), the CAP, and over 110 other medical societies supported meaningful prior authorization reforms proposed for Medicare Advantage and the Medicare prescription drug benefit. The group has asked the Centers for Medicare & Medicaid Services (CMS) to finalize proposed prior authorization reforms that target the inappropriate use of authorization requirements by Medicare Advantage plans to delay, deny, and disrupt the provision of medically necessary care to patients.

On February 13, they sent a letter to the CMS encouraging them to finalize as it represents significant advancements in reforming prior authorization policies. The group stated that the proposed reforms must be implemented amid mounting evidence that Medicare Advantage plans delay or even prevent Medicare beneficiaries from getting optimal care. The proposals could be better, but they are major steps forward in the collective prior authorization reform efforts.

In late December 2022, the CMS issued a Medicare Part C and D Proposed Rule. The proposed prior authorization reforms reflect many of the AMA policies for which the AMA, the CAP, and others have been advocating in the states and at the federal level for many years, including:

• increased clinical validity of coverage criteria;
• restrictions on retroactive denials after prior authorization approvals;
• a grace period for patients switching plans to promote continuity of care;
• greater physician-patient autonomy in determining where care can be provided and by whom; and
• prior authorization information at the point-of-care.

On February 6, on behalf of the Washington State Society of Pathologists (WSSP), and in consultation with the CAP, Dominique Coco, MD, FCAP, urged the Washington State Senate Higher Education and Workforce Committee, to support Senate Bill 5523, which would establish a statewide forensic pathologist loan repayment program. The CAP works closely with state pathology societies to advocate on behalf of the specialty. The legislation addresses forensic pathologist shortages in Washington State by offering loan repayments up to $25,000 annually for board-certified forensic pathologists providing forensic services in underserved and rural areas.

Additionally, the bill mandates a legislative report in coordination with the Washington State Department of Health and Washington’s Coroners and Medical Examiners Association to study the shortages of forensic pathologists, Conrad 30 J-1 visa waivers, local university forensic pathology programs, and other considerations to bolster the profession.

Dr. Coco explained that “SB 5523 importantly brings attention to the shortage of forensic pathologists in our state, a problem that has grown worse over the last decade…This stems from two trends: More death investigations as the result not only of additional deaths related to the pandemic but also an upward trajectory of homicides, overdoses, and even traffic-related fatalities. At the same time, the country is simply not training enough forensic pathologists to keep up with the workload.

“It is vital that we enact policies that helps attract physicians in training to the field of forensic pathology. We applaud your efforts in presenting this loan forgiveness program as one of the policies to bolster the ranks of forensic pathologists in Washington State and also support the proposed study.”

The bill awaits further consideration in the Washington Senate Ways and Means Committee.

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