Advocacy Update

• Over 300 Pathologists Encourage Senators to Reverse January 1 Cuts to Medicare Pay
• Deadline for UnitedHealthcare Z-Code Compliance for Reimbursement April 1
• Change in Scoring for Pathology Practices Reporting MIPS via Claims
• Expanding Leadership Skills in the Laboratory and on Your Career Path at the Pathologists Leadership Summit!
• CAP and AMA Urge Veteran Affairs Dept. to Halt Standards of Practice Workgroups to Comply with Scope of Practice Laws
• New Resource: 2023 Your Voice Matters Advocacy Wins Infographic
• Take Our News Quiz for February

Over 300 pathologists responded to an Action Alert by the CAP sent to its grassroots advocacy network encouraging outreach to their legislators to sign a Dear Colleague Letter drafted by Sens. John Boozman (R-AR) and Peter Welch (D-VT). The letter, sent to Senate leadership on February 22, emphasized the urgent need to address the 3.37% cut to Medicare physician payments that went into effect January 1. Thirty-two senators signed the letter.

Over the last five years, payments to pathologists have decreased by approximately 6%, while physician practice costs have increased by nearly 14%. This year, pathologists are predicted to experience a 7% reduction in income as revenues are expected to fall by close to 2.7%. At the same time, expenses are forecasted to increase by over 4.6%.

These cuts are on top of the lack of an inflationary update to the physician fee schedule. According to the American Medical Association (AMA), Medicare physician pay fell 26% from 2001–2023 because physicians do not get yearly inflationary payment updates. While Congress passed legislation to mitigate the impact of the cuts in 2023 and 2024, they did not stop the cuts completely. The CAP expressed deep disappointment after Congress ended its legislative session in 2023 without addressing future Medicare payment cuts to physician services.

Grassroots advocacy is at the root of driving change at the federal and state level on health care policies that will impact pathologists’ ability to practice and protect the patients they serve. Learn more about CAP’s grassroots advocacy network and how you can take action at PathNET.

The CAP met with officials from UnitedHealthcare to express our continued opposition and strong concern over the insurer’s decision to move forward with new requirements to use Z-codes beginning April 1, 2024. In response to questions from the CAP, UnitedHealthcare officials reviewed its plan to minimize disruption of pathology services and allow for some assistance for laboratories working to comply with the new requirements.

The CAP opposes this requirement for specific Z-code identifiers on claims to receive payment, as it would be confusing and result in complex workflow processes that will be difficult for CAP members, especially those unfamiliar with Palmetto. The CAP was successful in getting the insurer to delay this requirement from the original October 2023 date until the new implementation date of April 1. The Z-code requirement will initially cover 133 CPT codes and 104 proprietary laboratory analysis codes. Claims will be denied if the Z-code plus the appropriate CPT code information is missing.

UnitedHealthcare said they will provide the following to assist in the transition:

• “Provider advocates” who are engaged and monitoring labs and will reach out to help with the Z-code process.
• Increased communication with Palmetto and within hospital systems.
• A commitment to work collaboratively with providers to understand who are struggling with the new process.

Learn how to prepare for April 1 compliance here. For additional queries or issues with the Z-codes, UnitedHealthcare suggests emailing them at united_genetics@uhc.com.

Small practices who are working with their billing companies to submit data for MIPS via Medicare Part B claims should be aware of a recent change in scoring for their measures. For 2024, the Medicare Part B claims version of measure QID 396, Lung Cancer Reporting (Resection Specimens), no longer has a benchmark. That means practices submitting on this measure via claims will earn at most 3 points on this measure no matter their performance score.

It is not too late to enroll in the Pathologists Quality Registry and access higher-scoring measures that are only available in the registry. If interested, practices should contact registry.inquiries@cap.org.

Leadership in pathology is a multifaceted journey, with countless avenues for pathologists to explore as they progress in the laboratory and on their career path. Don’t miss out on two engaging sessions at the Pathologists Leadership Summit in Washington, D.C. on Sunday, April 14 that will inspire you to delve into the diverse world of pathology leadership.

“Lessons in Laboratory Leadership” co-led by Earle S. Collum, MD, FCAP and Patrick Godbey MD, FACOG, FCAP will compare and contrast the leadership challenges and opportunities that exist in preparing for and conducting inspections in our laboratories. Using specific examples with which the audience can identify, the presenters will focus on how laboratory directors must build relationships with their teams and their physician and administrator colleagues, as well as demonstrating value to the executive team.

The lunch session titled “Paths in Leadership” co-led by Xiaoyin "Sara" Jiang MD, FCAP and C. Leilani Valdes MD, MBA, FCAP spotlights the leadership roles found in various practice settings, catering to professionals at various stages of their careers. Aspiring and seasoned pathologists alike will gain invaluable insights and tips for becoming successful leaders in our field. They will discuss tools and opportunities for effective networking, mentorship, and collaboration to help build fulfilling leadership roles.

Register today!

The CAP, the American Medical Association (AMA) and other medical organization are asking the Department of Veterans Affairs (VA) stop the development of National Standards of Practice (NSP) workgroups that conflict with state law arguing that they will lead to a confusing mix of standards that are not meaningfully different than the current variability among state scope of practice laws. In a letter, the organizations also asked the VA to disclose the names of all participants on the 51 NSP workgroups and to include unbiased physician representatives on every workgroup.

The VA launched its effort to develop NSPs for 51 healthcare occupations, referred to as the Federal Supremacy Project, following publication of the “Authority of VA Professionals to Practice Health Care” Interim Final Rule in November 2020. The VA has invoked the Supremacy Clause so that it can develop NSPs unrestricted by state scope of practice and medical licensure laws, potentially enabling some healthcare occupations to practice independent of physician supervision. This includes optometrists, physician assistants, pharmacists and other nonphysician providers who serve more than 9 million veterans enrolled in the VA health care program.

To learn more, watch the House Committee on Veteran’s Affairs Subcommittee on Health oversight hearing titled: “VA’s Federal Supremacy Initiative: Putting Veterans First?” held on September 19, 2023.

Learn how pathologists made a difference in 2023 by helping to reduce payment cuts, mobilizing for political action, and in state level advocacy in our new downloadable resource: 2023 Your Voice Matters Advocacy Wins Infographic.

The CAP lobbies for laws that protect the pathologist's ability to provide high-quality services in a fair, competitive environment. Unlike other pathology-related groups with only a handful of advocates, we have more than 35 advocacy professionals fighting for your interests. Our efforts are bolstered by 120 pathologists continuously tackling the issues important to the pathology specialty on policy-related committees.

Together, we are leading advocacy regarding pathology issues across the country and throughout the lawmaking process—from concept to revisions, to passage, and real-world application.

Join us in-person for the 2024 Pathologists Leadership Summit where you will gain the education and training needed to grow personally and professionally. Then, put these newly honed tools into action on Capitol Hill as we advocate together for pathology and patient care. Your voice matters in 2024. Register now!

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