Advocacy Update

• What 3 Federal Changes Pathologists Should Know for 2023
• Who Will Lead Important Senate Health Care Committees in the 118th Congress
• The CAP, Infectious Disease Groups Ask FDA to Update ‘Breakpoint’ Criteria
• CAP Encourages Pathologists to Apply to be Scholars in Diagnostic Excellence Program
• CMS Extends MIPS Extreme and Uncontrollable Circumstances Deadline to March 3, 2023
• New Year- New Advocacy News Quiz
• Editor’s Note: Next CAP Advocacy Update is January 24

With a new year, there are several new laws and regulations now impacting pathologists and their practices. Below is a recap of what changes you should know for 2023.

New Digital Pathology Codes

The CAP worked with the American Medical Association (AMA) CPT Editorial Panel to establish 13 new digital pathology add-on codes. The new codes are intended to capture and report additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis. Digitization of glass microscope slides enables remote examination by the pathologist and/or in conjunction with the use of artificial intelligence (AI) algorithms. As a result of CAP advocacy, the new codes will help pathologists, pathology practices, and laboratories providing digital pathology digitization procedures appropriately report these services. The new digital pathology codes have been effective since January 1, 2023.

Medicare Cuts Mitigated for 2023

The CAP and the physician groups lobbied lawmakers to prevent the entire 4.5% Medicare cut stemming from the program’s policy to increase payment for evaluation and management services. Congress opted to mitigate the cut by 2.5 percentage points in 2023. As a result, the CAP estimates that the average Medicare spending impact on pathology will be a -1.16%.

The Centers for Medicare and Medicaid Services (CMS) released its updated national Medicare physician payment files that incorporate the changes in the Consolidated Appropriations Act of 2023. Specifically, in response to concerted advocacy by organized medicine, Congress reduced the 4.5% cut to Medicare physician payment by increasing the 2023 conversion factor by 2.5%. The updated 2023 Medicare physician payment schedule conversion factor will be $33.8872. The previously finalized conversion factor was $33.0607. The 2022 conversion factor was $34.6062.

Download our 2023 Medicare Physician Fee Schedule impact table showing these changes.

CMS Delayed Enforcement of GFE Requirements

Earlier in December 2022, the CMS announced it delayed the enforcement of the good faith estimate (GFE) requirements for uninsured and self-pay individuals. The CMS released a FAQ stating that the Department of Health and Human Services (HHS) extended enforcement discretion, pending future rulemaking, for situations where GFEs for uninsured (or self-pay) individuals do not include expected charges from co-providers or co-facilities.

The GFE requirements were included in the No Surprises Act and intended to protect uninsured (or self-pay) individuals from unexpectedly high medical bills.

As the 118th Congress took office in early January, Democrats continue to control the Senate. The CAP expects several leadership changes on key congressional committees overseeing Medicare, Medicaid, and health care that will be pertinent to the CAP's advocacy strategy in the Senate.

In the Senate Finance Committee, Sen. Ron Wyden (D-OR) will be the chair with Sen. Mike Crapo (R-ID) serving as the ranking member. In the Senate Health, Energy, Labor, and Pensions (HELP) Committee, the chair will be Sen. Bernie Sanders (I-VT) with Sen. Bill Cassidy, MD, who is a gastroenterologist, (R-LA) as the ranking member on the committee.

The CAP and three infectious disease organizations asked the Food and Drug Administration (FDA) to update the antimicrobial susceptibility interpretive criteria (called breakpoints). The American Society for Microbiology, the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, and the CAP are concerned that updated breakpoints are not being recognized by the FDA promptly, putting patients at risk and compromising diagnosis and treatment of infections.

In the January 6 letter to the FDA, the group outlined how more than 2.8 million antibiotic-resistant infections occur in the United States each year, and more than 35,000 people die as a result. The group said it’s critical to determine how to speed up updating breakpoints in cooperation with the FDA. In the absence of an FDA-recognized breakpoint, laboratories are forced to either apply off-label testing or use grandfathered tests, which in many cases, are obsolete.

The 21st Century Cures Act allowed the FDA to codify the recognition of breakpoints from the recognized standards development organization such as the Clinical Laboratory Standards Institute. However, since the Cures Act’s enactment, the Center for Drug Evaluation and Research has been slow to accept current, updated breakpoints, which puts patients at high risk and increases the likelihood of disease transmission and proliferation of antibiotic-resistant infections.

The group has requested a meeting with the FDA to discuss this critical matter further.

On January 5, the Council of Medical Specialty Societies (CMSS) announced the National Academy of Medicine Scholars in Diagnostic Excellence program, aimed at mid-career professionals to drive the implementation of effective strategies to raise awareness of diagnosis in medicine, support diagnostic excellence, and reduce diagnostic errors at the national level. The CAP is a member of the CMSS. The one-year part-time remote program for up to 10 scholars includes monthly educational sessions, mentorship, a $35,000 grant, and an additional $5,000 in domestic travel funds. Applications are due by 3 PM ET on March 1, 2023.

Funded by the Gordon and Betty Moore Foundation, this collaborative program, a partnership with the CMSS, is designed to develop a cadre of leaders who can drive the implementation of effective strategies to raise awareness of diagnosis in medicine, support diagnostic excellence, and reduce diagnostic errors at the national level. To learn more, visit: dxexscholars.nam.edu.

The CAP is a recent recipient of an innovative Diagnostic Excellence grant from CMSS and the Gordon and Betty Moore Foundation to assess patient experience with their pathology report. The CAP encourages all pathologists who may be interested in any aspect of diagnostic excellence to consider this Scholar opportunity.

The CMS announced late in 2022 that it has extended the Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances application to March 3, 2023. By extending the deadline, the CMS allowed pathologists, groups, and alternative payment model entities to request the reweighting of MIPS performance categories due to the ongoing COVID-19 public health emergency.

The deadline for applications citing COVID-19 as the triggering event is 8 PM ET on Friday, March 3, 2023. Please note that applications received between January 3 and March 3, 2023, will not override submitted data for individuals, groups, and virtual groups.

It’s a new year, a new Congress and new CAP advocacy issues! Test your knowledge with the January Advocacy News Quiz. See how you compare against your fellow CAP members and brag about your top scores on social!

Take the news quiz

Your Advocacy Update newsletter will take a scheduled break for Martin Luther King, Jr Day. The next issue will be on January 24, 2023. For more immediate updates, please check out our Twitter feed @CAPDCAdvocacy.