Advocacy Update

• Government Remains Open Until March, Congress Fails to Address Medicare Payment Cuts Again
• Bipartisan House Members Speak Out Against Medicare Cuts for Physicians, Call for Permanent Reform
• No Surprises Act Website Updated with New IDR Fee Ranges
• CAP Applauds CMS Prior Authorization Rule Prioritizing Patients’ Access to Care
• Register for the Pathologists Leadership Summit in D.C. April 2024
• Take Our News Quiz for January

Congress avoided a partial government shutdown by passing a stopgap spending bill to fund federal agencies until March. Unfortunately, the spending bill did not include a provision to reverse a 3.37% Medicare cut to physician services in 2024. The CAP continues to express deep disappointment over Congress’s failure to stop the cuts and pursue a retroactive solution to reverse them.

Throughout 2023 and now 2024, the CAP has lobbied Congress to stop these cuts. CAP members can continue to urge their representatives and senators to stop the cuts by using the CAP’s Action Center. The CAP will continue pushing Congress to pass legislation to mitigate the impact of the Medicare Cuts before March, when Congress will again work to pass legislation to fund the government throughout the rest of the year.

On December 20, CAP President Donald S. Karcher, MD, FCAP issued a statement urging Congress to take up legislation to stop the cut as soon as lawmakers return to Washington in the New Year. The CAP supports the passage of the Preserving Seniors’ Access to Physicians Act of 2023 (HR 6683) that reverses the cut to Medicare physician payments.

The CAP and other physician groups reached out to members of the House of Representatives and asked them to speak out against the 2024 physician Medicare cuts after word that a stopgap spending bill, to fund part of the government until March 2024, did not include relief for physicians.

From January 10-17, 14 members of the House took to the floor and made impactful speeches against the cut to Medicare physician payments.

Rep. Ami Bera, MD (D-CA) called for not only temporary relief now, but a permanent fix to Medicare in his speech. Rep. John Joyce (R-PA) talked about how Medicare cuts are threatening patient care in rural parts of America. Rep. Diana Harshberger (R-TN) asked her colleagues what physician would keep practicing year after year when their salaries are always being cut? Rep. Greg Murphy, MD (R-NC) Co-Chair of the GOP Doctors Caucus and sponsor of the Preserving Seniors’ Access to Physicians Act of 2023 - HR 6683 gave a moving speech about what it was like to serve Medicare patients but also worry about how to keep the doors open at his private practice.

This joint effort highlighted the issue in an effort push Congress to include relief for physicians when the new stopgap funding bill expires in March.

On January 12, the departments of Health and Human Services, Labor, and the Treasury updated the No Surprises Act website to reflect changes to the Federal independent dispute resolution (IDR) fees in accordance with a recently released final rule. The IDR Fees Final Rule was published in the Federal Register on December 21, 2023, and sets the administrative fee amount and certified IDR entity fee ranges for disputes initiated on or after January 22, 2024.

For these disputes, the administrative fee amount is $115 per party per dispute, and the certified IDR entity fee ranges are $200-$840 for single determinations and $268-$1,173 for batched determinations. The website now includes information on the fee set by each certified IDR entity within these ranges.

The CAP has argued that increased fees could be cost prohibitive for certain parties disputing low-dollar items and services. “By precluding the overwhelming majority of pathology claims from the IDR process (along with all other low-dollar claims), this administrative fee amount also injects a serious inequity into the process and undercuts the critical balance the legislation sought to achieve,” the CAP wrote in a recent comment letter. In response, the departments have proposed a reduced administrative fee in low-dollar disputes, which will be finalized at a later date.

Also, on January 17, the Departments reopened the comment period for the proposed rules entitled “Federal Independent Dispute Resolution Operations.” The comment period has been reopened to provide additional time for interested parties to consider and comment on any implications of the “Federal Independent Dispute Resolution Process Administrative Fee and Certified IDR Entity Fee Ranges” final rules, which were published and finalized December 21, 2023. Additional details about this comment period reopening can be found in the Federal Register notice here.

On January 18, the Centers for Medicare & Medicaid Services (CMS) released a final rule that makes important reforms in prior authorization programs for medical services. The rule is a direct result of important advocacy efforts taken by the CAP together with the American Medical Association and other physician organizations to addresses prior authorization in government-regulated health plans.

On March 13, 2023, the CAP wrote a letter to the CMS asking them to streamline the prior authorization process, reduce physician practice burdens, and prevent patient care delays in Medicare Advantage and other public health plans. The CAP emphasized how streamlining or automating prior authorization and other utilization management processes is critically important, and that it is imperative that any cost-control measures balance other considerations and continue to ensure access to timely and appropriate care.

In the final rule, the CMS has taken important steps toward improving the prior authorization process implementing many of the CAP’s requests. Improvements include:

• Electronic prior authorization process that is embedded within physicians’ electronic health records—bringing automation and efficiency to manual workflow.
• Mandating shortened prior authorization processing timeframes.
• Enhancing transparency around prior authorization, including requirements for specific denial reasons and public reporting of program metrics.
• Requiring that payers provide physicians and patients more prior authorization-related information.

The CMS noted enforcement of its policies, particularly around Medicare Advantage payers, can include CMS sanctions and civil monetary penalties. These policies will go into effect January 1, 2027. Download the prior authorization final rule fact sheet.

Year after year, pathologists’ payments are being threatened to decline, workforce shortages are causing burnout, and cuts to clinical laboratory payments hang in the balance.

Advocate for pathology and plan to attend the Pathologists Leadership Summit in-person where you will gain unparalleled access to the education and training to make an impact on Capitol Hill and protect the future of our specialty.

The Pathologists Leadership Summit takes place, in-person only, April 13-16 in Washington, DC. Mark your calendars and register today!

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