Advocacy Update

• Special Report: AMA Prioritizes Medicare Payment Reform, Legal Action Against Change Healthcare at Annual Meeting
• Congress Reintroduces CAP-Supported Prior Authorization Reform Bill
• New Resource! The CAP’s Laboratory-Developed Test Oversight Webpage
• Federal Grants Now Available to Fund Cybersecurity at Rural Hospitals
• CAP President Attends Annual House Call on the Mall Political Event
• CDC Calls on Lab Industry for Bird Flu Test Development Solutions
• Podcast: What Happens After the Pathologists Leadership Summit?
• Take Our News Quiz for June 

The American Medical Association (AMA) House of Delegates focused on three major factors influencing the practice of medicine at its 2024 AMA Annual Meeting in Chicago – Medicare payment reform, cybersecurity attacks on health care systems, and the deployment and use of artificial intelligence in health care. The CAP and its leadership engaged in debates at the AMA meeting on these and other topics to represent the interests of pathologists and the patients we serve.

The CAP also led the delegation of pathologists, called the Pathology Section Council, at the meeting. The section council includes American Society of Clinical Pathology, American Society of Cytopathology, the CAP, National Association of Medical Examiners, and the American Society of Dermatopathology. In addition to Medicare payment reform, cybersecurity and AI, the Pathology Section Council discussed a variety of topics concerning the specialty, including medicolegal death investigations, prior authorization, and the corporate practice of medicine and private equity.

The Importance of AMA Membership

Your membership in the AMA ensures pathologists have a strong voice in the house of medicine. Learn more about AMA membership or go to ama-assn.org/cap-join to activate an AMA membership today.

Ensuring Sustainable Payment Rates

Unsustainable payment rates do not reflect practice costs, or the value of the care provided, according to an AMA Council on Medical Service report adopted at the meeting. Delegates adopted a policy stating that payment benchmarks should reflect the cost of providing care while acknowledging risk, variable expenses, an appropriate allocation of fixed costs and physician work. Delegates representing the CAP at the meeting supported the measure as pathologists have fought against across-the-board Medicare cuts to all physicians for several years and, most recently, at our Pathologists Leadership Summit in April.

Cybersecurity and Change Healthcare

The AMA House of Delegates adopted a resolution calling on the AMA to investigate the possibility of filing a class action lawsuit against Optum, United Health Group and Change Healthcare to recoup the damages from the disruption caused by the February 21 cybersecurity breach, and to distribute the unfair enrichment profits made by Optum et al to the practices whose retained payments allowed them to generate interest and investment profits.

The CAP has heard from members that the cyberattack has had “ripple effects in the pathology billing world,” with even non-Change Healthcare clearinghouse vendors continuing to have trouble transmitting and processing claims, as well as billing platforms still not backed up. Members have also said that this is a huge issue for those in small practices who are contracted with Change Healthcare and cannot pivot quickly to bring billing in-house or find another third-party option. The cyberattack has wreaked havoc on collections and caused increasing cash flow constraints.

Augmented/Artificial Intelligence

New policy on artificial intelligence builds on AMA principles that addresses the development, deployment, and use of AI in health care. The House of Delegates extensively discussed the issues around AI and requested a report back at the 2024 Interim Meeting of the House of Delegates in November. Pathology section council delegates spoke to concerns around ethics requirements, sham science, and terminology issues.

The CAP is actively engaging with the Food and Drug Administration (FDA), the Coalition for Health AI (CHAI), and others to establish a leadership role in the regulation and accreditation of AI/ML products. The CAP is also engaged internally on education and technical issues particularly related to verification and performance monitoring.

Medicolegal Death Investigations

A resolution asking the AMA to support the independent authority of forensic pathologists and to advocate with state and federal governments to ensure laws and regulations do not compromise a physician’s ability to use their medical judgement in the reporting of postmortem assessments and medicolegal death investigations was brought to the floor by the CAP along with the National Association of Medical Examiners (NAME), American Society for Clinical Pathology, and American Society of Cytopathology. The Pathology Section Council secured support of several groups, including the Hospital-Based Physician Caucus. During reference committee, NAME, the CAP, the American College of Obstetrics and Gynecology (ACOG), PacWest, American Academy of Pediatrics (AAP), and American Psychiatric Association (APA) all spoke in strong support.

This AMA has a policy against encroachment in other circumstances, but encroachment policy specific to forensic pathologists or legislative efforts impacting the practice of medicine does not exist.

Prior Authorization

The Pathology Section Council supported, and the AMA House of Delegates adopted a resolution calling on the AMA to advocate for increased legal accountability of insurers and other payers when delay or denial of prior authorization leads to patient harm.

On January 18, the 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 address prior authorization in government-regulated health plans. As a result of the recent final rule, legislators now see a path forward toward enacting this legislation and making these reforms into law.

Corporate Practice of Medicine and Private Equity

The AMA House of Delegates heard concerns about the corporate practice of medicine and private equity and asked the association to study how to increase competition, increase transparency, support physicians and physician autonomy, protect patients, and control costs in already consolidated health care markets. The House of Delegates also directed the AMA to oppose all restrictive covenants.

Reforming Medicare Advantage Payment Policies

To address outdated Medicare Advantage policies, strengthen traditional Medicare, and help patients make more informed choices between traditional Medicare and Medicare Advantage, AMA delegates adopted new AMA policy to:

• Encourage that risk-adjustment formulas be revised so that claims data is based on the actual cost of providing care
• Provide or create educational materials such as an infographic to compare traditional Medicare and Medicare Advantage plans so that patients are able to make informed choices that best meet their health care needs.

AMA President-Elect Meets with Pathology Section Council

Bobby Mukkamala, MD, an otolaryngologist from Flint, MI, is the new president-elect of the AMA. Dr. Mukkamala, who has been active in the AMA since residency, is chair of the AMA Substance Use and Pain Care Task Force, serving as a strong voice in advocating for evidence-based policies to end the nation’s overdose epidemic.

Dr. Mukkamala met with the Pathology Section Council (pictured below) to hear concerns affecting the practice of pathology and how the AMA can support the specialty in the future.

A bipartisan group of senators and representatives reintroduced the Improving Seniors’ Timely Access to Care Act, which would streamline the prior authorization process under Medicare Advantage to better serve patients and reduce unnecessary administrative burdens for clinicians. This bill is supported by the CAP, over 380 national and state health care organizations, 42 Senators, and 130 House members.

In September 2022, the House passed the bill that was cosponsored by a majority of members of both the House and Senate. Since then, the Senate and House have been working with the Centers for Medicare & Medicaid Services (CMS) to advance the legislation to the President’s desk, but the bill’s cost has been a factor.

On January 18, the 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 address prior authorization in government-regulated health plans.

The CAP, the AMA and others have been advocating for prior authorization reform at the state and federal level for many years, which includes:

• 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
• prior authorization information at the point-of-care

To see the list of health care organizations who support the bill, click here.

How will you determine if a test meets Food and Drug Administration (FDA) regulatory requirements for laboratory-developed tests (LDTs)? Confused on how and when you will need to be compliant with the new rule? The CAP has combined multiple resources on one easy to follow webpage that provides the following:

• The stage/phase one requirements beginning May 6, 2025
• A place to submit questions about FDA LDT oversight
• The May 2024 CAP webinar: Preparing for Implementation of FDA’s Laboratory-Developed Test Final Rule and downloadable presentation slides
• Frequently asked questions
• Resource documents
• Links to CAP legislative action on LDT’s dating back to 2010

Check it out and “favorite” the link: Laboratory-Developed Test Oversight. The site will be updated regularly as new information and resources become available.

The Biden Administration, the American Hospital Association (AHA), and the National Rural Health Association (NRHA) have combined efforts and recruited Google and Microsoft to offer free and low-cost tools and services for independent critical access and rural emergency hospitals. With limited resources and outdated systems, rural hospital systems are often easy targets for hackers.

Google said it will provide endpoint security advice to rural hospitals at no cost and will also offer funding toward software migration. Additionally, Google plans to launch a pilot program to package cybersecurity technologies that meet the unique needs of small and rural facilities.

The new Microsoft Cybersecurity Program for Rural Hospitals aims to offer grants and up to a 75% discount on security products optimized for smaller organizations. Eligible rural hospitals can receive free cybersecurity assessments by qualified technology security providers and free training for frontline and IT staff. Eligible hospitals that are already using Microsoft tools can get its advanced security suite at no additional cost for a year. Microsoft will also extend security updates for Windows 10 to participating hospitals for one year at no cost.

Earlier this month, CAP President Donald Karcher, MD, FCAP had the opportunity to build on his relationships with congressional healthcare champions through his participation in the Doc Caucus’ House Call on the Mall event in Washington, DC. PathPAC’s sponsorship of this annual event made it possible for Dr. Karcher to attend and represent the CAP.

Dr. Karcher heard from Reps. John Joyce, MD (R-PA), Michael Burgess, MD (R-TX), Brett Guthrie (R-KY), all members of the House Committee on Energy and Commerce (and its Health Subcommittee), along with Sen. Roger Marshall, MD (R-KS) at a policy breakfast that morning, which was also attended by dozens of fellow physicians participating on behalf of their respective medical specialty groups.

As the only political action committee solely representing pathologists at the federal level, PathPAC is a crucial tool in maintaining a strong political footprint for the pathology profession and strengthening relationships with congressional allies. Click here to learn more about PathPAC’s work to advance the CAP’s advocacy agenda.

On June 10, the Centers for Disease Control and Prevention (CDC) put out an open call to industry for innovative solutions to meet the CDC’s diagnostic test development needs for Influenza A(H5). The CDC is responding to a multistate outbreak of avian influenza A(H5N1) virus, or “A(H5N1) virus,” in dairy cows and other animals in the United States. On May 13, the CDC recommended a state of “heightened awareness” in the laboratory community while they continue to use their flu surveillance systems to monitor H5N1 activity in humans.

Solution providers shall submit concept papers via email to mcrow@cdc.gov no later than 11:59 PM Eastern on Monday, June 24, 2024, to be considered for further evaluation. Review the contract opportunity notice and attachment for more information and visit: CDC Open Call to Industry – Influenza A(H5) Diagnostic Test Development and Validation.

Questions? If you are a clinical or public health laboratory professional, contact the Laboratory Outreach Community System (LOCS).

The 2024 Pathologists Leadership Summit took place in mid-April and featured the Spring House of Delegates meeting, educational courses, Advocacy programing, and our annual Hill Day. CAP House of Delegates Speaker Sang Wu, MD, FCAP, and Mary Le, MD, FCAP, who is vice chair for the CAP Federal and State Affairs Committee, recapped what took place at the spring meeting during a recent podcast episode. Dr. Wu and Dr. Le further discussed what CAP members can expect going forward from the CAP House of Delegates and our Advocacy programs.

Give it a listen.

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