Advocacy Update

• CAP Gives Administration Guidance for No Surprises Act Regulations
• CAP Releases Strategies to Mitigate Shortage of ‘Blue Top’ Test Tubes
• AMA Adopts New Policy to Increase Diversity in Physician Workforce
• Deadline Extended: 2021 Practice Leadership Survey
• Think You Know CAP Advocacy? Then Put It to the Test!
• Breaking Advocacy News: Check out the Advocacy Twitter Channel

The CAP provided key recommendations for implementing the No Surprises Act to the Department of Health and Human Services (HHS) as it will issue regulations and guidance before the law goes into effect January 1, 2022. The CAP sought to ensure patients are protected from surprise medical bills while appropriately settling disputes between pathologists and insurers. The No Surprises Act, which became law in December 2020, contained several provisions advocated for by the CAP.

In a June 21 letter to HHS Secretary Xavier Becerra, the CAP argued that strong regulations are needed to prevent health plan manipulation. “Even now, health plans are finding ways to circumvent the protections provided in the No Surprises Act; for example, by proposing to subject patients to full liability for services received at facilities listed as being in-network, but not additionally ‘designated’ as eligible for coverage. We need strong regulations to prevent such health plan manipulation and gaming that harms patients, while ensuring robust oversight and audit/complaint processes.” The CAP further asked the regulatory agencies to “support an equitable and balanced system for resolving payment disputes, so as to ensure fair reimbursement for out-of-network services and an independent dispute resolution (IDR) process that is accessible to all.”

In particular, the CAP asked Secretary Becerra to consider the range of activities within pathology services and the variety of associated costs and resources across different provider settings when considering qualifying payment amounts for services provided. The CAP also asked for added measures in the IDR process that would ensure efficiency and minimize administrative costs while providing access to the process for physicians no matter their situation. For example, providing an entirely online/virtual process will allow providers to participate more fully no matter their schedule or resources.

Finally, the CAP reiterated that inadequate insurer networks are the cause of surprise medical bills. If networks were comprehensive, patients would not need to worry about out-of-network providers' surprise medical bills. The CAP appreciated that the Government Accountability Office will study network adequacy and asked for continued enforcement from the agency as we can better evaluate the implementation and success of the No Surprises Act.

With a national shortage of certain test tubes to collect blood for coagulation testing, the CAP published recommendations on June 15 for ordering physicians, nurses, and laboratories to follow until supplies for the tubes return to normal levels. The CAP reviewed the recommendations to address the shortage of 3.2% sodium citrate blue top tubes with officials from the Food and Drug Administration (FDA). Shortages are expected to continue throughout the rest of 2021.

Coagulation tests measure the blood’s ability to clot and how long the body will take to clot. This testing determines the risk of excessive bleeding or developing clots (thrombosis) in blood vessels. The CAP recommendations aim to reduce clinical impact of shortages and protect critical patient access to coagulation testing.

The shortages of these tubes have occurred due to several recalls, along with unprecedented levels of demand for citrate products following surges in COVID-19 infection rates, COVID-19 vaccines, and treatment development. Since sodium citrate tubes supplies are not expected to meet demand until the end of the year, the CAP developed mitigation strategy recommendations to guide clinical laboratories and federal regulators in reducing the clinical impact of these shortages.

What To Do If Your Laboratory Has Shortages?

The FDA has encouraged pathologists and other providers to report any adverse events or suspected adverse events experienced with the tubes. If you or your laboratory is experiencing shortages, you may contact the FDA at deviceshortages@fda.hhs.gov.

Prior to the CAP’s meeting with the FDA, the CAP wrote Health and Human Services Secretary Xavier Becerra on June 7 and asked for immediate actions from the administration to resolve the supply shortage. On June 11, the FDA added the sodium citrate blood specimen tubes to its list of medical device shortages during the COVID-19 public health emergency. The FDA further released guidance on the blue tops shortage and conservation strategies for pathologists and laboratory professionals.

During the American Medical Association (AMA) House of Delegates meeting, the AMA adopted policy aimed at improving the diversity of the physician workforce. The policy’s report outlined practices and interventions that can increase racial, ethnic, gender, and socioeconomic diversity among the physician workforce, including targeted recruitment and revised medical school admissions policies, curriculum changes, summer enrichment programs, and comprehensive programs that integrate multiple interventions, such as financial, academic, and social support.

Read the AMA’s Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity.

The report also identified institutional and structural factors that interfere with or create attrition on the path to becoming a physician and discusses recommendations to minimize these interferences. Additionally, the report examined the harmful past actions that the medical profession as a whole and organized medicine have perpetrated on communities of color, particularly the role that the Flexner Report of 1910 played in the closure of the majority of Black medical schools at the time and in severely limiting the number of Black physicians.

The new policy calls on the AMA to:

• Recognize some people have been historically underrepresented, excluded from, and marginalized in medical education and medicine because of their race, ethnicity, disability status, sexual orientation, gender identity, socioeconomic origin, and rurality, due to racism and other systems of exclusion and discrimination.
• Commit to promoting truth and reconciliation in medical education as it relates to improving equity.
• Recognize the harm caused by the Flexner Report to historically Black medical school the diversity of the physician workforce, and the outcomes of minoritized and marginalized patient populations.
• Work with appropriate stakeholders to commission and enact the recommendations of forward-looking, cross-continuum, external study of 21st century medical education focused on reimagining the future of health equity and racial justice in medical education improving the diversity of the health workforce, and ameliorating inequitable outcomes among minoritized and marginalized patient populations.
• Encourage the development of evidence-informed programs to build role models among academic leadership and faculty for the mentorship of students, residents, and fellows underrepresented in medicine and in specific specialties.
• Encourage physicians to engage in their communities to guide, support, and mentor high school and undergraduate students with a calling to medicine.
• Encourage medical schools, health care institutions, managed care and other appropriate groups to adopt and utilize activities that bolster efforts to include and support individuals who are underrepresented in medicine by developing policies that articulate the value and importance of diversity as a goal that benefits all participants.
• Continue to study and provide recommendations to improve the future of health equity and racial justice in medical education, the diversity of the health workforce, and the outcomes of marginalized patient populations.
• Encourage the U.S. Department of Education and Department of Labor to develop policies and initiatives in support of students from marginalized backgrounds.
• Advocate for funding to support the creation and sustainability of Historically Black College and University, Hispanic-Serving Institution, and Tribal College and University affiliated medical schools and residency programs, with the goal of achieving a physician workforce that is proportional to the racial, ethnic, and gender composition of the United States population.
• Work with appropriate stakeholders to study reforms to mitigate demographic and socioeconomic inequities in the residency and fellowship selection process, including but not limited to the selection and reporting of honor society membership and the use of standardized tools to rank applicants, with report back to the House of Delegates.
• Establish a task force to guide organizational transformation within and beyond the AMA toward restorative justice to promote truth, reconciliation, and healing in medicine and medical education.

The CAP 2021 Practice Leadership Survey has been extended by one week and will now close on Friday, June 25. Help shape and empower CAP advocacy by providing data from your pathology practice regarding economics, demographics, and market trend information in an evolving business environment.

Data from the survey will help CAP leaders determine which advocacy issues are most important to pathology practices and to support CAP advocacy efforts on behalf of the pathology specialty. The survey is targeted to practice leaders who can answer the questions for the whole practice.

Survey participants will have early access to survey results and will receive a $20 gift card. The survey should not take more than 20 minutes to complete.

The survey invitation was sent to all board-certified pathologists with 5 or more years in practice. If you have not received your invitation, please contact practicesurvey@cap.org.

Test your Advocacy news savvy by taking this month’s news quiz. Last month, over 90 pathologists took the quiz. See how you compare against your fellow CAP members in the June News Quiz and brag about your top scores on social!

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