Advocacy Update

• AMA CPT Announces 30 New Digital Pathology Codes for 2024
• CAP, Laboratory Groups Ask Congressional Leaders to Prevent Cuts to Clinical Lab Services
• How the Debt Limit Deal Affects Pathologists
• House Lawmakers Advance Proposals on Price Transparency and Site-Neutral Payments
• CAP Teams Up with Laboratory Coalition to Address Workforce Shortages
• Take Our New News Quiz for June

Following on our success for 2023, the CAP advocated for the inclusion of 30 new CPT digital pathology codes for pathologists to use in 2024. The CAP worked with the American Medical Association (AMA) CPT Editorial Panel to develop the new digital pathology add-on codes that were posted online on June 2. The new digital pathology Category III CPT codes will be used to report additional service requirements associated with digitizing glass microscope slides for primary diagnosis.

The AMA CPT will also revise the Category III Digital Pathology Digitization Procedure guidelines. The CAP applauds the AMA for their public release of this information, and the CAP will provide resources throughout 2023 to inform CAP members about anticipated CPT changes.

Through its advocacy, the CAP worked with the AMA CPT Editorial Panel to improve reporting of digital pathology services. As a result, the new codes will help pathologists, pathology practices, and laboratories providing digital pathology digitization procedures appropriately report these services. The new Category III digital pathology add-on codes (new CPT code numbers and CPT descriptors) will be released with additional information on July 1, 2023, and effective on January 1, 2024.

Last month, the CAP joined the American Clinical Laboratory Association and several other laboratory and medical groups to urge leaders in Congress to take up and pass the Saving Access to Laboratory Services Act (SALSA). The CAP advocates to protect the value of pathology and clinical laboratory services. The CAP has strongly opposed Medicare cuts to fees for clinical laboratory services.

The bicameral, bipartisan legislation would update Medicare’s payment system for laboratory services to make it predictable and sustainable, the groups said in a letter to lawmakers on May 22. Without congressional action, Medicare reimbursement cuts – a fourth round scheduled to begin January 1, 2024 – of up to 15% could jeopardize access to many clinical laboratory tests that are used to diagnose, monitor, prevent, and manage common diseases for Medicare beneficiaries.

SALSA would give the Centers for Medicare and Medicaid Services new authority to collect private market data through statistically valid sampling from all laboratory segments for the widely available test services where previous data collection was inadequate. By providing a gradual phase-in approach, the bill protects clinical laboratories, the Medicare program, and patients from the impact of dramatic rate increases or decreases.

How Pathologists Are Fighting Against These Cuts

During the Pathologists Leadership Summit, CAP members advocated to support passage of SALSA. Pathologists can still encourage their representatives and senators to support the bill by signing into our Action Center.

The threat of a Medicare pay stoppage in early June would have occurred if the federal government hit its debt limit and could no longer borrow money to pay its bills. But with the White House and Congress reaching a deal to raise the debt ceiling, Medicare payments will continue uninterrupted for patient services.

The House of Representatives voted to pass the bipartisan Financial Responsibility Act of 2023 on May 31 and the Senate followed by voting for the package on June 1. The bill, signed into law by President Joe Biden on June 3, extends the debt limit for the next two years.

Passage of the bill alleviated immediate concerns of default on the nation’s debts and obligations, which include funding federal health programs. The deal cut by the Biden Administration and congressional leaders will keep nondefense spending for 2024 at 2023 levels. Topline federal spending will be limited to 1% annual growth. Medicare, Medicaid, and Social Security programs were left untouched.

Negotiators agreed to recoup nearly $28 billion in unspent funds allocated to combat the COVID-19 pandemic. New work requirements and time limits were also enacted for the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families programs. IRS funding was also cut by $1.4 billion in 2023.

With the debt deal reached, Congress will now turn to legislating on other priorities. The CAP remains engaged on representing the interests of pathologists on Capitol Hill.

The House Energy and Commerce Committee advanced legislation to institute site-neutral Medicare payment cuts to hospital outpatient departments and modify hospital price transparency requirements. The CAP, along with other groups such as the American Hospital Association (AHA), has opposed these proposals and is concerned burdensome measures will negatively affect hospital-based practices and patient access to services.

HR 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023, includes a section to increase price transparency of clinical diagnostic laboratory tests under Medicare. The section would require laboratories to make publicly available the discounted cash price, the de-identified minimum rate, and de-identified maximum rate for clinical diagnostic laboratory tests offered by the lab to be included in the list of shoppable services specified by the CMS.

The utility of price transparency efforts has been questioned in the past as patients often can’t shop for such services. The requirements also create extra burdens for hospitals and physicians.

The site-neutral payment cuts would apply to drug services furnished in an off-campus, provider-based department. According to the AHA, the cut would amount to $54.2 million over the first year and $3 billion over 10 years. “This legislative effort would expand existing site-neutral payment cuts, which have already had a significantly negative impact on the financial sustainability of hospitals and health systems and have contributed to Medicare’s chronic failure to cover the cost of caring for its beneficiaries,” the AHA said.

The College of American Pathologists is proud to join forces with a group of laboratory and health care association leaders working to identify and implement strategies to strengthen the workforce of laboratory professionals and pathologists. To address a trend of laboratory workforce shortages, a coalition of more than 20 national and regional laboratory, pathology, and other health care associations has formed to work toward building a robust, more diverse medical workforce.

“The CAP supports a variety of solutions to strengthen the workforce of laboratory professionals and pathologists, and we welcome the opportunity to collaborate with the Medical and Public Health Laboratory Workforce Coalition on these efforts,” said CAP President Emily E. Volk, MD, FCAP. “Along with this group, we will continue to advocate for health care policies across the country to alleviate pathology and clinical laboratory workforce shortages wherever they exist.”

The medical and public health laboratory workforce that underpins the US health care system is currently experiencing a personnel shortage. A significant number of laboratory professionals—experts at performing patient laboratory testing—have left the workforce due to retirement, others because of the burnout from the COVID-19 pandemic. On top of this, many accredited training programs for non-physician laboratory professionals have closed. As a result, the number of pathologists and qualified laboratory professionals has rapidly declined, and this has the potential to disrupt the delivery of high-quality patient care.

As the Coalition embarks on this new task, we welcome those interested in joining the effort to address laboratory personnel and pathologist shortages. Learn more about the Coalition at www.MPHLcoalition.org.

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