Advocacy Update

• Let Congress Know Where You Stand: Reverse Medicare Cuts
• Legislators Say They Will Fix Medicare Pay During Reconciliation
• CAP Responds to FDA Draft Guidance on Validation of IVDs
• CAP Supports Patient Cybersecurity Protections
• Indiana Pathologists, CAP Oppose Legislation Favoring Insurers
• Oklahoma Pathologists Oppose Out-of-Network Bill
• CAP Signs on to Amicus Brief Protecting Forensic Pathologists
• Key Health Confirmation Hearings and Meetings

Congress has failed to reverse Medicare payment rate cuts to pathologists and other physicians that took effect January 1 of this year.

Pathologists are facing financial strain that directly impacts patient care. These harmful cuts have serious consequences for patient access to care.

It’s time for pathologists to let Congress know we must reverse the cuts to ensure adequate payment for physicians and access to care for patients. Make your voice heard at Hill Day during the House of Delegates/Pathologists Leadership Summit in Washington, DC, April 26–29.

Register today

Can’t make it in person? Visit us online to learn more about opportunities to be involved in PathPAC.

Congress averted a government shutdown on March 14, but neglected to stop cuts to Medicare physician payment rates in 2025.

Lawmakers had hoped to use the government funding bill to reverse the Medicare cuts amounting to 2.8%. Leaders in the House of Representatives are now saying they will include a Medicare pay rate fix in an upcoming budget reconciliation bill.

The CAP will continue to press representatives and senators to stop these cuts. The CAP is supporting HR 879, the Medicare Patient Access and Practice Stabilization Act led by Reps. Greg Murphy (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA). This bill prospectively stops the entirety of the current reimbursement reduction and helps account for rising inflationary costs with a 2% payment increase. The bill enjoys the support of more than 100 representatives in the House and over 100 physician associations and medical societies.

The CAP expressed support for draft guidance by the Food and Drug Administration (FDA) on validating in vitro diagnostics (IVDs) for emerging pathogens during emergencies.

The CAP said the proposal would provide necessary guidance for the development of IVDs during a health emergency declared by the Department of Health and Human Services secretary. The CAP letter of support emphasized the vital role pathologists play in test development and validation and further recommended adding a provision to the guidance that encourages test developers to involve practicing pathologists.

The CAP letter also recommended revisions to provide greater flexibility for tests developed within a laboratory setting.

The CAP supports proposed cybersecurity protections for patients, while also encouraging a federal health agency to avoid unintended consequences of new regulation.

The Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), published a proposed rule to improve cybersecurity and better protect the US health care system from a growing number of cyberattacks. In response to the proposed rulemaking, the CAP suggested implementing a risk-based approach to standardized federal cybersecurity procedures to protect sensitive patient data.

If finalized, the rulemaking would modify the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements for health plans, health care clearinghouses (an organization that enables the exchange of health care data between a provider and a payer, and most health care providers and their business associates, to strengthen cybersecurity protections for individuals’ protected health information.

Additional information is available online.

The Indiana Association of Pathologists (IAP), with the support of the CAP, is opposing House Bill 1003, which would burden the practice of pathology and financially favor the insurance industry at the expense of patients.

Pathologists are opposing the bill because it would promote the narrowing or tiering of health plan insurance networks, outlaw contracts that require comprehensive in-network access to health plan enrollees, mandate an expedited time frame for the provision of written estimates to be furnished immediately upon request, and require the public posting by all clinical laboratories of charge and price data for every pathology/laboratory CPT code across all payers, governmental and non-governmental, for inspection. 

In opposition, the IAP noted that President Donald Trump’s Executive Order on Price Transparency placed the burden to provide pricing information on health plans and hospitals, not physicians or laboratories.

The IAP further noted that: "Without this particular amendment, the State Legislature is proposing under HB 1003 a regulatory requirement on clinical laboratories … that challenges operational practicality, will be financially punitive in implementation, and will be of no value to our patients. The proper role for price transparency resides with health plans and hospitals, not clinical laboratories."

HB 1003 passed the Indiana House on February 18 by a vote of 66-22 and is now pending in the State Senate.. The CAP will continue to oppose the bill in collaboration with IAP and update members as information becomes available.

Pathologists in Oklahoma and the CAP are working together to oppose legislation that would establish a state benchmark for physician out of network payment.

The Oklahoma State Association of Pathologists (OSAP), with the support of the CAP, has communicated strong opposition to Senate Bill 1047. A hearing on the bill was held in the Senate Business and Insurance Committee on March 6. The bill passed unanimously from committee and awaits consideration by the full Senate. 

As noted by OSAP: "of specific concern SB 1047, establishes a 'Minimum benefit standard' which means the eightieth percentile of all allowed amounts for the same or similar health care service furnished by an in-network provider or in-network facility as reported in an independent benchmarking database maintained by a nonprofit organization specified by the Insurance Commissioner. The 'Allowed amount' means the contractually agreed-upon amount paid by a health benefit plan to an in-network provider or in-network facility in the health benefit plan network."

OSAP further stated that: "This formula is highly adverse to the physician community and the medical delivery system. Tying physician and laboratory payment to a payment methodology under the exclusive and unilateral control of the health insurance industry will only serve to encourage health insurers to further slash contracted physician payment. This approach was knowingly rejected by the Congress when President Trump signed into law the federal No Surprises Act in 2020."

The CAP will continue to oppose the bill in collaboration with OSAP and update members as information becomes available.

The CAP signed on to an amicus brief in support of immunity for forensic pathologist and CAP member, Darshan R. Phatak, MD, FCAP, in a case that could have broader negative repercussions for the forensic pathology community.

In 2017, Dr. Phatak, a county-employed medical examiner in Texas, compiled an autopsy report on a woman who died of a gunshot wound, in which he determined homicide to be the cause of death. Following a criminal trial that resulted in a hung jury, the medical examiner's office changed the autopsy report to indicate the cause of death was "undetermined." The charges against the defendant were dropped and the defendant filed suit against Dr. Phatak.

At the time, the CAP and other medical organizations filed an amicus brief in support of Dr. Phatak, and with the case back in the Fifth Circuit Court, the CAP is once again signing on to an amicus brief.

Multiple confirmation hearings and meetings are happening on Capitol Hill.

On Thursday, March 13, the Senate Health, Education, Labor, and Pensions (HELP) Committee voted to advance the nominations of Marty Makary, MD, MPH, as Federal Drug Administration (FDA) Commissioner and Jay Bhattacharya, MD, PhD, as National Institutes of Health (NIH) Director. Both Makary, a surgeon, and Bhattacharya, a health economist, previously appeared before the Committee during their confirmation hearings. Television personality Mehmet Oz, MD, MBA, nominated as Centers for Medicare and Medicaid Services (CMS) administrator, also testified during a confirmation hearing with the Senate Finance Committee on March 14.

On March 13, the White House withdrew the nomination for former Rep. Dave Weldon, MD, who had been nominated to lead the Centers for Disease Control and Prevention (CDC). 

The CAP will continue updating members as information becomes available.