Advocacy Update

• CAP’s 2023 Hill Day Compels Members of Congress to Act
• CDC Says Mpox Is Not Over, Urges Caution
• HIPAA Privacy Rule Proposes to Protect Patients Seeking Reproductive Health Care Services
• Advocacy Win: Tennessee Pathologists, CAP- Amended Laboratory Choice Bill Enacted
• Advocacy Recap Podcast: Hill Day Experiences
• News Quiz: How Many Can You Get Right?
• Editor’s Note: Next Issue Will Be June 6

Following 145 meetings with congressional offices on the CAP’s annual Hill Day, several legislators agreed to cosponsor legislation that pathologists specifically asked their representatives and senators to support. The positive response to pathologists lobbying their lawmakers was just another example of a successful 2023 Pathologists Leadership Summit in Washington, DC.

“Being constituents to these representatives and senators in Congress when we go to Capitol Hill is a big deal and what we have to say really resonates with them,” said CAP President-elect Don Karcher, MD, FCAP. “All of us have tremendous sway because we are their constituents, and they do listen to us.”

The CAP’s lobbying on Hill Day yielded nine cosponsors to legislation concerning the specialty. Two members of Congress agreed to cosponsor the Saving Access to Laboratory Services Act (SALSA), which would address pending Medicare cuts to clinical laboratory services, and another seven members agreed to cosponsor the Resident Physician Shortage Reduction Act, which would address physician workforce shortages. Pathologists also asked their legislators to support future legislative efforts to stop Medicare cuts to pathologists and other physician specialties.

Overall, the reception to advocacy by CAP members was favorable. For example, Dr. Karcher, along with Drs. Vidya Sathiyamoorthy and David Daniel, spoke with Rep. Jamie Raskin’s (D-MD) office about the CAP’s three asks of Congress and he followed-up with the staff legislative director after Hill Day. Dr. Karcher expressed his appreciation for taking the time to meet with his group and for listening to their concerns. He again asked for the congressman’s support for SALSA, the Resident Physician Shortage Reduction Act, and efforts to stop the Medicare payment cuts to pathology services. During the meeting, Dr. Karcher and his colleagues emphasized the impact of payment cuts and how cuts affect pathology practices in rural communities and health care shortage areas like in the city of Baltimore. Payment cuts and shortages of physicians in the workforce pipeline make recruiting pathologists to communities throughout the state much more difficult.

Dr. Karcher had also noted that Rep. Raskin had cosponsored the previous version of the Resident Physician Shortage Reduction Act and suggested it would be helpful if he could cosponsor the bill again as it was recently reintroduced.

A couple weeks later, the legislative director thanked Dr. Karcher for the follow-up and let him know that Rep. Raskin agreed to cosponsor the Resident Physician Shortage Reduction Act again.

“We didn’t have to change his mind on the Resident Physician Shortage Reduction Act but participating in the CAP’s Hill Day does have an impact on legislation and legislators,” Dr. Karcher said. “This is important work and I’m hopeful more and more CAP members will get involved.”

The Centers for Disease Control and Prevention (CDC) cautioned that while in the United States, cases of mpox (formerly known as monkeypox) have declined since the peak in August 2022, the outbreak is not over.

In a May 15 Health Alert, the CDC said it continued to receive reports of cases that reflect ongoing community transmission in the United States and internationally. Currently, the CDC and local partners are investigating a cluster of mpox cases in the Chicago area. From April 17 to May 5, 2023, a total of 12 confirmed and one probable case of mpox were reported to the Chicago Department of Public Health. All cases were among symptomatic men. None of the patients have been hospitalized, according to the CDC.

Nine of the 13 cases were among men who had received two JYNNEOS vaccine doses. Travel history was available for nine cases: four had recently traveled (New York City, New Orleans and Mexico).

The CDC noted that although vaccine-induced immunity is not complete, vaccination continues to be one of the most important prevention measures. The agency expects new cases among previously vaccinated people to occur, but people who have completed their two-dose JYNNEOS vaccine series may experience less severe symptoms than those who have not.

Although approximately 1.2 million JYNNEOS mpox vaccine doses have been administered in the United States since the beginning of the outbreak, only 23% of the estimated population at risk for mpox has been fully vaccinated. To help prevent a renewed outbreak during the spring and summer months, the CDC is urging clinicians to be on alert for new cases of mpox and to encourage vaccination for people at risk. If mpox is suspected, test even if the patient was previously vaccinated or had mpox. Clinicians should also refamiliarize themselves with symptoms, specimen collection, laboratory testing procedures and treatment options.

For specimen collection, the CDC says that all recommended PPE should be worn when collecting a specimen from a person with suspected or confirmed mpox. Only sterile, synthetic swabs with plastic, wood or thin aluminum shafts should be used to collect suspected or confirmed mpox specimens for diagnostic testing. Do not use cotton swabs. More information on handling of specimens and testing procedures is available here.

The CAP has analyzed, and is continuing to monitor, a proposed regulation concerning reproductive health care privacy. The proposal, which was released in April, would clarify that protected health information (PHI) cannot be disclosed to aid an investigation of someone seeking or obtaining reproductive health care.

The Biden administration proposed the draft regulation to strengthen the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule protections by prohibiting the use or disclosure of PHI to identify, investigate, prosecute, or sue patients, providers and others involved in the provision of legal reproductive health care, including abortion. Disclosure of PHI would also be prohibited when it is sought to investigate a person traveling to another state to seek reproductive health care. Physicians and other providers would be able to disclose PHI to defend themselves from negligence, malpractice, or other lawsuits.

The rule would only preempt state law where reproductive health services are legally provided. It also would not prohibit disclosure of PHI to investigate a sexual assault when permission has been granted.

If finalized, the rule would go into effect 60 days after publication. The CAP will provide additional information on this proposed regulation as it becomes available.

On May 17, Gov. Bill Lee enacted Tennessee Society of Pathologists-CAP amended Senate Bill 1275, prohibiting health insurance issuers from denying clinical laboratories the right to participate in their network plans under the same terms as conditions as others participating laboratories furnishing covered laboratory services. The CAP did not take a position on the “any willing provider” bill but focused on removing a provision of concern.

Specifically, the Tennessee Society of Pathologists and the CAP, in collaboration with the Tennessee Medical Association successfully removed an anti-competitive provision permitting health plans to limit and restrict patient and health care provider referral access to a single clinical laboratory for non-emergency services under certain circumstances. The proposed provision would have conferred unprecedented statutory authority on health plans to limit clinical laboratory choice and access under vaguely defined conditions.

The CAP advocates for sufficient health plan network adequacy mandates to ensure that health plans are subject to regulatory incentives and state oversight to contract with clinical laboratories and pathologists. The amended legislation ensures Tennessee patients are not limited or restricted in clinical laboratory testing by optimizing patient and physician choice in the referral of the clinical laboratory services.

The law will take effect on July 1, 2023.

For our monthly Advocacy recap podcast, we discussed the FDA’s newest proposal on blood donations, as well as plans from the CMS to improve health equity in a regulation for hospitals. We also sat down with Dr. Victoria Jones and Dr. Eric Loo to discuss their experiences at this year's Pathologist Leadership Summit and Hill Day.

Give our monthly recap podcast a listen.

Test your knowledge of the last month’s advocacy activities with our Advocacy Update news quiz. About 150 of your colleagues took the previous month’s quiz. May’s quiz is just three questions – can you get all of them right?

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Due to the Memorial Day holiday, your next issue of Advocacy Update will be pushed to the MyCAP app and sent to your email inbox on June 6. If important news breaks between now and that date, we will send a special alert or publish the information on our Twitter channel: @CAPDCAdvocacy.