Advocacy Update

• Pathologists Advocate to Reduce Medicare Cuts, Increase Workforce, Prepare for Future Pandemics at Leadership Summit
• PathPAC Raises $37,000 During HOD Competition as the Pathologists Leadership Summit Begins
• CAP Urges FDA Against Reclassification of Histocompatibility Antigen Testing Devices
• Colorado Pathologists, CAP Advocate for Prior Authorization Exemption Safeguard
• New Month - New Advocacy News Quiz

To prepare for the CAP’s annual Hill Day, CAP members discussed strategies for how they will engage their members of Congress at the Pathologists Leadership Summit on May 2. CAP Advocacy leaders prepared pathologists to lobby Congress on three main policies affecting the specialty: stopping Medicare cuts to pathology services, resolving workforce shortage issues, and preventing future pandemics.

In her opening remarks, CAP President Emily E. Volk, MD, FCAP, passionately described the importance of pathologists advocating for their profession and educating legislators on the impact of their payment policies.

“Our ability to practice medicine and serve patients can be significantly impacted by our congressional representatives' laws and policies. It is up to us to let them know how congressional decisions affect our laboratories and our patients. No one can explain our medical policy concerns better than us provide the texture, color and flesh that only we as pathologists can bring,” Dr. Volk said. “We must continually remind policymakers and others that we pathologists are physicians who practice clinical medicine, and what we do is critical to the care of patients. The foundation of all modern clinical medicine.”

Council of Government and Professional Affairs Chair Jonathan Myles, MD, FCAP, provided an overview of the current political landscape, the CAP’s advocacy agenda, updates on implementation of the No Surprises Act, private-sector advocacy, and the Hill Day asks for participants. Dr. Myles also answered questions about the political landscape, the impact of MACRA on physician payment, and current CAP-backed legislation.

Dr. Myles along with David Gang, MD, FSAC, Chair of Federal and State Affairs Committee; Diana Cardona, MD, FSAC, Chair of the Quality and Clinical Data Registry Affairs Committee; and Stephen Black-Schaffer, MD, FCAP, Chair of the Economic Affairs Committee answered questions regarding the current advocacy issues facing pathologists. These issues include MACRA reform, laboratory-developed tests, reimbursement issues and possible Medicare cuts.

On May 3, a record-breaking number of CAP members signed up to legislators to:

• Extend the 3% provider relief provided in the Protecting Medicare and American Farmers from Sequester Cuts Act for 2023 until that process is complete.
• Cosponsor the Resident Physician Shortage Reduction Act of 2021 (S 834/HR 2256).
• Cosponsor the Senate PREVENT Pandemics Act, S. 3799.

Advocacy Update will provide more coverage of the Pathologists Leadership Summit in the next issue.

The 2022 Pathologists Leadership Summit kicked off on April 30 with the Spring House of Delegates (HOD) meeting with hundreds of pathologists from around the country participating in-person and virtually.

During the day, Chair of the CAP PathPAC Board Sang Wu, MD, FCAP, announced that the Frontier Region won the Back the PAC HOD competition with over $37,000 raised by HOD members during an 8-week period. The goal of the competition was to garner more support for the CAP’s political action committee (PAC) and further raise awareness for PathPAC’s role to advance the CAP’s legislative objectives. PathPAC is nonpartisan and the only PAC representing pathologists at the federal level.

In addition, pathologists received an Advocacy overview from Council of Government and Professional Affairs Chair Jonathan Myles, MD, FCAP. Dan Harris, award-winning ABC News anchor and a #1 New York Times best-selling author, also had a lively discussion about anxiety and the benefits of meditation during the PathPAC hosted HOD luncheon.

The hybrid audience sharpened their leadership, communication, advocacy, and practice management skills during the second day of the Pathologists Leadership Summit on May 1. For example, CAP members Suzanne Dintzis, MD, FCAP; Vaishali Pansare, MD, FCAP; and Chakshu Gupta, MD, FCAP; reinforced the importance of state pathology society membership and advocacy. All three highlighted that advocacy is a life-long commitment, and its impact will affect your practice.

“No matter if you are at a private practice or salaried physician, advocacy is the only way you can influence your reimbursements and interactions with your hospital administrators,” said Dr. Gupta.

Working to improve diagnostic medical device regulations, the CAP urged the Food and Drug Administration (FDA) to reconsider plans to reclassify three histocompatibility antigen devices due to concerns over future availability and other uncertainties. The FDA is proposing this reclassification into class II with special controls as a necessary measure to prevent risk from medical device malfunction in the transplantation and transfusion setting.

The CAP advocates ensuring regulations protect patients without overburdening pathologists and laboratories. In the April 21 letter, the CAP asked the FDA not to place Human Leukocyte Antigen (HLA), Human Platelet Antigen (HPA), and Human Neutrophil Antigen (HNA) devices as a generic type of device into class II of special controls. The CAP said it understood that test manufacturers need such guidance to ensure safe and effective HLA, HPA, and HNA testing. However, the proposed regulation will likely negatively influence the use and availability of these devices, and possibly raise additional questions regarding medical liability.

In the letter, the CAP recognized that the HLA, HPA, and HNA testing market is expected to significantly grow due to an increasing number of organ transplants. The reclassification may have an impact on the availability of HLA, HPA, and HNA clinical testing because of the limited number of methods available, the CAP said.

The CAP will continue to engage with the FDA on this issue.

On April 22, the Colorado Society of Clinical Pathologists (CSCP) and the CAP urged the Colorado legislature to amend Senate Bill 78 to insert a statutory safeguard to deter potential adverse claims impacts on pathologists, laboratories, and patients.

The CAP advocates against reimbursement limitation and denial by health insurance carriers to pathologists for health care services based on whether the ordering physician has utilized or failed to utilize a laboratory benefit management program or clinical decision support system.

The Colorado state legislation requires health carriers or private utilization review organizations to offer a health care provider who met a 95% approval rate for prior authorization over the preceding year an exemption from prior authorization, an incentive award, or other programs designed by the carrier that reduces administrative burdens or wait times for patients.

The CSCP and the CAP wrote to the House Health and Insurance Committee to “urge an amendment to ensure when prior authorization requirements are waived under an there will be a statutory protection against an adverse claims impact upon any physician that performs or supervises a service exempted from such prior authorization. Without this statutory protection, pathologists and laboratories can be denied or limited payment for the services subject to prior authorization exemptions. In these cases, patients may be at financial risk for uncovered health care services.” The CSCP and CAP enhanced and modeled the payment safeguard after Texas’s prior authorization gold-carding law enacted in 2021.

The CSCP and the CAP continue to coordinate with the Colorado Medical Society (CMS).

It’s May and that means a new Advocacy News quiz. See how you compare against your fellow CAP members and brag about your top scores on social!

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