Advocacy Update

• In Case You Missed It: CAP Works to Offset Cuts to Pathologists Pay for 2025
• Patient Advocates, Physicians, Others Support FDA LDT Rule
• CAP, 50 Physician Organizations Urge Congress to Stop Medicare Payment Cuts
• AMA, Illinois Physicians Sue Insurance Contractor for Price Fixing
• AMA Meeting Kicks Off Nov. 8: Register Today
• PathPAC Members Meet with Key Senators
• Register Today for LDT Webinar Happening This Thursday, Nov.7: Ready Your Laboratory for the FDA’s Stage 1: Adverse Event Reporting Requirement
• Webinar: What Will Be the Impact of the Final 2025 Fee Schedule on Your Practice?

The Centers for Medicare & Medicaid Services (CMS) adopted several payment policies advocated for by the CAP in the 2025 final Physician Fee Schedule and Quality Payment Program regulation released November 1. As a result of the CAP’s advocacy efforts, for example, the CMS updated the relative value units (RVUs) for three apheresis services and increased non-physician cost components for key pathology and laboratory labor types.

The 2025 Medicare Physician Fee Schedule does, however, include payment cuts to pathologists, independent laboratories, physicians, and other providers. These cuts are not a result of new policies, but stem from the expiration of two congressional Medicare pay relief packages. These relief packages were intended to offset the previously finalized cuts in the 2023 and 2024 Medicare Physician Fee Schedules. The CAP strongly opposes these cuts and is actively pushing Congress to act before the relief expires and the cuts take effect.

Briefly, here are the key topics included in the 2025 final rule:

• The expiration of congressional relief will negatively impact pathologists and other specialties throughout the physician fee schedule. Download the impact table showing the finalized changes to pathology services in 2025.
• The CMS increased Medicare Quality Payment Program (QPP) requirements for 2025, making it more difficult for eligible clinicians to avoid payment penalties.
• Learn more: Register for the CAP’s Medicare webinar on December 4, 2024. providing a comprehensive overview of the finalized fee schedule changes to pathology services and the QPP.

Several organizations representing patients, physicians, and other nonprofit groups filed court briefs supporting the Food and Drug Administration (FDA) regulation on laboratory-developed tests (LDTs) on November 4. The groups urged the court to deny motions by the American Clinical Laboratory Association (ACLA) and Association for Molecular Pathology (AMP) to vacate the FDA final LDT rule.

Read the three amicus briefs filed by:

• Public Citizen, American Cancer Society Cancer Action Network, Association for Clinical Oncology (ASCO), Friends of Cancer Research, National Brain Tumor Society, and Ovarian Cancer Research Alliance.
• The Center for Science in the Public Interest, a nonprofit consumer advocacy organization.
• Democracy Forward representing practicing physicians and pharmaceutical and medical device policy analysts.

The CAP has filed its own amicus brief urging the court to stop the FDA LDT rule from being implemented. Read the CAP’s amicus brief to the court cases ACLA et al. v. FDA, and AMP et al. v. FDA, US District Court Eastern District of Texas.

The CAP and more than 50 physician organizations are urging Congress to protect Medicare beneficiaries by enacting the Medicare Patient Access and Practice Stabilization Act of 2024.

The bill was introduced by Reps. Greg Murphy, MD (R-NC) and Jimmy Panetta (D-CA), and cosponsored by Reps. Mariannette Miller-Meeks, MD (R-IA), Raul Ruiz, MD (D-CA), Larry Bucshon, MD (R-IN), Kim Schrier, MD (D-WA), John Joyce, MD (R-PA), and Ami Bera, MD (D-CA). It would eliminate a 2.8% conversion factor cut and provide an increase to Medicare pay based on an economic index for 2025.

The CAP has lobbied throughout 2024 to stop the cuts to physicians. With the proposed cut for 2025, over the last six years, payments to pathologists have decreased by approximately 7% while physician practice costs (medical supplies, lab personnel, professional liability insurance) have increased over 17%. With inflation, in 2025 alone, pathologists are anticipated to experience a net 6% reduction in revenues as Medicare reimbursement is expected to fall by close to 2.4% while expenses are expected to increase by 3.6%.

Ongoing yearly Medicare cuts fuel economic uncertainty and make it harder for pathologists to serve patients and provide effective care with the latest tools and diagnostics. The CAP will continue advocating for long-term Medicare Payment reform and continued relief until that objective is achieved.

Read the legislation here.

The American Medical Association (AMA) and the Illinois State Medical Society (ISMS) filed a lawsuit on October 24 against MultiPlan accusing the third-party insurance contractor of price-fixing and undercutting fair payment for out-of-network health care services. The CAP has raised concerns over the use of such third-party contractors by insurers to interfere with the physician-patient relationship.

The lawsuit filed in the Northern District of Illinois, seeks to hold MultiPlan accountable for its role in an unlawful multilateral price-fixing scheme that has operated roughly since 2015 and has forced physicians to accept increasingly low payment amounts for out-of-network services, which often do not cover their operating costs. This practice has forced many medical practices, particularly smaller ones, to shut their doors, cease offering certain services, or seek other employment arrangements, leaving patients with fewer and fewer medical practice options, the AMA said.

According to an April 2020 study published by the Office of the New York State Comptroller, depending on the service provided, payments based on MultiPlan’s repricing methodology were 1.5 to 49 times lower than payments for the same services based on the traditional method of calculating out-of-network payment rates for physicians.

MultiPlan has a direct economic stake in suppressing out-of-network payment rates below fair levels. For each claim it reprices, MultiPlan receives a fee from the insurer based on a percentage of the difference between the initial claim amount and what the insurer pays. In other words, MultiPlan gets paid more as physicians get paid less. The revenues generated by MultiPlan from its repricing services have increased from $23 million in 2012, to $564 million in 2020 and $709 million in 2021.

Register now for the 2024 Interim Meeting of the American Medical Association (AMA) House of Delegates meeting happening November 8-12. Physicians from across the house of medicine will gather to address policy issues impacting physicians and patients. This year’s discussion will focus on shaping policy on critical issues, including solutions to systemic challenges in healthcare delivery.

Register online to view and access the live sessions.

CAP Secretary-Treasurer Al Campbell, MD, MBA, FCAP and John Caldwell, MD, FCAP attended a political retreat for Sen. John Thune (R-SD) in Kiawah Island, SC, earlier last month. While there, Drs. Campbell and Caldwell also had the opportunity to visit with Sens. Tim Scott (R-SC) and John Boozman (R-AR).

This weekend-long event provided a valuable opportunity to promote the pathology specialty as well as grow personal relationships with three of the Senate’s key members. Sen. Thune, who is vying to become the next Senate Republican Leader, has been a key supporter of many of the CAP’s priorities over the years.

Click here to learn more about PathPAC.

Under the Food and Drug Administration’s (FDA) new regulation, laboratories with laboratory-developed tests (LDTs) must have a process in place for adverse event reporting starting May 6, 2025. The CAP’s second webinar in our series on the rule will discuss existing accreditation requirements and ways laboratories can comply with the medical device-related adverse event reporting requirements. Accreditation experts will review best practices and review real world scenarios. Join us this Thursday, Nov. 7, Noon-1 PM CT to learn more!

Speakers

• Bobbi S. Pritt, MD, FCAP, chair, Council on Scientific Affairs
• Earle S. Collum, MD, FCAP, chair, Council on Accreditation

Register today!

The Centers for Medicare & Medicaid Services (CMS) released the final 2025 Medicare payment regulations, including rules for the Medicare Physician Fee Schedule and the Quality Payment Program.

On Wednesday, December 4 at 2 PM ET/1 PM CT, the CAP will offer a complimentary live webinar where CAP experts will review final regulations that will impact Medicare payment for services and pathologists’ participation in the quality initiatives. Webinar presenters will be the Council on Government and Professional Affairs Chair A. Joe Saad, MD, CPE, FCAP; Economic Affairs Committee Chair Ronald McLawhon, MD, PhD, FCAP; and Quality and Clinical Data Registry Affairs Committee Chair Gregary Bocsi DO, FCAP.

Register today.