Advocacy Update

• In Case You Missed It: CAP Succeeds in Convincing CMS to Further Mitigate Cuts to Pathologists Pay for 2024
• CAP Advocacy Win: HHS Adds Flexibility in Batching and Reduced Fees in IDR Proposed Rule
• CMSS Awards $100,000 Grant to CAP to Promote Effective Communication of Pathology Results to Patients and Care Team
• OMB Releases Proposed Guidance on How Federal Agencies Should Implement AI Executive Order
• Webinar: What Will Be the Impact of the Final Fee Schedule on Your Practice?
• Take Our News Quiz for November

The Centers for Medicare and Medicaid Services (CMS) released the 2024 final Physician Fee Schedule and Quality Payment Program regulation on November 2. The CMS reacted favorably to the CAP’s comments to increase pay to pathologists in 2024 from what had been first proposed in July. The CAP successfully advocated for an increase to the cytotechnologist clinical labor rate used by the CMS in their practice expense methodology. This advocacy provides an increase to the technical component (TC) and global payments for some pathology services. Briefly, here are the key topics included in the 2024 proposed rule:

• The CMS continues to implement CAP requested increases to clinical labor rates.
• The CMS finalized the evaluation and management add-on code, G2211, causing budget neutrality adjustments that negatively affect pathologists and other specialties throughout the physician fee schedule.
• Download the impact table showing the proposed changes to pathology services in 2024.

The CMS also published its final 2024 Quality Payment Program (QPP) rule, which aims to limit changes in traditional Merit-based Incentive Payment System (MIPS) to provide clinicians continuity and consistency while they gain familiarity with their new MIPS Value Pathways (MVPs) and move toward accountable care and advanced alternative payment models. Though limited, the proposed changes to the MIPS program will have a significant impact on participating pathologists’ scores and payment bonuses.

The CAP has long advocated to make MIPS less burdensome for pathologists and has created measures to increase pathologists’ opportunities to demonstrate the quality they provide and to score well in the program. Read more.

The Department for Health and Human Services (HHS) is making changes requested by the CAP to the independent dispute resolution (IDR) process for settling out-of-network billing disagreements between physicians and health insurers. The CAP had advocated for significant improvements to the IDR process so to reduce barriers for pathologists to participate.

The CAP had repeatedly expressed to the HHS and Congress a number of concerns about pathologists accessing and appropriately navigating the current IDR system. On October 27, the HHS and other federal departments involved in the IDR system released a proposed rule on the No Surprises Act’s federal IDR process that addressed several of the CAP’s concerns. The CAP had said pathologists needed flexibility for batching claims together as well as reduced fees for low-dollar disputes—both of which have been added to the proposed rule. Additional changes include:

• Accessing Information: The CAP advocated for as much information as possible upfront for the initial payment, or notice of denial of payment, in order to ensure physicians have the necessary insurer-held information to decide about negotiation and to successfully initiate IDR, if needed. The government is now proposing payers be required to provide additional information at the time of initial payment or notice of denial of payment.
• Open Negotiation: The CAP asked to formalize or centralize the open negotiation period to ensure notice is provided and the timeline requirements are successfully met. The government is now proposing to centralize the open negotiation process by requiring that a party choosing to initiate open negotiation give notice through the federal IDR portal.
• Batching: The CAP advocated for flexibility that facilitates broader batching of qualified IDR items and services. The government is now proposing under some circumstances to allow multiple qualified IDR items and services that treat a similar condition to be batched together in a single payment determination proceeding to encourage efficiency and result in cost savings for disputing parties. Pathology and laboratory services fall into this category.
• Administrative Fees: The CAP has said it is vital that any fee requirements take into consideration low-dollar claims and ensure an even and fair playing field for all IDR parties. The CAP urged HHS to waive the administrative fee for low-dollar claims, defined as $250 or under. Alternatively, the CAP would support a tiered fee based on the amount of the claim. The government is now proposing a reduced administrative fee structure and amounts for parties in low-dollar disputes to promote equitable access to initiate the federal IDR process. For amounts less than the amount of the standard administrative fee ($150), the fee will be 50% of the administrative fee, anticipated to be $75.

The Council of Medical Specialty Societies (CMSS), a coalition of 51 specialty societies representing more than 800,000 physicians across health care, awarded the CAP and 10 other member specialty societies grants of $100,000 each to promote diagnostic excellence across the field of medicine.

In 2022, CMSS and the Gordon and Betty Moore Foundation awarded a $100,000 grant to the College of American Pathologists that focused on understanding patients’ experience with their pathology report. This second grant addresses the challenge of redesigning a pathology report that effectively communicates pathology test results to patients and all members of the care team. The goals of the new grant will have a focus on colorectal cancer pathology reports, but generally will be to:

• Gain insight from multiple stakeholders on the critical components of a pathology report
• Recommend ways to improve communication of test results through pathology reports.
• Disseminate best practices through education and engagement, including potential publications and podcasts.

Read more.

On November 1, the Office of Management and Budget (OMB) drafted a memo proposing to mandate that the Department of Health and Human Services (HHS) and other federal agencies have minimum safety measures in place for their use of artificial intelligence (AI) by August 1, 2024, or stop using the technology until it is compliant. The memo also called for agencies to designate chief AI officers, establish internal coordination mechanisms, and report how they are managing AI risks. This comes after the Biden Administration released an executive order on October 30, establishing new standards for AI safety and security, and the protection of Americans’ privacy while advancing equity and civil rights.

In addition to having minimum guardrails in place, the draft memo asks agencies to identify and address additional risks, which include impacts to safety, security, civil rights, civil liberties, privacy, democratic values, human rights, equal opportunities, potential harms to worker wellbeing, access to critical resources and services, and effects on market competition.

This is not an external policy and does not directly affect pathologists. It only applies to federal agencies (including HHS) and their use of AI.

The CMS just released the final 2024 Medicare payment regulations, including rules for the Medicare Physician Fee Schedule and the Quality Payment Program.

On Thursday, November 30 at 3 PM ET/ 2 PM CT, the CAP will offer a complementary 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 Bosci, DO, FCAP.

Register today.

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