Advocacy Update

• In CAP Advocacy Win CMS Finalizes Increase to Pathology Clinical Labor Rates in 2023
• CAP and Coalition of Medical Groups Support Senate Effort to Stop Medicare Pay Cuts in 2023
• AMA, CAP Urge Congress to Oppose Legislation that Endangers Patients’ Health Care Quality
• 2022 Practice Characteristics Survey: Download the Latest Trends for Pathology Practices
• What Will Be the Impact of the Final Fee Schedule on Your Practice?
• ICYMI- November Advocacy Webinars
• Test Your Advocacy Prowess with a News Quiz 

In an advocacy win for the pathologists, the Centers for Medicare & Medicaid Services (CMS) finalized the proper rank order of the clinical labor rates for histotechnologists and laboratory technicians in the final 2023 Medicare Physician Fee Schedule (PFS). Because of the CAP’s advocacy, there will be more accurate payments for pathology services in 2023.

Pathology Clinical Labor Repricing

Previously, the CMS finalized updates to its clinical labor pricing for 2022. Clinical labor rates had not been updated in 20 years, which created a significant disparity between the CMS’ clinical wage data and the market average for clinical labor. However, the agency’s 2022 efforts made flawed assumptions for the pricing and the CAP intervened to correct the errors in select labor rates.

The CMS primarily used Bureau of Labor Statistics (BLS) wage data to update its clinical labor pricing in 2022. For certain labor categories where BLS data were unavailable, the CMS had to crosswalk or extrapolate the wages using supplementary data sources for verification. This is the case for the flawed 2022 clinical labor price per minute for histotechnologists. The CAP advocated early in 2022, providing the agency with current wage data resources, relative BLS comparison rates, and current open histotechnologist job salary offerings that convinced the CMS to correct the final clinical labor rate for histotechnologists. This correction additionally positively impacted another pathology blended clinical labor rate.

The CMS finalized the implementation of the clinical labor update, including the CAP-requested corrections over four years to transition to the final updated prices in 2025. For 2023, the clinical labor pricing will be in year two of the transition. The repricing positively impacts the technical and global components of physician services.

The final pathology CMS clinical labor rate phase in increases secured by CAP advocacy are:

• Laboratory Technicians 67%
• Histotechnologists 73%
• Lab Tech/Histotechnologists Blend 70%

Lower Conversion Factor and Impact on Pathology

The final 2023 conversion factor used for the physician fee schedule’s payment formula is $33.0607, representing a 4.5% decrease from the final 2022 conversation factor. This 4.5% decrease to the physician fee schedule accounts for:

• the required update to the conversion factor for 2023 of 0%;
• the expiration of the 3% supplemental increase to PFS payments for 2022 as required by the Protecting Medicare and American Farmers from Sequester Cuts Act; and
• the required budget neutrality adjustment to account for increases in physician payment for evaluation and management visits for hospital, nursing facility, home health and emergency patients.

The CAP calculated the total average Medicare spending impact on pathology will be a -3.6% and a -3.0% for independent laboratories. The individual impact of the 2023 payment changes will vary from the average based on the individual pathology practice mix of services. See the 2023 payment changes on a code level basis in the impact table developed by the CAP.

The CAP continues to aggressively lobby Congress to mitigate these cuts to pathologists for 2023. The CAP is actively participating with a coalition of specialty societies and the AMA to ensure that physicians are accurately reimbursed for their work.

Supplies and Equipment Pricing Update

Several pathology supply and equipment items commonly used by pathologists will have updated prices impacting the technical component of pathology services. The CAP advocated for these updates and advocated to correct the mispricing of one common pathology supply based on new invoices submitted during the proposed rule comment period. As a result of the CAP’s advocacy with the agency, the CMS reversed an incorrect reduction proposed for 2023 in the supply input price that translates to a more accurate finalized payment for the impacted pathology services.

Colorectal Cancer Screening

The CAP also supported colorectal cancer screening policy changes adopted by the agency to expand access to quality care and improve patient health outcomes through prevention and early detection services. Specifically, the CMS expanded Medicare coverage for specific colorectal cancer screening tests by reducing the minimum age payment and coverage limitation from 50 to 45 years.

In addition, the agency expanded the regulatory definition of colorectal cancer screening tests to include a complete colorectal cancer screening, where a follow-up colonoscopy after a Medicare-covered non-invasive stool-based colorectal cancer screening test returns a positive result. The revised colorectal cancer screening policies directly advance health equity goals supported by the CAP by promoting access for much needed cancer prevention and early detection in rural communities and communities of color that are especially impacted by the incidence of colorectal cancer.

The CAP and a coalition of medical professional organizations have asked Senators to sign a letter as a strong show of support to prevent 2023 Medicare cuts from going into effect. The November 1 letter urged Senate Majority Leader Chuck Schumer (D-NY) and the Senate Minority Leader Mitch McConnell (R-KY) to work on a bipartisan basis to address these imminent payment cuts.

Last month, the CAP and over 100 medical and health groups had already asked members of the House of Representatives to cosponsor the Supporting Medicare Providers Act of 2022 (HR 8800), which aims to lessen the upcoming Medicare reimbursement cuts in 2023 and provides guidance to improve the Medicare Payment system for physicians. To date, 72 members of the House have cosponsored the bill.

The CAP with its coalition partners will continue to advocate to get the Congress to enact legislation to mitigate the cuts prior to the end of the year.

The American Medical Association (AMA), the CAP, and over 80 other professional medical groups urged Congress to oppose legislation that would endanger health care quality by expanding the scope of practice of nonphysician practitioners. The coalition asked congressional leaders to oppose the Improving Care and Access to Nurses (I CAN) Act, as it would expand the medical scope of practice for nonphysician practitioners, including nurse practitioners (NPs), certified nurse midwives (CNMs), certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNS), and physician assistants (PAs). The CAP advocates to protect pathologists’ scope of practice from encroachment by nonphysician groups.

In the November 2 letter, the AMA and the groups asked Congress not to pass the I CAN Act. The coalition stated that “the broad, sweeping bill endangers the care of Medicare and Medicaid patients by expanding the types of services NPPs can perform and removing physician involvement in patient care. This legislation would allow NPPs to perform tasks and services outside their education and training and could result in increased utilization of services, increased costs, and lower quality of care for our patients.”

The bill endangers patients’ health and the quality of health care by removing the supervision requirements for CRNAs, a change that could have devastating quality outcomes for patients. In the letter, the group states that “while all health care professionals play a critical role in providing care to patients and NPPs are important members of the care team, their skill sets are not interchangeable with those of fully educated and trained physicians. This is fundamentally evident based on the difference in education and training between the distinct professions.”

The CAP will work with the AMA to further oppose this legislation.

The CAP released the anticipated 2022 Practice Characteristics Survey Report. Data from the survey provides empirical support for setting advocacy priorities and for informing lawmakers and regulators of the important issues facing pathologists today. Since 1994, this survey is a primary source of data on board-certified pathologists, their practice settings, and compensation trends.

The 2022 Practice Characteristics Survey was sent to over 15,000 board-certified pathologists, including members and CAP non-members.

The 2022 Practice Characteristics Survey reports on trends in practice size and setting, gender, average time worked, pathologist compensation, the current job market for pathologists, rates of adoption of and experiences with innovative activities and technologies such as digital pathology and laboratory information systems, and the extent to which pathologists are concerned about threats to scope of practice. The 2022 Practice Characteristics Survey helps the CAP set advocacy priorities and understand market pressures that affect you, the practicing pathologist.

Soon the Centers for Medicare & Medicaid Services (CMS) will release the final 2023 Medicare payment regulations, including the final Medicare Physician Fee Schedule and the Quality Payment Program regulations.

On Monday, December 5 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 Jonathan Myles, MD, FCAP; Economic Affairs Committee Chair Stephen Black-Schaffer, MD, FCAP; and Quality and Clinical Data Registry Affairs Committee Chair Diana Cardona, MD, FCAP.

Register today

Pathologists Advocating for Health Equity Webinar

The CAP hosted a complementary webinar on disparities in health care and what federal policies are in discussion to combat this issue. The COVID-19 pandemic exacerbated underlying disparities in health and health care, emphasizing the importance of addressing them. The federal government is prioritizing health equity as part of the pandemic response and recovery effort. In response to federal action, the CAP developed policies addressing these disparities. CAP President Emily E. Volk, MD, FCAP, Governor from the Board of Governors Kalisha Hill, MD, FCAP, and Kisha Mitchell Richards MD, FCAP, Director of Pathology and Laboratory Medicine at Greenwich Hospital in Greenwich, Connecticut, discussed the colleges approach to these vital policy issues.

Watch the recording

Good Faith Estimates - What Pathologists Need to Know

The CAP hosted a webinar where CAP experts Council of Government and Professional Affairs Jonathan Myles, MD, FCAP and member of the Economic Affairs Committee Theresa Emory, MD, FCAP, explained what pathologists need to know for good faith estimates in compliance with the No Surprises Act regulations. Additionally, the speakers reviewed what pathologists and their practices must do to comply with the new regulations in 2023.

Check out the recording and download the slides.

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