Advocacy Update

• CAP Opposes Cigna’s Latest Plan to Deny Payment for PC of CP
• CAP Objects to New Rules Implementing No Surprises Act
• CAP Urges Senate Leaders to Include Insurance Access Provisions in Reconciliation Bill
• CAP Urges to Include Forensic Pathologists in Federal Loan Forgiveness Program
• MyCAP Puts Advocacy at Member’s Fingertips
• 75th Anniversary Featured in October Advocacy News Quiz

In late September, pathologists and laboratories began receiving letters from Cigna stating that the insurer would go forward with an updated payment policy on the professional component of clinical pathology (PC of CP) it had previously tabled following opposition from the CAP and pathologists from around the country.

The CAP is analyzing the latest communications from Cigna to determine its exact effect on pathologists practicing in a variety of settings. The CAP has contacted Cigna officials to get additional information and discuss concerns pathologists have with the policy.

Previously, the CAP has said that for Cigna to discontinue reimbursement for these services would prove detrimental to patients and to the integrated delivery of care to which laboratory diagnostic services are central. The CAP will provide further updates on its discussions with the insurer as they develop.

In April, Cigna had initially announced the payment policy change would take effect in July. In communications to Cigna, the CAP maintained the PC of CP services are critical to the reliable and accurate diagnosis and treatment of patients. In a letter to Cigna on April 23, the CAP urged Cigna to continue paying for the PC of CP services for all pathologists. Cigna then announced in June it would continue to payment.

The CAP has strongly opposed new federal regulations that give insurance companies the upper hand during what should be an impartial independent dispute resolution (IDR) process as set in the No Surprises Act. The interim final rule for the IDR process, released on September 30, disregards Congress’s intentions of creating a fair system where physicians and health insurers can resolve disputes without one single factor having more weight than another.

Congress passed the No Surprises Act in December 2020. The final legislation included several provisions the CAP adamantly pushed for, such as holding patients financially harmless, fair reimbursement for care, and efforts to address network adequacy standards. Congress established a balanced IDR process to ensure physicians are paid appropriately for the services they provide.

“The new rules to implement the No Surprises Act ignore congressional intent,” said CAP President Emily E. Volk, MD, FCAP. “Congress was quite clear that to ensure an equitable and balanced system to resolve disputes no single factor should be given preference over others. However, the new rules will favor payment rates developed by insurance companies, which will only exacerbate ongoing health plan manipulation and disincentivize insurers from offering fair contracts to physicians caring for patients.”

American Medical Association President Gerald A. Harmon, MD, who spoke recently at CAP21, also said the new rules ignored the insurance industry’s role in creating the problem of surprise billing at the expense of independent physician practices whose ability to negotiate provider network contracts continues to erode.

“Congress appreciated the negative consequences of national price setting for health care services and spent considerable time and effort developing a robust independent dispute resolution process to maintain market balance and preserve access to care, which the Administration apparently ignored,” Dr. Harmon said. “It also is apparent that the Administration failed to appreciate the importance of creating an accessible and impartial dispute resolution processes as a backstop against even greater insurer abuses.”

In the regulations, effective January 1, 2022, the Centers for Medicare & Medicaid Services (CMS) stated that when making a payment determination, certified IDR entities must begin with the presumption that the insurer’s initial qualifying payment amount, for an out-of-network service is the appropriate amount. For an IDR entity to deviate from the offer closest to that qualified payment amount any information submitted must demonstrate that the value of the service is materially different.

However, the No Surprises Act states that an impartial IDR entity must equally consider many factors, such as training and quality outcomes, patient acuity or complexity of services, and prior contract history between the two parties over the previous four years.

The CAP will remain engaged with the CMS to address the regulations and ensure they follow the statute.

With Senate lawmakers continuing to debate a budget reconciliation package, the CAP engaged with Senate leadership to expand access to health care insurance coverage, improve the pandemic response with a national testing strategy, and address health inequities. In a September 30 letter to Senate leaders, the CAP asked lawmakers to stop upcoming cuts to pathologists’ Medicare payments and address physician shortages throughout the United States.

As COVID-19 highlighted weaknesses in the health care system, Congress is looking to address some of the inadequacies through the budget reconciliation package. In the letter to Senate leadership, the CAP outlined how it “supports continued efforts to improve access to meaningful health insurance coverage and lower health care costs for patients.” The CAP’s position on increasing access to health care coverage is closely aligned to those of the American Medical Association (AMA). The CAP also stated its support for a pluralistic system that increases access to care for all patients. This includes supporting the expansion of Medicaid to cover more uninsured Americans to address health disparities throughout the United States.

Additionally, the CAP asked Senate leadership to consider a national COVID-19 testing strategy. This included an additional $5 billion for renovation, expansion, and modernization of state and local public health laboratory infrastructure; renovating, expanding, and modernizing laboratories of the Centers for Disease Control and Prevention (CDC). The CAP also supports another $8 billion to prepare for, and respond to, public health emergencies, including shoring up the Strategic National Stockpile, strengthening our supply chains, supporting domestic and global manufacturing of vaccines, bolstering biosecurity, and investing in therapeutics, among other activities.

The CAP will continue to track this package carefully and provide timely updates.

The CAP urged the Department of Education to improve their Public Service Loan Forgiveness Program (PSLF) policies by providing additional information about forensic pathologists and their public services.

The US Department of Education oversees the Public Service Loan Forgiveness Program (PSLF) to maintain a highly educated public service workforce to serve as teachers, nurses, and physicians that serve our communities. Concerns about shortages across the public sector and public service workforce have persisted for decades, especially in the forensic pathology section.

In the September 25 letter to the Department of Education, the CAP urged officials to expand forensic pathologists’ loan forgiveness program eligibility. Currently, forensic pathologists are not considered within the public service definition, but the CAP asked the Department of Education to consider including them because of their public health roles involving acute drug intoxication deaths, homicides, and COVID-19. Without including forensic pathologists in the PSLF, the critical shortage of these important public servants will be detrimental to public health and communities.

“There is a national shortage of forensic pathologists so a federal loan forgiveness program specifically structured for practicing forensic pathologists is needed. Forensic pathologists are experts in the investigation of sudden, unexpected, suspicious, and unnatural deaths, and most work as governmental employees in medical examiner/coroner (ME/C) offices at the local (county) or state levels,” the CAP stated in the letter. “A public health workforce loan repayment plan for forensic pathologists will help to ensure an adequate supply of, and encourage recruitment of, these public health medical professionals to eliminate critical ME/C workforce shortages in local, State, and Tribal jurisdictions. As medical school loan debt is a significant deterrent to choosing a career as a government FP, funding loan forgiveness programs would encourage medical students to choose forensic pathology as a career.”

Congress enacted the College Cost Reduction and Access Act in 2007, creating a range of new benefits and protections for student loan borrowers, including the PSLF program. PSLF offers loan cancellation for Federal student loan borrowers who make 120 qualifying payments made while engaging in eligible public service work. The Department is committed to addressing the barriers to attaining PSLF and to providing debt relief to public service workers.

The CAP recently launched MyCAP, a new app that helps pathologists stay up to date with Advocacy news, engage with Congressional leaders, and connect with other CAP members and resources, right from the palm of their hand.

MyCAP features quick access to the latest advocacy news via the in-app Advocacy Update weekly newsletter and its friendly user interface enables pathologists to easily find past newsletter articles directly from a phone or tablet. CAP members can also respond to action alerts directly from the app—to immediately contact federal policymakers on a key issue when it arises. And the enhanced CAP member directory makes connecting with other CAP members as easy as a search.

MyCAP is where pathologists connect. Download MyCAP now on Google Play or the Apple App Store. Search for the “MyCAP-CAP Member App.”

This month we are featuring the CAP’s 75th anniversary, with a special prize for the first 50 CAP members to take the quiz. Last month, over 90 pathologists took the quiz. See how you compare against your fellow CAP members’ in the October News Quiz and brag about your top scores on social!

Take the news quiz