Prevent Medicare Cuts for Pathology Services

In November 2019, the Centers for Medicare and Medicaid Services (CMS) finalized a Medicare policy to increase reimbursement for evaluation and management (E/M) services beginning in 2021. To offset the increase and maintain budget neutrality, the CMS has reduced payment for non-E/M services as increases to these services have been implemented. These cuts combined with the lack of an inflationary update to the Medicare Economic Index represent significant negative financial factors.

Over the last 5 years payments to pathologists have decreased by approximately 4.6%, while physician practice costs (medical supplies, lab personnel costs, professional liability insurance) have increased by nearly 13.8%. In 2024 alone, pathologists are anticipated to experience a net 5.7% reduction in Medicare Physician Fee Schedule income as revenues are expected to fall by close to 1.1% while expenses are expected to increase by over 4.6%. The lack of an annual inflationary update for pathologists, especially those that operate small businesses, compounds the wide range of shifting economic factors impacting the practice of pathology. The absence of an annual inflationary update, combined with the physician fee schedule’s statutory budget neutrality requirements and ongoing Medicare payment cuts, further compounds the difficulties pathologists face in managing resources to continue caring for patients in their communities.

The CAP remains committed to the fight against further cuts to pathology services. The financial instability of the Medicare payment system, including the lack of an inflationary update, ongoing Medicare cuts, and budget neutrality requirements, are all eroding our nation’s laboratory infrastructure.

Without significant engagement by CAP members with their respective members of Congress, getting this issue addressed before the end of the year is going to be a major challenge. The CAP has asked its members to contact their members of Congress on the Medicare cuts. You can contact them here. For more information, review our issue brief.

The CAP has urged Congress to provide further economic assistance to pathology practices by directly engaging with congressional leaders with their concerns regarding the instability of Medicare’s payment system.

• Pathologists Meet with Congress (April 23, 2024)
  
• Congress Passes Bill Giving Pathologists $19.1 Million in Additional Medicare Payment Relief through 2024 (March 12, 2024)
  
• CAP, AMA and Medical Organizations Call on Congress to Pass Legislation to Reverse Physician Medicare Cuts (January 16, 2024)
  
• Pathologists Urge Congress to Mitigate Medicare Cuts at CAP ‘Virtual Fly-In’ (October 31, 2023)