Advocacy Priorities with CAP President Dr. Donald Karcher

Alec Bose:

Every two years, CAP members elect a new president to lead the College. Dr. Donald Karcher was recently inaugurated At the annual meeting in October, we sat down with President Karcher to discuss his advocacy priorities and how the CAP can influence policy in important ways. So we are joined by Dr. Donald Karcher, president of the CAP, newly inaugurated. Thank you for joining us. How are you doing today?

Dr. Donald Karcher:

I'm great. Thanks very much for having me.

Alec Bose:

Fantastic. So just to start out our discussion as president, what do you feel are some of the most important issues facing pathologists and why do you feel that way?

Dr. Donald Karcher:

Yeah, so I'm happy to answer that question, but maybe before I do, let me just say, first of all, it's let, certainly a great honor to serve as CAP President, but I like to tell people that's not why I ran for this office. What I'm really excited about are the things that I might be able to accomplish as president. So this first question really kind of gets at that issue. We do have several important issues that we in pathology and we in the CAP are facing, and I'm happy to list the ones that I think are sort of utmost. First of all, I think that the first major issue is payment for our services. Over the past several years, payment for pathology services, both by government and private payers, has been under siege, and that's frankly not an exaggeration. In recent years, this has gotten actually more acute than it's ever been with government programs shifting payment from specialist to primary care providers and with private payers increasing their efforts to restrict payments for both pathologists and clinical labs.

This really impacts us in three basic ways. First and foremost, pathologists aren't being paid fairly for the critically important services that we provide, but there's another really important impact that this has and that is that some pathology practices are now struggling to afford enough pathologists to provide services whenever and wherever our patients need us, resulting in less access for patients to our services, particularly in underserved areas, which are definitely in rural areas, but there are also inner city areas that are clearly underserved. So it impacts both. Also, just to tack onto that, labs are also having to decrease their test menus and outsource more assays than ever before, which is negatively impacting the turnaround time for many of those tests. So the second major issue is regulatory oversight of clinical labs. The current big issue is the FDA's proposed oversight of laboratory developed tests. This issue has been around for more than a decade with proposed rulemaking and proposed legislation over the years. Most recently with the VALID act, when the VALID act did not pass in Congress at the end of 2022, the FDA made it very clear that they intended to proceed with oversight through rulemaking, under its current statutory authority. And so the CAP has been monitoring this very closely, and we're currently preparing comments in response to a proposed rule recently released by the FDA. Another regulatory challenge is how new technologies like digital pathology and artificial intelligence will be regulated. We're working very closely with CMS and the FDA on these issues as well.

A third major issue is the worsening shortage of pathologists for a variety of reasons. Not enough students and medical students have chosen pathology as a career over the past 10 years or so. Add to that the ongoing retirement of pathologists and the growing demand for pathology services, and you can see how this shortage has developed. The CAP a few years ago started a pathologist pipeline initiative, and I'm very happy to report that our initiative seems to be bending the curve with more students now aware of pathology as a great career option and with more applicants and matches for pathology residency programs. So now that we have more students choosing pathology, we really need more residency slots to train pathologists. We're currently strongly advocating for Congress to increase support for more residency slots across the board, which will increase the number of slots available for pathology. Also, many pathology residents are international medical graduates who are in the US on J-1 visas, which requires them to return to their home country after finishing their training. We're currently advocating strongly for visa reform so that more of these well-trained young pathologists can stay in the US to practice. So I think those are the main issues that come to mind.

Alec Bose:

Thank you. And I think that's a long list of items, but I think it comes down to being able to advocate for these very important issues that you've raised. What do you feel the CAP needs to do to accomplish these advocacy goals?

Dr. Donald Karcher:

Really, when it comes down to it, we really need to continue to do the things we've done well for many years to advocate and lobby for what pathologists and clinical labs need to care for our patients. So first, we need to continue to advocate strongly with CMS, with Medicare max, the administrative contractors that determine coverage of our services and also private payers to ensure a fair payment and appropriate coverage for pathology and clinical lab services. Challenges from private payers have markedly increased in recent, although the CAP has to be careful when dealing with private payer issues due to antitrust laws, we have continued to fight very hard to the limit of the law on these issues, and I can assure everyone we will continue to push forward very hard on these payment issues with private payers as we move into the future. Regarding the regulatory challenges that we talked about, we really must continue to work closely with the various federal agencies such as CMS and the FDA to ensure that there are regulations are appropriate and don't interfere with our ability to provide innovative services for our patients and certainly don't overburden pathology practices in clinical labs.

Finally, we need to work with Congress to increase training slots for pathologists and to provide visa reforms to allow more international graduates to stay in the US to practice. So I think those are the things that we really need to focus on to accomplish our advocacy goals in the coming months and years.

Alec Bose:

Following up with that, how has the CAP advocacy helped pathologists and how can it help them in the future?

Dr. Donald Karcher:

Well, the CAP has really been the lead organization for decades in advocating for pathology and for pathologists. CAP was founded 77 years ago expressly for the purpose of advocating for the profession of pathology, starting right from the very beginning of our existence. We were organized as a 501(c)6 organization, and we are still the only 501(c)6 national pathology organization. This allows us to spend unlimited resources on lobbying and also to sponsor a political action committee. And of course, that's the CAP PATHPAC. Also, the CAP Washington Office has one of the largest staffs of any medical specialty, so that allows us to have the resources to really cover all of the issues really quite completely. I'm happy to say our advocacy efforts over the years dealing with payment issues have really been very successful through our efforts. More federal payment challenges for pathologists and clinical labs have been successfully resolved with CMS over the last 20 years than any other medical specialty. So that's certainly a record that we can be proud of, but it's never enough. We have to keep pushing forward on payment issues and other issues as we go into the future. In fact, looking into the future, our advocacy enterprise, including our Washington office, must and will continue to lead all pathology organizations in advocating for pathologists and clinical labs, very important for the future of our profession.

Alec Bose:

Thank you, Dr. Karcher. And I think all of this in context, it would be important to mention the Leadership Summit, the CAP's advocacy event that happens every year in Washington DC where pathologists from across the country come to lobby their congressmen and advocate for the advancement of the profession. Can you talk about how important the Pathologist Leadership Summit is and why it's so important that so many pathologists get involved?

Dr. Donald Karcher:

Yeah, so the Pathologist Leadership Summit, this is actually our spring National meeting, and this meeting was envisioned as a way to bring pathologists together to learn about the issues, to also increase their leadership skills, and then ultimately, as you noted, to go to Capitol Hill as pathologists to advocate for the things that we need for our profession ultimately to give the best possible care to our patients. So this meeting is actually more than just going to Capitol Hill. I'm happy to say that the meeting begins each year with a meeting of the House of Delegates. This is the organization within the CAP that serves as the voice of the membership. And although one does not have to be a member of the House of Delegates to attend, house delegates do attend and conduct business, but the meeting is much more than that. And so we really encourage everyone to attend the House of Delegates meeting because there are many sessions in that meeting talking about issues, talking about other leadership aspects of leadership and pathology.

And we usually have a great speaker for the lunchtime at the House of Delegates meeting. The second part of the meeting really deals with leadership and the opportunity for a pathologist to up their game in terms of their leadership skills and their approach to leadership across the board in our profession, leadership as laboratory directors, leadership within their organizations, and ultimately leadership when it comes to dealing with the issues that we all deal with as pathologists. That session, those sessions are followed by sessions designed specifically to make sure that the attendees at this meeting are fully informed on all of the important issues of the day. So there's a detailed discussion of each issue, and then there are actually sessions designed specifically to help attendees prepare for their visits to Capitol Hill. So the final day of the Pathologist Leadership Summit is what we refer to as our Hill Day, and we have groups of pathologists, and I'm happy to say we set a new record in our last year of having more pathologists attend and visit with their members of their congressional delegations in person than we've ever had the past.

So here's an opportunity for a pathologist armed with information and armed with talking points to go to members of Congress to their congressional offices and advocate for the things that we need. Now, why is this important? Well, first of all, we are constituents, so we always try to have our attendees go to congressional offices that are their district and also in their state so that they are actually constituents of those members of Congress and members of Congress listen closely to their constituents. Also, the other important reason why having pathologists do this is so vitally important, is that who better than us understands what we need and why we need what we need to provide care for our patients. Only we really can give a convincing argument to members of Congress and their staffs as to the things that we need and why it's so important, not only for our profession, but we always, always try to point out why it's important for the members of Congress constituents, our patients who are their constituents.

And so it's really important for attendees to take the trouble to go to Capitol Hill. And by the way, I should note that we have people who have never done this before. It's their first opportunity to do this every year. We have a group of people who are going to Capitol Hill for the very first time. They are going with experienced advocates. So it may seem a little intimidating at first, but there are people there that are very experienced going with them, and I have never heard a person say that they did not find the experience, even their first time going to Capitol Hill as one of the most rewarding and actually even exciting experiences that they've had as a professional. It's really quite amazing to see retail politics conducted directly in the halls of Congress. And so we really strongly encourage people who've never done it before to come along. You'll learn from the experts and you'll, I can assure you, you'll find it a very rewarding experience.

Alec Bose:

And I think the college feels that it's very important to engage in that direct advocacy, and it is very rewarding for pathologists, not just personally, but also professionally as it does actually have some sway in terms of the actual political climate. My final question is, obviously as CAP President, advocacy is not the only thing that you are engaged in with the CAP, but can you talk about why it is so important that the CAP President at least speak out and advocacy among the members?

Dr. Donald Karcher:

Well, I've always viewed advocacy for pathology as really a job for all pathologists. I mean, in a way, pathologists owe it to their profession, and ultimately, I think they owe it to their patients to advocate for the things we need to provide the best possible care for exactly those patients as we explain our advocacy needs to policymakers and payers, really no one knows better than us what we need and why we need it. I mentioned that before about Hill Day, but it's certainly true in all settings where we are advocating. I think it's also very important for pathologists to be a member of their state and local pathology societies. Many advocacy issues, particularly coverage and scope of practice related issues are regulated at the state level and not at the federal level. Also, it's not uncommon for state payment and coverage issues to eventually become national issues.

So I think it's really essential that pathologists be aware of those issues and advocate on those issues at the state level because many of them ultimately, ultimately become national issues that we're all dealing with. I'm happy to say the CAP works very closely with all state pathology societies on a range of state and federal issues, and that allows us to keep very well informed of issues at the state level and also to help our colleagues advocate at the state level and eventually to involve those pathologists who are working at the state level to ultimately get involved on federal issues. So it's actually a win-win as we cooperate and support our state pathology societies. I think the important thing is to stay focused as an organization, and I can assure you that our CAP advocacy enterprise, our Council on Government Professional Affairs and its various committees and our Washington office are constantly focused on these issues.

We have a great Washington office staff that literally have their ear constantly on the rail listening for any issues that may be emerging, and that's by the way, at the local, state and federal level. So I think along with all the issues that I listed, I think the main thing is for all of us to stay focused on these issues. It sometimes takes years for our advocacy to ultimately succeed, but we're very determined to get what we need for our members, for pathologists, and ultimately for our patients.

Alec Bose:

Well, I think that's a perfect place to leave it off. Thank you, Dr. Kar. We really appreciate you being here with us today.

Dr. Donald Karcher:

Very happy to have been with you today. Thank you.

Alec Bose:

That's all for this CAPcast. Thank you so much for listening. For more information on all things advocacy, be sure to subscribe to our weekly newsletter and follow us on Twitter at CAPDCadvocacy for advocacy communications. I'm Alec Bose, and we'll see you in the next CAPcast.

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