July 2023 Advocacy Recap

Alec Bose:

Hello and welcome to the CAP Advocacy Recap, a monthly podcast dedicated to catching you up on the top news for pathologists. I'm Alec Bose here with your July, 2023 recap. This month we'll look at Senate efforts to strengthen laboratories for future pandemics, the potential burdens of post-market surveillance in AI software and new digital pathology CPT codes developed by the CAP. Later, we'll hear some highlights from the proposed 2024 Medicare physician fee schedule webinar.

We start the day with updates from the US Senate. The CAP has asked a key healthcare committee in the Senate to make several changes to pandemic preparedness legislation to ensure laboratories can act swiftly to combat future public health emergencies. First passed in 2006, the Pandemic and All Hazards Preparedness Act is set to expire at the end of September. The Senate Health Education, Labor and Pensions, or HELP Committee, called for input from health providers and public health experts on how to improve the law during the reauthorization process.

In response, the CAP sent a letter to the committee outlining policy recommendations to make the law better. These included the consideration of policies to standardize electronic laboratory reporting, strengthening the supply chain, mechanisms to ensure adequate coverage and reimbursement for testing, funding for the laboratory workforce, and the addition of the SALSA Act to the legislation as a permanent solution for the reimbursement of clinical laboratory services. The CAP believes this is important as laboratories continue to prepare for future pandemics. You can read the CAP's full comment letter on our website.

We turn now to news on AI software. While the CAP supported potential guidance on market submission of AI and machine learning for medical software, the CAP urged the FDA to take the steps to ensure regulatory burden is not transferred to pathologists that are required to provide local verification of enabled device software functions. In the letter to the agency, the CAP supported the concepts proposed within the current draft guidance. However, for clinical laboratories to meet clear requirements, it is imperative that performance monitoring or regulatory responsibilities do not place undue burden on pathologists or other physicians. Because of the expected impact of these technologies on the practice of pathology and laboratory medicine and the need to adhere to CLIA in the laboratory setting, the CAP has a keen interest in the regulatory approach for AI and ML technologies. You can read the full story on our website.

The AMA CPT editorial panel released 30 new CAP developed CPT code numbers, descriptors, and revised guidelines. The early release of these codes will assist practices as they prepare to integrate the new codes into their billing systems ahead of the January 1st, 2024 deadline. Digital pathology enables the acquisition, management and interpretation of pathology information generated from digitized glass microscope slides. The new CPT codes are intended to capture and report additional clinical staff work and service requirements associated with digitizing glass microscope slides for a primary diagnosis. As a result of CAP advocacy, the new codes will help pathologists, pathology practices and laboratories providing digital pathology digitization procedures appropriately report these services. You can find out more details about these codes on our website.

We end the day with important information on payment for pathology services. Recently, the CAP held a webinar on the release of the proposed 2024 Medicare physician fee schedule. Here are some highlights from the meeting with Dr. Jonathan Myles, Chair of the Council on Government and Professional Affairs, Dr. Diana Cardona, Chair of the Quality and Clinical Data Registry Affairs Committee, and Dr. Ronald McLawhon, Chair of the Economic Affairs Committee as they present and answer questions about the latest Medicare payment policies concerning individual pathology services and the quality payment program next year.

Dr. Jonathan Myles:

The 2024 proposed rule for the physician fee schedule came out on July 13th, and we at the CAP know that this is important to our members, so our staff were diligent in getting out a special advocacy update with a preliminary analysis of this regulation. We at the CAP will continue to engage with the CMS on this proposed rule. Now, our written comments are due by September 11th and we'll be getting input from CAP members as well as staff in formulating those comments. We'll also follow up with a meeting with CMS on the comments before the final rule is released on or about November 1st.

Dr. Ronald McLawhon:

The big thing that's affecting the Medicare fee schedule for all physicians this year, but including pathologists, has been this evaluation of management add-on code G2211 and the other E&M services for the office visits and outpatient services. In the 2024 final rule in 2021, CMS adopted a new add-on code for complex patients, G2211. That's a visit complexity inherent to evaluation and management associated with medical services that serve as continuing focal point for all needed healthcare and/or medical services that are part of ongoing care related to a single serious condition or complex condition. CMS adopted the recommendations for the revised E&M services, but felt that there were values that did not fully account for the resources associated with primary care and other longitudinal care for complex patients, so they developed this code. This is the first year that they're going to be implementing it. GT2211 can be reported in conjunction with all outpatient and office visits, E&M visits, to better account for these resources.

Dr. Diana Cardona:

I think one thing I would like to stress before we dive in is that we're hearing a lot about cuts. We have cuts to the physician fee schedule, to the clinical lab fee schedule. I would really like to reiterate that this is one of the things that's more likely in your control. It should definitely be something that you and your practice is aware of in order to avoid additional cuts. If this at all seems foreign to you or if you still don't know how you or your practice is participating in the QPP, I would highly recommend that you go onto CMS's QPP website and look yourself up. It's really easy to do. You just need your MPI number and your name. You can look up how CMS views you as far as the QPP goes. Do they see you being eligible as a MIPS provider or maybe you are a qualifying participant in an advanced APM, which is completely a different pathway.

If you are seen as someone that's participating via MIPS, are you in a small practice or large practice? Are you considered facility-based eligible? There are a lot of different elements that are really important to understand because they impact how you have to report, how you have to participate, and your scoring, which we'll go on to in a couple of slides.

Alec Bose:

You can listen to the full webinar and download the webinar slides on our website.

That's all for this edition of the CAP Advocacy Recap. Thank you so much for listening. For more information on any of the stories that you heard today, please visit our website, subscribe to our newsletter, and follow us on our Twitter @CAPDCadvocacy. Once again for CAP Advocacy Communications, I'm Alec Bose and we'll see you next month.

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