May 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 May, 2023 recap. This month we'll talk about the CAP's communication with the CMS on surprise billing, efforts to pin Medicare pay to the inflation index and more. We start the day with news regarding the pathology workforce. A bipartisan group of senators reintroduced the Resident Physician Shortage Reduction Act to increase Medicare supported training slots and address physician shortages in the near and long-term. The bill provides 14,000 new Medicare supported graduate medical education or GME slots over seven years. The CAP has consistently called on Congress to support more GME slots to address the projected shortage of primary care and specialty physicians. The issue was paramount during this year's Pathology Leadership Summit and CAP Hill Day, where pathologists urged their representatives to support the bill.

Medicare pays for graduate medical education directly by taking on the cost to educate residents and indirectly by covering the generally higher cost teaching hospitals to incur. In 2021, Congress made a vital initial investment in the workforce by providing 1,000 new GME positions through the Consolidated Appropriations Act. The US still faces a severe long-term shortage of up to 124,000 physicians. This has been exacerbated by the aging physician population, rising rates of physician burnout and early retirement due to the COVID-19 pandemic. We will continue to keep you updated as the bill moves through Congress.

We turn now to news from the US Food and Drug Administration. The FDA finalized its recommendations on gender neutral blood screening and assessing blood donor eligibility. This comes after CAP advocacy and comments to the FDA suggesting that there be an expansion of the number of people eligible to donate blood while also protecting the safety of the nation's blood supply. Previously, the FDA issued time-based deferrals for gay and bisexual men, as well as women who have sex with gay and bisexual men to donate blood within a given timeframe. These deferral periods were shortened from 12 months to three months to address the shortage of the nation's blood supply at the start of the COVID-19 pandemic. However, there is still a severe shortage of blood in the United States, particularly with O negative and O positive red blood cells. Instead, the new guidance recommends that blood donor eligibility be assessed with a set of individual risk-based questions to continue reducing the risk of transfusion transmitted HIV. Under this finalized guidance, all prospective donors would be subject to the same individual risk-based questions to determine eligibility regardless of their gender or sexual orientation.

The chair of the CAP's Transfusion, Apheresis and Cellular Therapy Committee, Dr. Glenn Ramsey, has noted that these changes are necessary for maintaining the nation's blood supply as well as making the donation process more inclusive for those who otherwise would not be able to. Quote, "Lifting the gender barriers in the blood donor screening measure while still maintaining the highest safety protocols is critical to making the blood donation process more inclusive, objective and approachable. This may broaden the pool of eligible donors, which is essential to help alleviate the severe nationwide blood shortage crisis." End quote. You can find out more about the CAP's policy on gender neutral blood screening on our website.

We turn now to news from Capitol Hill. The CAP and more than a hundred medical societies applauded congressional leaders in the house for introducing a bill to adjust Medicare payment rates with an inflation based index that will provide greater stability for physician practices. The Strengthening Medicare for Patients and Providers Act would utilize the Medicare Economic Index to provide the physician payment system with annual pay rate adjustments. The bill also allows lawmakers to enact one payment reform measure that will guarantee payment rates, keep pace with inflation, and help maintain patient access to timely and quality care.

In a letter to Congress, the coalition thanked the representatives who introduced the bill. Quote, "Congress has a unique opportunity to adopt comprehensive, transformative reforms to the Medicare payment system and we applaud your leadership in introducing this legislation. We look forward to working with Congress to ensure passage of HR 2474 and continue conversations around further payment reform to ensure America's seniors continue to receive access to the high-quality care they deserve." The CAP has worked with a strong coalition of organizations to oppose Medicare cuts and strengthen the Medicare system and will continue to do so moving forward.

And we round out the day with a response from CMS. Regulators responsible for implementing the No Surprises Act at the CMS replied to the CAP's request for changes to the rules for the law's independent dispute resolution process where physicians and insurers can settle claims for out of network services. The CAP sent a letter to CMS calling for specific changes to the open negotiation process, batching and administrative fees. In response to the CAP's comments on batching claims during the independent dispute resolutions, the CMS said the government is considering potential improvements to its batching policy and the CAP's insight on the issue will be helpful during ongoing conversations. The CAP also raised the issue regarding increased administration fees, which were increased from $50 to $350 per party per dispute. Since a pathology claim is often less than $350 and the current batching requirements making packaging multiple claims into a single dispute difficult, reducing the cost effectiveness of participating in the dispute process in the first place.

The CAP recommended that the administration rescind the fee increase, allowing more flexibility in batching claims. The CMS however responded by saying the fee increase was necessary to administer the federal independent dispute resolution process and meet the needs of disputing parties. Without the fee increase, the process would yield slower payment determinations according to CMS. You can read the full response on our website. That's all for this edition of the Advocacy Recap. Thank you so much for listening. For more information on any of the stories you heard today, be sure to subscribe to our weekly advocacy newsletter and follow us on Twitter @CAPDCAdvocacy. Once again for CAP advocacy communications, I'm Alec Bose and we'll see you next month.

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