October 2021 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 from the CAP's Advocacy Communication Team, here with your October recap.

For this episode, we have a conversation with Dr. Richard Eisner to discuss the CAP's virtual fly into Capitol Hill that he participated in to urge members of Congress to mitigate future cuts to Medicare.

But first, we start today off with recent updates regarding the health insurer, Cigna. 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 From the CAP's perspective, for Cigna to discontinue reimbursement for these services would prove detrimental to patients and laboratory diagnostic services.

Following a request for additional details on the policy change, Cigna provided the CAP with its updated policy to deny these claims. The CAP pressed for additional details after the insurer acknowledged the role of pathologists in oversight services and laboratory management.

In their response, officials representing Cigna stated that it would, "Issue denials when the facility where the services were provided is contractually responsible for laboratory management and oversight services." Cigna said this is similar to how Medicare Part A reimburses pathologists for this work.

Under Medicare Part A, a payment is assigned to each diagnosis related group, DRG, which is for the full spectrum of services received by the patient, including PC of CP Services. Hospitals then pay pathologists for such services at fair market value.

As noted earlier, the CAP has asked Cigna for additional details regarding its policy. As the CAP remains engaged on this issue, we will keep you updated on any developments on Cigna and their policy regarding PC of CP services.

We move now to Capitol Hill where a bipartisan bill has been introduced in the Senate to address the social determinants of health. The Social Determinants Accelerator Act, sponsored by Senators Todd Young and Debbie Stabenow would provide grants for state, local, and tribal governments to develop strategies that target social determinants negatively impacting the most vulnerable populations.

The CAP sent a letter on August 24th supporting similar legislation introduced in the House of Representatives. The primary objective of these initiatives is to better understand the factors that drive healthcare disparities in the United States. Given the importance of laboratory data in the US healthcare system, the CAP engages with agencies like the CDC and the FDA on it to represent pathologists. We applaud the effort to bring these agencies together and tackle social determinants of health and disparities in care. The CAP is in the process of reviewing the Senate bill and plans to engage with its co-sponsors.

In more legislative news, 245 members of the House of Representatives urge congressional leadership to extend a 3.75% positive Medicare payment adjustment through 2022. The goal provides stability to physicians and other providers serving Medicare patients.

The letter was led by representatives Amy Barra, a physician from California, and Larry Bouchon, a physician from Indiana. Doctors Barra and Bouchon led the successful effort last year to mitigate proposed cuts in healthcare payments. In December, 2020, lawmakers followed through by including a 3.75% Medicare payment increase, which mitigated budget neutrality cuts from CMS.

The CAP has continued to support this relief and has called on it to be extended for another year. This was a specific legislative ask pathologists advocated for during the CAP facilitated "virtual fly-in." More than 65 pathologists met with their federal congressional representatives to urge them to mitigate Medicare cuts to pathology services. One such participant was Dr. Richard Eisner.

We sat down with Dr. Eisner to discuss this year's unique fly-in experience and the importance of advocacy on this issue.

So we are joined here today by Dr. Richard Eisner. Dr. Eisner, thank you so much for joining us. We really appreciate your time today.

Dr. Richard Eisner:

Sure, thank you. Happy to participate.

Alec Bose:

So you're from Arizona, right?

Dr. Richard Eisner:

Right.

Alec Bose:

So tell me a bit about your representatives, the representatives you reached out to, and tell me what that experience was like.

Dr. Richard Eisner:

So we reached out to, and were connected with legislative assistance for Representative Schweikert. I live in the district that he represents here in Arizona and also to [inaudible] office. So those two sessions we had, and they went very well, actually.

I did participate in a virtual fly-in at the previous weekend meeting that was part of the session in Washington that we normally fly into, and also connected with the same two offices at that time. This session actually went better because I think the virtual platform used was improved. So it was a little bit better connecting and also submit your responses, and both of the folks we engaged with I think were engaged with us, understood I think the ask. Both folks were able to connect by video with us, which was much more informative and interactive. One of the offices, I forget which one, that person connected just via phone, so it's certainly much better.

I think they had the option of not choosing video if they don't want to, and certainly if they're on there with you in a video format when it's virtual is much better.

Alec Bose:

Right. So tell me a little bit about this legislative ask. You went to this virtual fly-in to advocate a specific policy. Tell me about that and why you feel that policy was significant enough to warrant your advocacy.

Dr. Richard Eisner:

Right. So the specific ask we were speaking to was regarding mitigating the projected cuts in Medicare reimbursement for pathology services, which is part of the larger cuts that are affecting those physicians who work largely in the hospital like pathologists, radiologists, et cetera, who aren't necessarily directly facing patients.

Because of the increased reimbursement to primary care physicians and other patient facing physicians because of the budget neutrality provision that exists, it has to come out of other services and they've elected to take it from specialties like pathology. Especially during the pandemic, and we stress that during this pandemic and evolution of committed resources, increased resources and stress on the laboratory and the pathologists, that it's not the time to cut these services.

And it's very important, as I said, for our practice to not have those services reduced as we continue to work through the pandemic and the resources for laboratory testing. We're still facing shortages in the supply chain that's affecting the laboratory, and and we're just facing that right now in my own lab where we're short of reagents to run certain tests, and then we have to either send them out to a lab that still has the reagents. So it's become a bit of a chronic problem.

Alec Bose:

So we've been in this hybrid pandemic virtual meeting space for quite a bit of time now. Have you done other fly-ins in the past where they weren't in-person clients?

Dr. Richard Eisner:

Right. Yeah, thank you. I participated in a number of them actually over the years. Beginning probably 10 years ago, maybe even a little more, and I enjoyed those, but clearly it's a very different experience.

Alec Bose:

Yeah. Speak a little bit about the advantages and limitations. I think there's always something to be said, especially for people who are starting into this advocacy who haven't been able to do it in person, who are a little bit maybe hesitant or maybe aren't sure how to do it as a virtual versus in person or vice versa. Can you speak a little bit about that?

Dr. Richard Eisner:

I think one of the biggest advantages of being in person is being at the room with the person you're engaging with, probably get a little bit more of a feel of body language and facial language and nuances in that regard, and just being closer together, whether you're with one-on-one or with a group of people representing the issue in your state.

The preparation time is probably about the same. I think with the virtual aspect, the materials being available and being able to review everything in the same space was a little bit easier. Although with current technology and loading of documents, even if you're flying in, I think you could prepare pretty much easily the same.

The advantage of the virtual is, one, not having to take the time to fly in, stay overnight, the flight, depending on where you're coming from. With the virtual, you're obviously at home or at work and being able to connect right in. So it does bring in that advantage of not having to commit to the travel and that amount of time to go in. So there is a trade off. Certainly through the pandemic, I mean, our virtual technology has been a tremendous advantage for so many businesses, not just healthcare.

Alec Bose:

Right. Yeah, I think that's a good point. For the last question, I just want to jump back to the policy side. When we talk about mitigating cuts, we talk about maybe the continuous threats facing pathology reimbursement to specific services that are really important. Can you talk about some of the challenges you see down the road with some of this legislation mitigating Medicare cuts, and some of the potential opportunities you see?

Dr. Richard Eisner:

Well, I think one is the budget neutrality issue. If that stays in place and they look to shift reimbursement, increase it in some areas, it's got to come obviously out of other service lines or other disciplines, and that's a threat to a pathologist. Particularly if it's in this mode of increasing reimbursement to the primary care or patient-facing physicians. And that's important. We don't oppose that in any way, and I don't think any pathologist would, but I think there has to be a mechanism devised where we can work through these with Congress and Medicare services to prioritize what should be reimbursed or even increased and those that can be reduced.

I think the challenges are with testing in a lot of areas, not just the laboratory, whether it's radiology and other services and procedures, we have such an expense of the cost of care in this country in particular versus the outcomes we see. You compare it to other countries and other healthcare systems, and I think that's a big challenge going forward.

I think there's certainly opportunity for the pathology community and let's say working with other similar service lines like radiology to be able to bring forth what we really provide for patient care and how much of that is important. And what we need to keep funded for both the hospitals, the laboratories for their operations, as well as pathologists, the physician reimbursement piece.

Part of the challenge I think we face is that we're not on the front lines. Radiologists who do procedures are sort of there, but for those radiologists who are non-patient facing and other service lines in the hospital, we're kind of in the background. The patients don't see us, the community doesn't see us in terms of our importance, so we need to advocate for that. I think the CAP has been doing a better job about that, but I think education to our legislators and to the public as to how critical we are to patient care.

Alec Bose:

Thank you so much. We really appreciate your time.

Dr. Richard Eisner:

All right. Take care.

Alec Bose:

That's all for this edition of this month's CAP Advocacy Recap. Thank you so much for listening. Be sure to read our weekly advocacy newsletter and follow us on Twitter @CAPDCAdvocacy. Once again for CAP Advocacy, I'm Alec Bose, and we'll see you next month.

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