September 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 September 2023 recap. This month we'll discuss efforts to improve Medicare payments advocacy wins with UnitedHealthcare name changes for cytotechnologists and more.

We start the day with the 2023 Practice Expense Survey. The Practice Expense Survey is available until spring 2024. This survey is vital to understanding key economic metrics of pathology laboratories and how to meet their specific needs. We sat down with Pam Wright, Senior Director for Economic and Regulatory Affairs at the CAP to go in depth on what the survey is, why it's important, and how its results can help pathology practices. Okay. So thank you Pam. Welcome to the podcast. We really appreciate you being here today.

Pam Wright:

Thanks. That's great to be here.

Alec Bose:

So just to start off our conversation, can you tell us what the Practice Expense Survey is and what does it mean to pathologists?

Pam Wright:

Sure. This is an effort led by the American Medical Association and it's referred to as the Physician Practice Information Survey or PPI and what it is, it's a comprehensive effort, a national effort to get practice level cost information from over 173 healthcare organizations and different medical specialties. The goal of the survey is to gather information that Medicare can use in its rate setting for physician services. For example, currently the AMA conducted a survey effort, I believe it was in 2008, to collect 2006 level data. And that 2006 level data is what Medicare currently has on the books to calculate practice expense costs for all physician services and that's how physicians and including pathologists are paid for their services provided to Medicare patients on the Medicare physician fee schedule. So this effort is long overdue and necessary to make sure that the current costs associated with providing patient care are included that can be used for Medicare and that also the AMA and other societies can use this information when they're advocating to Congress for important physician payment information, legislative efforts.

Now, to address the second part of your question, why is this important to pathologists? Well, when pathologists are paid for Medicare service, they provide a Medicare patient. The practice expense represents approximately 45% of the compensation received. And the exact value of these practice expense costs is actually determined by Medicare through a complex series of evaluations and equations. But part of these equations includes the data, the type of data that this survey will collect and update so that the information is accurate for pathologists and their Medicare payment. As I said earlier, these equations rely heavily on this indirect expense cost that will be collected. This effort is actually will provide this comprehensive information just to ensure that pathologists and all physicians are receiving compensation for the cost that they incur to run a practice.

Alec Bose:

So that's really fascinating and I think that is actually very important data that pathologists can in fact use. Sort of just going from there, what kind of information is being collected from the survey and how is that data interpreted?

Pam Wright:

Actually, there will be two parts to the survey. The first part is detailed practice level cost information and this part of the survey will require for the pathologist practice to rely on their financial expert or their practice manager. This information will require access to information such as their payroll or tax forms or financial reports. So this part of the report will look at annual practice costs in providing patient care and services to Medicare patients on the physician fee schedule. The second part of this survey is a shorter, more direct part that will be filled out by the pathologist. This shorter survey will correct direct patient care hours, which will be completed by the pathologist. It'll look at the weekly hours and a time spent providing patient care to Medicare beneficiaries. And this survey also includes definitions specifically related to physician care provided by pathologists and the CAP also work jointly with the AMA and others in defining these patient care hours.

Alec Bose:

Thank you, Pam, so much again, I think that's a great point and I think all this information does benefit pathologists particularly those questions and I think they're very practical just around this up. Just to confirm, just to confirm for our listeners, the survey is currently available, correct?

Pam Wright:

Yes. The survey is actually currently in the field. It was launched in July, and it will be open through April of 2024.

Alec Bose:

And once the survey period is over, what will be done with the results and what can pathologists expect and when can pathologists expect to see 'em?

Pam Wright:

Okay. Following the conclusion of the survey starting next spring, the data will be analyzed and then the reporting information will presented and put together starting late next summer through the end of 2024. And what will happen with this data is once it's completed, the AMA will share this data with Medicare for their use in calculating the physician fee schedule services. This data will be in aggregate with specialty level data and no individual practice level data will be shared with Medicare. Another thing to keep in mind for those who participate in the survey that each participating practice, they will receive an individualized report and in addition, each medical society such as the College of American Pathologists and other professional organizations will receive specialty level reports of the completed data. Once this data is turned into Medicare, we anticipate that it will be used for updating Medicare physician fees as early as 2026. One thing I'd just like to emphasize for pathologists, the importance of when you receive this survey, the importance of ensuring that it's filled out, including, as I said earlier, one, the detailed practice level cost survey to have your financial expert fill that out. And also secondly, the shorter physician direct patient care hour survey. It's important for pathologists to be well represented in this data so that when Medicare updates physician fees, that we have the best available data for our members going forward.

Alec Bose:

I think that's a fantastic note to leave it on. Thank you so much, Pam, for all your time. We really appreciate it.

Pam Wright:

Oh, you're welcome. And thank you for taking the time to allow me to provide more information on this important topic.

Alec Bose:

Absolutely. Thank you.

We now bring our attention to the fight to stop Medicare cuts. The CAP is urging pathologists to contact their members of Congress to urge them to pass legislation to provide additional relief from Medicare cuts scheduled to take effect in 2024. This desperately needed relief will provide crucial short-term financial stability until permanent bipartisan payment reforms are enacted without this pathologists face Medicare payment cuts of 2.75% in 2024, even with the 1.25 conversion factor adjustment Congress provided for physicians at the end of 2022 for 2024. While Congress has taken action to address some of these fiscal challenges by mitigating some of the recent Medicare physician fee schedule cuts, payment continues to decline. These cuts combine with the lack of an inflationary update to the Medicare economic index represents significant negative financial factors. It is essential for pathologists to let Congress know that with workforce shortages preparing for future pandemics and inflationary pressures, now is the time to invest in our nation's laboratory infrastructure not eroded in a win for advocacy.

The CAP was able to meet with UnitedHealthcare to discuss the planned update to the insurer's molecular pathology policy professional and facility reimbursement. Following the meeting, UnitedHealthcare made the decision to delay the new molecular pathology policy to ensure that those providers who have not yet taken steps to register applicable tests or have not yet completed the registration process, have additional time to do so and to receive Z codes for use in submitting claims. Claims will not be denied if they do not contain a Z code. However, continued submission of the Z codes will provide time to ensure compliance when the policy goes into effect and may lead to fewer requests for information to be prepared for the policy's. Publication providers should continue to register their phase one tests and complete the steps. To obtain Z codes For more information, please visit cap.org.

And we end the day with a name change for key laboratory staff. The Commission on Accreditation of Allied Health Education Programs Board of Directors voted to approve the revised standards and guidelines for the accreditation of educational programs in cytology within the new standards and guidelines. They approved a name change and softened educational requirements compared to what was previously proposed. Of specific concern, the name change moves forward despite objections and strong opposition from the CAP. According to these new guidelines, a cytotechnoloist is now referred to as a cytologist and cytotechnology is now referred to as cytology. In addition, there were changes to the education requirements. It was previously proposed that a cytotechnologist would be required to acquire a master's degree. It is well documented that name changes are often the first step in scope of practice expansions. The AMA and the CAP have both prioritized fighting scope of practice, expansions of non-physician providers, which can confuse and ultimately endanger patients. We will continue to keep CAP members updated on scope of practice concerns.

That's all for this edition of the advocacy recap. Thank you so much for listening. For more on all the stories you heard today, be sure to subscribe to our advocacy newsletter and be sure to follow us on X at CAPDCadvocacy. Once again, for advocacy communications, I'm Alec Bose and we'll see you next month.

Download Transcript