What Do Pathologists Want From Congress?

Robert Johnson:
What do pathologists want from Congress? Find out what's on the CAP Federal Policy Agenda this year. Pathologists plan to be in Washington, DC next month where federal policy will be front and center. Members of the College of American Pathologists will visit Congress to ask for support on several issues important to the specialty and patients. The visits are part of the CAP's House of Delegates and Pathologist Leadership Summit planned for April 26th through the 29th. Dr. Mary Le is chair of the CAP's Federal and State Affairs Committee.

Dr. Mary Le:
We have four asks this year. The first is regarding Medicare payment reform. The second is the laboratory-developed tests. The third is regarding Conrad 30 waiver program. And lastly, we want to discuss local coverage determination.

Robert Johnson:
Let's examine each one of these on their own, starting with Medicare payment. What do we need out of Congress on that front?

Dr. Mary Le:
The main thing is issues regarding Medicare payment reform. We want to reintroduce the Medicare Patient Access and Practice Stabilization Act. This will provide a 6.6% adjustment to the Medicare physician fee schedule. It will stop the reimbursement reduction as well as providing a small 2.0% inflationary update. Now, we know it was not included in the recent continuing resolution, but we would like to reintroduce it. Basically, we are asking Congress to provide a permanent inflationary update to the Medicare physician fee schedule, as well as modify the budget neutrality requirement. Now, there are a number of bills in both the House and the Senate addressing this. The other bill is to reintroduce and pass the strengthening Medicare for Patients and Providers Act. This one provides the permanent inflationary update to the Medicare physician fee schedule based on the Medicare economic index. The other bills also focus on looking back to reconcile overestimates and underestimates of pricing adjustments. We are asking for timely updates to direct costs that were used to calculate the practice expense, relative value units, the RVUs, and we'd like to require the secretary to limit positive or negative increases in the conversion factor to no greater than 2.5% each year. That will prevent the wild swings.

Robert Johnson:
I'm guessing most members by now have heard about the FDA's LDT rule. What's our message on that one?

Dr. Mary Le:
So, as we know, the FDA final rule was introduced last year, and it's implemented to start May 6th of this year. However, we think that this is not the best approach for federal oversight of the laboratory-developed tests. We oppose the rule because it will reduce the number of highly accurate LDTs already available to patients, and this will impact patient access. It adds extraordinary costs and burdens associated with implementation of the final rule. For example, if this rule gets into effect in-house blood tests that are used to determine whether a patient with non-small cell lung cancer could benefit from targeted therapies would not be available. Histochemistry tests that assist in the diagnosis and classification of basically all cancers would be looked at tests to diagnose rare pediatric diseases tests to monitor disease response to therapies. All these tests would be scrutinized, and that would lead to extensive delay in diagnosis and treatment of basically the full spectrum of diseases that affect our patients. Therefore, we do ask Congress to support and pass a bill, the Freedom for Laboratory Innovation and Testing Act. This would prohibit funding for the implementation administration and the enforcement of the FDA rule.

Robert Johnson:
CAP members also have a concern about the workforce. How can Congress help on that issue?

Dr. Mary Le:
Right. So the Conrad 30 Waiver Program really addresses our physician shortage. As you know, non-US medical graduates, our international medical graduates, they play a critical role in providing healthcare service to underserved areas of our country with the highest rates of poverty and chronic diseases. While currently J-1 visas require that international medical graduates return to their country of origin for at least two years after completing their residency, unless a Conrad 30 waiver is obtained. Well, this program will forego the two year home country requirement and instead immediately allow the physician to provide the necessary patient care to our rural and underserved areas. The Conrad State 30 and Physician Access Reauthorization Act makes improvements to this program as well as increase the number of waivers granted to each state.

Robert Johnson:
Last but not least on the list is local coverage determination. What's the ask there and why is it important?

Dr. Mary Le:
So to start off, Medicare coverage policy decisions are made both the national coverage determinations, the NCD, and they're made locally, the local coverage determinations, the LCDs. These are developed by the Medicare administrator contractors, the MACs, and that determines under what circumstances a particular item or service is covered. Now, over the years, as the max grew, they covered larger and larger jurisdictions, and while this happened, there were fewer opportunities for stakeholders to interact with the contractor medical directors. The CMS does have what's called a program integrity manual. This does instruct MACs on how to develop LCDs. However, the overall process has been lacking in transparency. So we are asking Congress to introduce and pass legislation that ensures timely review of the LCD requests under the Medicare program. Basically, we are asking timely completion of requests for new and existing LCDs. We are asking for increased transparency in the entire process, and we are also asking to include sufficient opportunity for stakeholder input.

Robert Johnson:
We've heard that some members who come to this event may not be comfortable going to the Hill. What can you say to them about the work that we put into getting them ready for those meetings so that they can be effective?

Dr. Mary Le:
So over the weekend, we do have panel discussions on advocacy that really prepare you for the topics at hand. It really gives you the background information to get you ready to understand why these asks are so important to us. Also, while you're going to the hill, you're never really alone. We will pair you up with seasoned veterans who have done this before, or we will have a staff member accompany you to these Hill Day office visits. So you're never really alone. And the face-to-face interactions are so important because the offices have questions for us, and we are the authorities. We are the physician authorities to give them the reasons of why our asks are so important. It allows us to give the patient stories. It allows us to bring them to life to our congressional offices. Now, in terms of why to stay for the Hill Day, I understand that we are all working. We're carving time out of our work week to attend these meetings, the weekend meetings that enriches you personally. However, the Hill Day face-to-face meetings, that really is helping other pathology colleagues have a better work environment and ultimately increases patient access so we can continue providing high quality pathology services to our patients.

Robert Johnson:
If you are concerned about the impact of federal policy on you and your patients, then you need to make time to be in the nation's capital. Next month, you can sign up to attend the CAP House of Delegates and Pathologist Leadership Summit using the link in the show notes for the College of American Pathologists. This is Robert Johnson. Have a great day.