Pathologists Go to Capitol Hill

In April 2023, CAP members met with House of Representatives and Senate offices to ask Congress to mitigate Medicare cuts to physicians, set limits on future clinical laboratory fee cuts, and increase the medical workforce to address current shortages. Pathologists from across the United States traveled to Washington, DC, during the 2023 Pathologists Leadership Summit to meet in-person with 145 congressional offices in the Senate and House. The four-day hybrid summit—which concluded with the CAP’s annual Hill Day—included more than 600 pathologists who attended the House of Delegates meeting, educational courses, and advocacy sessions.

Without additional relief, pathologists were expected to receive a Medicare cut of up to 6.5% in 2024. Some Medicare fees for clinical laboratory tests would also be slashed by 15%. In addition, pathologists reviewed the looming medical workforce shortage and encouraged legislators to increase graduate medical education funding to support more residency slots, which is key to addressing projected shortages of pathologists in the coming years.

In September, lobbying on the 2024 Medicare cuts continued with CAP members sending more than 1,700 messages to 363 members of Congress. In late October, over 60 pathologists participated in a “virtual fly-in” to press their representatives and senators on this issue once again.

As a result of CAP lobbying efforts and a coalition of laboratory groups, cuts to Medicare fees for clinical laboratory tests were delayed by a year. Bipartisan legislation to reverse the Medicare cut to physician services was also introduced in the House of Representatives and garnered bipartisan support. Talks to enact the bill or similar legislative language continued into 2024. 

Separately, the Centers for Medicare & Medicaid Services later revised its own estimates and projected the cut to physicians would be 3.37%. This cut was mitigated through regulatory lobbying by the CAP to increase Medicare’s cytotechnologist clinical labor rate used in their payment methodology by 12%. This is in addition to a 2022 increase of 16% to the histotechnologists clinical labor rate. In total, these two clinical labor rate corrections resulted in a $34 million payment gain for pathologists thanks to the CAP. 

CAP Works with Congress to Address Health Disparities

In keeping with its vision to make people healthier through laboratory excellence, the CAP continued to seek enactment of legislation addressing health care disparities. In March, Emily Volk, MD, FCAP, then CAP president, met with the Congressional Black Caucus Health Braintrust during a forum discussion on strategies to address inequities in health care. Dr. Volk provided an overview of the CAP’s work to eliminate disparities in diagnostic algorithms and reference ranges, as well as current advocacy policies supporting Medicaid expansion and mitigating social determinants of health.

PathPAC Amplifies the Voice of Pathologists

PathPAC is nonpartisan and represents the interests of pathologists on Capitol Hill through political and financial means. As a 501(c)(6) nonprofit, the CAP is the only association with a federal political action committee strictly representing the interests of pathologists. In this capacity, the CAP advances the legislative agenda set by the Council on Government and Professional Affairs.

During 2023, PathPAC created additional opportunities for pathologists to engage with their representatives and senators on the political issues concerning the specialty. PathPAC raised $200,000 and supported 84 pro-pathology congressional candidates. PathPAC also executed its second “Back the PAC” competition with the House of Delegates, raising $51,000 from pathologists across the country. 

CAP Partners with State Pathology Societies for Major Wins

Last year, state pathology societies and the CAP collaborated to achieve several legislative victories dismantling adverse health insurer policies and protecting the pathologist’s scope of practice. For example, the Arkansas Society of Pathologists and the CAP amended a “gold card” prior authorization law. The amendment included safeguards protecting against wrongful denial or payment reductions of pathology services subject to prior authorization waivers.

State legislative wins and activities from 2023 include:

• Health plan network adequacy: Pathology and clinical laboratory-explicit health plan network adequacy laws enacted in Georgia, Tennessee, and Texas for facility-based physicians like pathologists.
• Out-of-network issues: Adverse out-of-network legislation defeated in Georgia, New Hampshire, and Wisconsin. Per CAP and state pathology society advocacy, Washington state successfully retained its state arbitration system until July 2024, avoiding the federal No Surprises Act independent dispute resolution process.
• Scope of practice deceptive advertising: First state society-CAP amended physician title protection law enacted in Georgia safeguarding “pathologist” nomenclature from non-physician use.
• Prior authorization gold carding: First state society-CAP amended gold carding prior authorization waiver law enacted in Arkansas protecting payment for exempt pathology services. Adverse health plan-backed legislation successfully defeated in Montana.
• Laboratory referral steering: Adverse legislation amended, removing anti-competitive health plan referral steering to a single clinical laboratory.

Pathologists Quality Registry Enrolls 1,721 Pathologists

In 2023, the Pathologists Quality Registry experienced over 20% growth, with 1,721 pathologists from 133 practices enrolled. The CAP’s scoring advantage and outstanding staff support brought in 29 new practices last year. Submission of quality data through the registry prevents a Medicare payment penalty of up to 9% and qualifies practices to receive a bonus. The Pathologists Quality Registry enables the highest scoring and payment bonus potential for pathologists participating in the MIPS program.

CAP Opposes FDA Rulemaking on LDTs

Following the release of the Food and Drug Administration’s regulatory proposal on the oversight of laboratory-developed tests (LDTs), the CAP engaged with the agency on strong concerns from CAP members and laboratories. The CAP’s comment letter submitted on December 4 formally opposed the rulemaking as written and sought significant changes as the proposal did not align with the CAP’s principles for LDT oversight. For example, the CAP recommended the FDA’s enforcement discretion policy continue in several areas because the rulemaking would substantially increase burdens and reduce the number of highly accurate LDTs. The CAP remains engaged with its opposition to the rule as the FDA works to finalize the proposal in 2024.

CAP Creates 30 New Digital Pathology CPT Codes

Continuing to build successes in 2023, the CAP advocated for the inclusion of 30 new Current Procedural Terminology (CPT^®) digital pathology codes for pathologists to use in 2024. The CAP worked with the American Medical Association CPT Editorial Panel to develop the new digital pathology add-on codes, which were published on June 2. The new digital pathology Category III CPT codes will be used to report additional service requirements associated with digitizing glass microscope slides for primary diagnosis. The CAP worked throughout 2023 to prepare pathologists to report the new codes correctly.

CAP Opposes Adverse Payer Policies

The CAP champions policies that preserve access to pathology services for patients and protect against overburdening pathologists with administrative requirements and interfering with the practice of medicine. Monitoring for developments in private health insurance policies at state and national levels, the CAP communicated updates to members while educating payers on any effect on the practice of pathology.

With issues ranging from steering of specimens and reimbursement requirements to new laboratory benefit management programs, the CAP represented pathologists’ interests in opposing adverse health insurer policies. For example, the CAP opposed insurer-imposed reimbursement policies that inappropriately devalue pathology services, limit access to timely and appropriate services, and threaten the ability of pathologists to provide care for patients. Further, insurers’ increased adoption of non-standard coding practices and reliance on narrow networks were not only administratively burdensome and operationally cumbersome but resulted in adverse consequences for quality patient care to benefit the financial interest of the payer.

Grant Awarded to Promote Diagnostic Excellence

In 2022, the Council of Medical Specialty Societies (CMSS), a coalition of 48 specialty societies representing more than 800,000 physicians, awarded the CAP a grant of $100,000 to promote diagnostic excellence across the field of medicine, specifically supporting improving patients’ experience with their pathology reports. Throughout 2023, the CAP conducted surveys, interviews, and focus groups with patients to form the basis of recommendations that will assist in developing a patient-centered pathology report. The work was highlighted at CAP23 as an Advocacy hot topic and at the CMSS Annual Meeting. In 2023, the CMSS and the Gordon and Betty Moore Foundation awarded a second $100,000 grant to the CAP to further assess the challenge of ensuring a pathology report can meet the needs of all care team members while still effectively communicating the results to patients, who need to make informed decisions about their health.

CAP Releases Practice Leader Survey Report

The CAP published the 2023 Practice Leader Survey Report, providing the latest socioeconomic data on pathology practices’ structure and ownership status, case volume and revenue mix, staffing, and problems they incur with coverage and payment for services.

Among the most notable findings from the survey, nearly 60% of practice leader respondents reported that it was difficult to hire laboratory staff. Additionally, the report highlighted the following:

• In 2023, 65% of practice leaders reported that they expected to hire at least one pathologist in 2023, an increase from prior years. However, most of those practice leaders (70%) do not expect to be able to fill all their open positions.
• Roughly 30% of practice leaders reported that pathologists in their practice perform some kind of remote sign out, including 9% whose practices used digital pathology for primary diagnosis.
• There were substantial increases in the share of respondents whose practice decided not to join or renew participation in a particular health plan/insurer network in the last two years; who have been denied participation in a network in which they were previously a participating provider; and who attempted to join a network but were denied participation.