Home >> ALL ISSUES >> 2013 Issues >> On cuts and consequences, pathologists make their case

On cuts and consequences, pathologists make their case

image_pdfCreate PDF

Berna Diehl

October 2013—James Richard, DO, directs CAP-Lab, an independent laboratory in Lansing, Mich., where he manages the business and does everything from signing off on pathology reports to paying the mortgage on the building. But among the many issues he tackles running his practice and in the midst of a shift in health care in the U.S., a single rule proposed by the Centers for Medicare and Medicaid Services is what’s keeping him awake at night.

Dr. Richard isn’t alone. CMS proposal 1600-P, a rule that would cut payments to physicians by changing the current fee schedule used to reimburse them for their services, has galvanized physicians around the nation and across disciplines.

The CAP analyzed the implications of the CMS’ proposed rule for several months. According to the analysis, the rule, as drafted, would inflict drastic cuts to 39 of the most common pathology services used to diagnose tissue biopsies.

Dr. Kathryn Knight with U.S. Rep. Phil Gingrey (R-Ga.) on Sept. 18. “They are out of bounds and need to withdraw the rule,” she says of CMS. [Photo: Kaye Evans-Lutterodt]

The rule’s legal grounding is questionable. An analysis conducted by law firm Sidley Austin LLP on behalf of the CAP says the proposal violates the statutory requirement that Medicare practice expenses be resource-based. It “relies on faulty assumptions and inapplicable facility resource data,” the analysis says, and “does not reflect actual resource costs in the non-facility setting—contrary to law and regulation and CMS’ stated policies and past practices.” The analysis continues, “Application of CMS’ proposed OPPS/ASC [Outpatient Prospective Payment System/Ambulatory Surgical Center] payment cap in the non-facility PE RVU methodology is not resource-based for the practice setting and is unlawful.”

Or, as Dr. Richard puts it, “CMS isn’t just coloring outside the lines here. They’re coloring off the page.”

Since the CMS introduced in July its revisions to the proposed 2014 Medicare physician fee schedule, it has received a deluge of comments from stakeholders. It is expected to issue its final rule by Nov. 1.

For its part, the CAP has led a multi­faceted advocacy effort to have the rule withdrawn. It has met with CMS officials and organized discussions on Capitol Hill between pathologists and members of Congress. Alone and as an advocacy coalition member, the CAP submitted four letters to CMS administrator Marilyn Tavenner on proposed rules related to physician payment.

Many CAP members contributed to the CAP’s advocacy efforts, submitting comments, sending letters, traveling to Washington to meet with members of Congress, and discussing issues related to the rule with the media. Several CAP members also conducted meetings in their home states with their members of Congress.

On the coalition front, the CAP and AMA and other organizations, including leaders of the Clinical Laboratory Coalition, have met with the CMS many times to express concerns about the proposed cuts.

“CMS is receiving tremendous pushback on the proposed rule, with 10,220 comments posted on the rule to date,” says John Scott, CAP vice president of advocacy. “CAP members have done an excellent job of making their voices heard and have made clear how important it is for CMS to withdraw this dangerous rule.”

Dr. Richard arrived in Washington on Sept. 18 to participate in an organized Capitol Hill fly-in with other CAP members and representatives of the American Clinical Laboratory Association.

For Dr. Richard, taking time from the practice to visit lawmakers is not easy. “It’s tempting to think of it as someone else’s job,” he said just before catching a cab for his first meeting on the Hill. “But given what’s at stake, there’s no question. I have to be that ‘someone else.’”

CAP TODAY
X