Physicians are the solution
October 2026—We have all heard the latest claims that the American Medical Association—and the medical specialties it represents—is misusing CPT codes to overpay physicians. Whether these statements come from the Medicare Payment Advisory Commission, members of Congress, or any other group, it’s no wonder we pathologists feel under attack.
It’s also no surprise that the Centers for Medicare and Medicaid Services seized on calls to reduce CPT payments accordingly. Pathology and laboratory medicine are facing efforts to reduce payment for clinical laboratory codes as well as pressure on pathology’s professional reimbursement. Fortunately, the CMS received enough pushback from the community and from the CAP’s advocacy team to stop previously scheduled cuts to the clinical laboratory fee schedule required by PAMA. The agency allowed laboratory teams to submit data on rates paid in the private sector for tests.
There’s also a provision in the CMS’ proposed 2027 Medicare physician fee schedule asking if surgical pathology codes are overpaid and if they need to be adjusted. The CMS received an empirical data analysis submitted to the agency that led to implausible conclusions misrepresenting the work of a pathologist. The CAP strongly disagrees and is fully engaged to fight this effort. (See comments.)
With the midterm elections coming up here in the U.S., many politicians seem to believe it’s a good time to blame physicians for spiraling health care costs. We know what they’re saying is just not true. Doctors are not the problem. In fact, I believe we are the solution.
First, consider a few points in the debate about whether pathologists are overpaid. As we all know, CPT codes are not indexed to inflation. But the cost of the materials we need to run tests does increase over time, often dramatically. Our CPT code payments are going down not only in real dollars due to ongoing government cuts, but also even more substantially when inflation is factored into the mix. For those of us whose income is based on services billed, we are being paid less and less.
Second, it’s important to look at the big picture. Overall, laboratory medicine and related services represent about three percent of total health care expenditures in the U.S. Even if you cut out all costs associated with our work, it wouldn’t move the needle in terms of reining in overall costs. As we all know, pathologists’ work actually contributes to lowering costs by guiding treatment selection, confirming the correct diagnosis, and using robust data to show which follow-up tests or treatments are necessary or unnecessary.
Clearly, it’s not pathologists who are responsible for increasing health care costs. What’s really behind this trend? One of many complex factors is that advanced medicine is allowing us to save lives that would otherwise have been lost to infectious diseases, cancer, cardiovascular disease, and more. People are living longer, and that often means they’re living longer with chronic diseases that are expensive to manage. The mission we have been given as physicians, to save lives, is also one that happens to increase the overall costs of medicine in the long term.
The CAP’s advocacy team works tirelessly to help policymakers understand that the clinical insights we provide are truly valuable. They educate legislators about how we deliver excellent patient care, and they work through the AMA and other groups to protect payments for our services so we can continue to provide that care.
But each of us has a role to play as well. We can find ways within our health care systems to demonstrate the value of our work and show how the results we generate improve patient care.
We also have to take advantage of opportunities to provide feedback when they arise. I mentioned the CMS data collection earlier; while the biggest reference laboratories responded, many of our smaller labs and practices did not. That means the CMS will be working with data based on the largest labs with the greatest operational and economic efficiencies, which may not be a good reflection of the reality at other labs. We can’t blame the CMS for making bad payment decisions if we don’t step up to provide supporting data when it is asked for.
Finally, I believe we must all look for ways to invest in new technology that could reduce our costs in the future, even if implementing that technology increases costs a bit in the near term. We know payment cuts will continue, and we have to be prepared to deal with them. AI tools, digital pathology services, and other technologies may offer us much-needed breathing room—but only if we make the time and commit the funds to investigate how to incorporate them in our laboratories now.
Dr. Zhai welcomes communication from CAP members. Write to him at president@cap.org.