September 2020—Pathologists have been feeling the pain for months. The COVID-19 pandemic triggered furloughs and layoffs even as we ran a grueling race to implement and scale high-quality testing. And now looming cuts to pathologist physician payments threaten to make our situation even worse.
The Centers for Medicare and Medicaid Services in early August announced a proposed nine percent cut to payments for pathology services. This is the result of a budget neutrality requirement that was built into the relative value system decades ago. Intended to keep health care costs in check, this requirement has effectively turned Medicare reimbursements into a zero-sum game. If one group earns more, another has to earn less.
Dr. Godbey
Last year, the CMS decided that certain groups of physicians, such as primary care doctors, deserve higher pay for their services. While the CAP takes no issue with that increase, we strongly object to its consequences: that other groups, including pathologists, must take a significant reduction in payments to make up the difference. Effectively, anyone who does not generally bill evaluation and management (E/M) codes will see reductions in payment.
Though we didn’t know until this summer how deep the cuts to our services would be, the CAP’s advocacy group has been actively working on this issue since last year’s announcement that other physicians would see higher payments for their E/M services. The CMS alone cannot eliminate the budget neutrality requirement. That is why CAP experts are focused on working with legislators, your legislators, to waive the budget neutrality requirements that are at the root of the problem.
CAP representatives have already met with congressional leadership to offer education about the impact of these cuts and to encourage legislation that would waive the budget neutrality rule. The CAP has also joined forces with dozens of groups representing nearly 50 other medical specialty areas that would also suffer from the proposed payment cuts. I believe this coalition is our best chance at avoiding these potentially devastating cuts.
I have used this column in the past to urge CAP members to become more active. If those earlier requests did not get your attention, please listen now. Unless we take action immediately, all pathologists will suffer. A nine percent cut will hurt whether you work in academia or in private practice—and the effects throughout our field may last for years.
There are specific, concrete steps you can take today to help the CAP make a difference and increase our odds of succeeding. I cannot stress enough how vital it is that every CAP member take action. Here’s how you can help:
- Bring in a new member. If you are already a member of the CAP, that’s wonderful. But your colleagues, residents, and fellows may not be members. Encourage them to join today. The more members we have, the stronger we are as an organization and the louder our voice will be on Capitol Hill.
- Sign up for our “Stop the Cuts” campaign. To make it easier for members to take part, the CAP has launched a campaign that will allow each of us to contribute as much or as little time as we can. Sign up at tinyurl.com/CAPsummercampaign and select activities you’d be willing to engage in, such as helping with social media, participating in a town hall with your members of Congress, or visiting your elected office holders virtually.
- Contribute to PathPAC. If you are a CAP member, I urge you to make a donation to our political action committee to support efforts to lobby Congress for change. If you have not previously donated, now is the time.
I truly cannot believe the severity and timing of this planned cut. At a time when the demand for our services has never been higher and we are actively fighting a pandemic, it is impossible to understand the rationale behind cutting payments for the valuable services we are providing.
Stopping these cuts will be a battle, and there is limited time to do it: The rule must be changed before Jan. 1, 2021 or the new fee schedule will go into effect. But if anyone can get this done, it is the CAP. We have the mechanisms, the connections, and the resources to make a difference in Washington. We have the passion of a dedicated and talented group of physicians and staff. Now we need every member’s commitment to help raise awareness about how important pathology is and always has been.
Dr. Godbey welcomes communication from CAP members. Write to him at president@cap.org.