CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Charles Fiegl
December 2022—The Centers for Medicare and Medicaid Services published on Nov. 1 its final 2023 Medicare physician fee schedule with payment rates and new policies set to take effect next year. The CAP had engaged with the CMS on payment rate changes affecting its members in the fee schedule and successfully lobbied the administration to increase payment to pathologists and laboratories in several areas.
Technical corrections to clinical labor rates, which were errors the CAP discovered in 2021, were a highlight in the final 2023 fee schedule. Following the CAP’s recommendations, the CMS finalized the proper rank order of the clinical labor rates for histotechnologists and laboratory technicians. This action will result in higher payments for the technical and global components of some pathology services in 2023 and beyond.
In the 2022 Medicare physician fee schedule released in November 2021, the CMS had finalized a proposal that updated the clinical labor pricing in conjunction with the final year of supply and equipment pricing changes. The prices for labor, supplies, and equipment are accounted for as part of Medicare payment for the technical component of fees paid to physicians and other providers. These clinical labor rates had not been updated in 20 years, and the long time frame between updates had created a significant disparity between the CMS’ clinical wage data and the market average for clinical labor. However, the CMS’ efforts for the 2022 fee schedule made several flawed assumptions for the pricing, and the CAP intervened.
The CMS had primarily used Bureau of Labor Statistics (BLS) wage data to update its clinical labor prices. The federal Medicare agency believed that BLS data was the most accurate source to use as a basis for clinical labor pricing, and it had used the most recent BLS survey data available for its calculations of wage data (2019). However, for certain labor categories where BLS data were not available, the CMS had to crosswalk or extrapolate the wages using supplementary data sources for verification. This was the case for the flawed 2022 clinical labor price per minute for histotechnologists.
The CAP began its advocacy seeking the corrections early in 2022 by providing the agency with the most current wage data resources, relative BLS comparison rates, and current open histotechnologist job salary offerings. These data from the CAP convinced the CMS to correct the final clinical labor rate for histotechnologists. This correction in addition had a positive impact on another pathology blended clinical labor rate.
In the 2023 fee schedule, the CMS finalized the implementation of the clinical labor update to include the CAP’s requested corrections over four years to transition to the final updated prices by 2025. The repricing has an impact on both the technical and global components of physician services. Services under the physician fee schedule that rely primarily on clinical labor rather than supplies and/or equipment will receive the largest increases relative to other services. In contrast, services that rely primarily on supplies or equipment items will experience decreases relative to other services because any changes to the physician fee schedule are subject to budget neutrality constraints. For 2023, the clinical labor pricing will be year two of the transition. The final pathology CMS clinical labor rate phase-in increases secured by CAP advocacy are as follows: laboratory technicians, 67 percent; histotechnologists, 73 percent; and lab technician/histotechnologist blend, 70 percent.
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