Florida Pathologists Engage on Critical Issues with Congress at CAP Policy Meeting

Florida Pathologists Engage on Critical Issues with Congress at CAP Policy Meeting

Authors: Marilyn M. Bui, MD, PhD, Anne Champeaux, MD, Prudence Smith, MD and Oleksandr N. Kryvenko, MD

On May 2-4, 2016, we saw first-hand that the College of American Pathologists (CAP)’s Policy Meeting (2016 CAP Policy Meeting - College of American Pathologists) is a must-attend event for pathologists. Seven Florida pathologists who are members of the CAP House of Delegates and the Florida Society of Pathologists attended this meeting. These included Drs. Marilyn Bui, Prudence Smith, Anne Champeaux, Jim Zhai, Jeffrey Smith, Oleksandr Kryvenko, and Peter Johnson. The meeting provided our Florida delegation with a unique opportunity to advocate for pathology and laboratory medicine, while also briefing us on key regulatory issues impacting the specialty and how to best advocate for legislative solutions to the problems that we all face.

The Policy Meeting reaffirmed that it is a critical time for American medicine, and our voices must continue to be heard in our nation’s capital.

Federal officials briefed us on the latest information regarding the oversight of laboratory-developed tests (LDTs) and new Medicare payment methodologies on the horizon from the Centers for Medicare & Medicaid Services (CMS). This included the impact of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act which creates a new Merit-based Incentive Payment System (MIPS)  and alternative payment models on pathology. Panel discussions also addressed the CMS’ implementation of the Protecting Access to Medicare Act (PAMA) which reforms the Medicare clinical laboratory fee schedule, as well as coverage of services from both Medicare and private health plan perspectives and their implications for pathology.

The meeting featured a diverse lineup of leading health policy experts and political thought-leaders. In addition to CAP President, Dr. Richard Friedberg, Keynote speakers included Harold Miller, the President and CEO of the Center for Healthcare Quality and Payment Reform, nationally recognized pollsters Peter Hart and Ed Goeas, and renowned journalist David Gregory, the former moderator of Meet the Press and political analyst at CNN.

During our congressional meetings at the CAP’s Annual Hill Day, Drs. Anne Champeaux, Oleksandr Kryvenko, Jeffrey Smith, Prudence Smith, and Peter Johnson met with congressional staffers from the offices of Senator Bill Nelson (D-FL), Senator Mark Rubio (R-FL), Representative Gus Bilirakis (R-FL) and others to discuss the CAP’s proposal for reform of the Medicare local coverage determination (LCD) process. Two members of Congress, Rep. Lynn Jenkins (R-KS) and Rep. Ron Kind (D-WI), have agreed to introduce the CAP’s proposal into legislation, which is expected to be drafted within the upcoming weeks. Our representatives were able to engage legislative staff on our concerns with the lack of an open and transparent process in how LCDs are made. This may sound familiar to you. As you may recall, last year we asked the Florida Medicare Administrative Contractor (MAC) First Coast to rescind an LCD because it was based on inadequate evidence and did not take into account patient characteristics that vary from practice to practice. The LCD ultimately impedes physician judgment and the practice of medicine.

MACs are multi-state, regional contractors responsible for adjudicating Medicare claims. MACs process nearly five million Medicare claims each business day and distribute more than $365 billion in program payments each year. We went to Capitol Hill with our concerns about the LCD process and advocated for:

• MAC carrier advisory committee meetings to be open, public, and on the record with meeting minutes published
• Upfront disclosure of the evidence and rationale used to arrive at the draft LCD
• Creation of a meaningful reconsideration and appeals process
• Stopping the abuse of LCDs as a backdoor to the creation of a national coverage determination affecting physicians and patients nationwide

In short, the LCD process needs more transparency and accountability. It’s our hope that legislation will be introduced soon and will gain broader support because of our advocacy efforts during this meeting.

Meetings with legislative staffers during the Hill Day were short, generally lasting 30 minutes or less with discussion of the CAP Legislative Ask: “Increase transparency and boost accountability in the Local Coverage Determination (LCD) process. “   Some of the staffers were familiar or somewhat familiar with the issue, and others less so.  All listened to us patiently and asked appropriate questions.  Group meetings were certainly less stressful.  Individual meetings where you are the only person present from your district can go very well if you’re a natural talker or be quite nerve racking if you’re not.  According to Dr. Prudence Smith, being the latter and talking to one of the less familiar staffers, she had to quickly figure out how to get through the hill visit tips, including getting the ask out as quickly as she could while also allowing for questions.  Prudence said: “The Ah-Ha moment came when I just left my chair, took the folder with explanatory material and crouched next to the staffer and went over the figures.  I was able to get through the material quickly and he could better understand what I was trying to explain to him.  It also helped me relax too.  Being able to let the staffers know that a draft would be forwarded to them was also extremely helpful, given that last year we were still looking for sponsors for the legislation”.

In conclusion, ask any of the above seven FSP members about the CAP Policy Meeting and they will encourage you to participate. It’s the one opportunity pathologists have to advocate and lobby Congress together on the issues important to our specialty and our patients. Please consider joining us in Washington in 2017 – you’ll be hearing more about attending next year’s Policy Meeting from us and the CAP in the months ahead.

For more information, please read the latest issue of CAP STATLINE (STATLINE - College of American Pathologists).