ASCP Urges Significant Changes to CMS E/M, Scope of Practice and QPP Proposals

On Oct. 5, ASCP submitted three comment letters to the Centers for Medicare and Medicaid Services (CMS) in response to the Agency’s Proposed Rule on the Physician Fee Schedule, which outlines an overall cut in pathology reimbursements of nine percent for pathologists and five percent for clinical laboratories. The letters outlined ASCP’s concerns and recommendations on issues related to payment and the quality incentives, i.e., the Medicare Quality Payment Program (QPP).

In the payment letter, ASCP focused much of its comments on CMS’s flawed office/outpatient evaluation and management (E/M) proposal. ASCP also opposed the Agency’s plan to allow diagnostic tests to be supervised by certain nonphysician providers, such as nurses and physician assistants. ASCP supported a plan, with reservations, to utilize wage data from the U.S. Bureau of Laboratory Statistics (BLS) in pricing physician services.

In the QPP letter, the ASCP urged CMS to make changes to increased opportunities for non-patient facing clinicians, such as pathologists, to participate in payment and delivery reform through the Medicare program. ASCP argued that the Agency needs to expand the QPP/MIPS program to effectively capture the efforts of non-patient facing clinicians who significantly impact patient care. 

ASCP also registered its strong objection to a proposed change to eliminate cervical cytology/Human Papillomavirus (HPV) co-testing from a QPP quality measure.

As previously reported, the Agency is planning to adopt an AMA proposal to increase payment for certain office/outpatient E/M services. This proposal is projected to cause major cuts in overall payments for certain physicians, including pathologists. This is because of Medicare’s budget neutrality requirements, which requires that when CMS increases payment rates it is mandated to impose offsetting cuts in payment rates for other services. As a result, CMS is projecting a reduction in overall reimbursements for pathologists of eight percent and four percent for clinical laboratories. ASCP recommended several changes to the proposal, including urging CMS to use its public health emergency powers to waive the budget neutrality requirement. ASCP also recommended that CMS rescind an add-on code, HCPCS code GPC1X, because these services are already factored into the revised E/M codes, and it adds significantly to the cost of the proposal.

Another issue ASCP addressed concerned a scope of practice proposal that would allow certain nonphysician providers to supervise diagnostic tests, of which diagnostic laboratory tests are a subgroup. ASCP urged the withdrawal of the proposal, raising concerns that the proposal could result in physician assistants and certain nurse practitioners supervising laboratory supervising testing in violation of the requirements of the Clinical Laboratory Improvement Amendments of 1988. ASCP also urged CMS to work with BLS to expand its wage data estimate to include a broader range of laboratory personnel. BLS currently only has a combined medical laboratory scientist/technician wage. CMS relies on the BLS for wage data, which it factors into pricing the Medicare PFS. ASCP also supported CMS’s plans to increase payment for the molecular diagnostics interpretation code (G0452), as well as a plan to postpone pricing cuts and reporting requirements for the Clinical Laboratory Fee Schedule.

In response to CMS’s QPP proposals, ASCP raised concerns about the overall applicability and potential for meaningful participation for pathologists in the QPP. As a result, ASCP urged CMS to re-examine the QPP’s relevance to specialists and non-patient facing clinicians when making policy changes. ASCP also outlined concerns that the requirements of the program are overly burdensome and difficult for pathologists, especially for those in small and/or rural practices.

ASCP observed that certain changes proposed by the Agency could make it impossible for pathologists and other non-patient facing clinicians to participate in the MIPS Value Pathways (MVPs) in 2022. Consequently, ASCP asked CMS to work with stakeholders to develop a framework that is inclusive of all clinicians. Lastly, ASCP outlined continued concerns that CMS policies for the Qualified Clinical Data Registry (QCDR) program unnecessarily restrict innovation and create difficulties for QCDR vendors to introduce new measures into the program.

ASCP responded with strong opposition to a proposal to remove cervical cytology/HPV co-testing from a QPP cervical cancer screening quality measure .  CMS maintained that the change was to conform the measure with applicable guidelines.  ASCP and the American Society of Cytopathology responded in a joint letter that we are unaware of any guidelines that do not recognize co-testing as appropriate for cervical cancer screening.

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