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September 17, 2018
ASCP is pleased to announced that a revised cervical cancer recommendation from the U.S. Preventive Services Task Force (USPSTF) largely follows ASCP’s recommendations. ASCP, working in concert with the Cytopathology Education and Technology Consortium, urged the USPSTF NOT to abandon cervical co-testing for women age 30-65. In a final recommendation released on Aug. 21, the USPSTF indicated it recommends “screening for cervical cancer every three years with cervical cytology alone in women aged 21 to 29. For women aged 30 to 65, the USPSTF recommends screening every three years with cervical cytology alone, every five years with high-risk human papillomavirus (hrHPV) testing alone, or every five years with hrHPV testing in combination with cytology (co-testing).”
In our comments on a 2017 draft recommendation from USPSTF, the CETC noted that the USPSTF did not include an option for cytology and human papillomavirus (HPV) co-testing for women 30-65 years, which differs from ASCP’s guidelines developed jointly with the American Cancer Society and the American Society for Colposcopy and Cervical Pathology as well as another guideline from the American Congress of Obstetricians and Gynecologists. In response, the CETC urged that “cytology and high-risk HPV co-testing be retained as a screening strategy for women aged 30-65 years.” The CETC argued that HPV testing only “may potentially impact safety and efficacy for cervical cancer prevention in the United States.” Click here for the CETC statement on the draft USPSTF recommendation.
On Sept. 10, ASCP submitted formal comments to the Center for Medicare & Medicaid Services (CMS) about its Medicare Physician Fee Schedule (PFS) Notice of Proposed Rulemaking (NPRM). In these comments, ASCP urged CMS to fix its new payment scheme for tests reimbursed by the Clinical Laboratory Fee Schedule (CLFS) tests. CMS’s current pricing system for clinical laboratory tests is highly flawed because it refused ASCP’s call to include pricing information from hospital outreach laboratories in the calculation of new payment rates.
As insurance payments for laboratory testing at hospital outreach labs tend to be more robust than such payment to independent laboratories, the absence of hospital pricing data has suppressed CLFS payment rates and increased the negative financial impact on laboratories. Because some private payers have followed CMS’s lead to cut their reimbursement rates, the financial impact is not limited to Medicare payments. ASCP argued in its comments that Congress had specifically instructed CMS to include hospital data in its pricing, urging CMS to “ensure that Medicare rates reflect true market rates for laboratory services and, as such, that all sectors of the laboratory market should be represented. ASCP wrote that “hospital labs account for 48.2 percent of the total 9.2 billion lab tests performed annually in the United States,” yet they account for only one percent of the applicable data on which CMS has based its revised payment rates. In contrast, independent laboratories account for 29.5 percent of the U.S. market for laboratory services, yet they account for 90 percent of the applicable data used to calculate new weighted median prices.” ASCP outlined several policies the Agency could adopt to address its flawed test pricing.
In addition to commenting on the CLFS, ASCP urged CMS to adopt several recommendations from the American Medical Association’s Specialty Society RVS Update Committee (RUC) concerning the pricing of pathology services reimbursed under the PFS. ASCP also urged CMS to proceed with caution on the adoption new pathology supply and equipment prices to ensure that payment rates cover the true costs of these items. ASCP’s advocacy efforts also included joining with the AMA and other medical societies in raising concerns about a proposal to consolidate Evaluation and Management (E/M) codes. For more information on E/M codes, click here.
ASCP also submitted formal comments on CMS’s CY 2019 Quality Payment Program (QPP) Proposed Rule on Sept. 10. The comments, part of ASCP’s comments on the Medicare Physician Fee Schedule, addressed the Agency’s policy proposals for the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). In our letter, ASCP provided perspectives and recommendations on issues impacting pathologists and their patients.
In our comments, ASCP urged the following:
To provide an example, in our comment letter we provided support for eight new episode-based cost measures included in the proposed rule. One of the new cost measures is related to colonoscopy screening, but it is unclear if this measure is attributable to pathologists through required ancillary testing. In our letter, we ask CMS for clarification on this matter and reiterate our desire for pathologists to have an opportunity to receive credit for their involvement in patient care.
CMS is expected to release the QPP Final Rule later this year. We will keep our members informed on policy changes that impact pathologists and laboratory medicine.
ASCP recently urged changes to the Stark Law prohibiting self-referral of anatomic pathology and other services by ordering providers. On July 17, ASCP, along with other members of the Alliance for Integrity in Medicare (AIM), submitted a statement for a House of Representatives Ways and Means Committee hearing, noting that the financial incentive for clinicians to take advantage of the in-office ancillary services (IOAS) exception continues to exist. Our comments contend that the best way to eliminate the financial incentive to self refer in fee-for-service settings would be to remove anatomic pathology, advanced diagnostic imaging, physical therapy, and radiation therapy services from the list of designated health services protected under the IOAS exception, for which physicians can self refer and bill Medicare. To encourage and ensure the successful transition from volume to value in the Medicare program, ASCP and AIM strongly urged Congress to narrow the Stark Law by removing anatomic pathology and these other services from its IOAS exception.
On August 24, ASCP and AIM also submitted formal comments in response to a Request for Information (RFI) from CMS. The Agency’s recent RFI provided comprehensive review of policies across the Medicare program that support value-based care coordination and alternative payment models. As a mechanism to foster value and patient care and reduce self-referral, ASCP and the AIM coalition have consistently highlighted the need to narrow the IOAS exception to the Stark Law to help achieve this goal. AIM’s comments, as well as its statement on the RFI, were recently noted in a related article on a RFI on the Anti-Kickback Rule.
For more information on the problems associated with self-referral, See ASCP’s policy statement on Self-Referral, Markups, Fee Splitting, and Related Practices.
For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202-408-1110).
ASCP ePolicy News is supported by
an unrestricted grant from Hologic.
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