The 2024 Physician Fee Schedule (PFS) proposed rule, published July 13 by the Centers for Medicare and Medicaid Services (CMS), calls for decreasing the Medicare conversion factor by 3.4%, from $33.8872 to $32.7476.
As a result, CMS projects that overall reimbursement for pathologists and independent laboratory services will decrease 2 percent and 1 percent, respectfully, in comparison with calendar year 2023 payment rates. The actual impact on pathologists and independent laboratories, however, will depend on the mix of services performed.
ASCP is disappointed in the reduction in the conversion factor. However, this is an improvement from earlier predictions, when the PFS was expected to be cut by 4.5 percent. As part of last year’s omnibus spending bill, ASCP, the American Medical Association (AMA), and other stakeholders worked diligently to urge Congress to reverse projected cuts in the PFS. Congress ultimately reversed approximately half the projected cut.
ASCP encourages members to urge their representatives in Congress to add a permanent inflationary adjustment to the PFS. (See ePolicy story here) ASCP is hopeful these efforts will succeed as the Medicare Payment Advisory Commission (MedPAC), a federal advisory agency to Congress, recently
recommended that Congress provide a physician payment update that is tied to the Medicare Economic Index (MEI), a measure of medical inflation.
While part of the cuts in pathology and laboratory services are the result of statutory provisions not being extended, the cuts are also attributable to expensive new services. For example, CMS is proposing a new code, G2211, as a separate add-on code for enhanced visit complexity of primary care and longitudinal care of complex patients. As the Medicare PFS is subject to a budget neutrality requirement, CMS requires new spending and, by extension. new codes, to be paid for with offsetting cuts to other services.
G2211 was previously proposed as part of a series of evaluation management (E/M) codes CMS was creating to support primary care. The proposals, however, would have had profound impacts on payment rates for other services, including pathology services. As a result, ASCP opposed the proposed E/M codes, requiring CMS to scale back the proposal, phase it in over 3 years, and postpone the implementation of some of the codes.
In addition, the rule includes a request for information (RFI) related to how the Clinical Laboratory Improvement Amendments (CLIA) regulations should handle certain issues pertaining to histopathology, cytology, and clinical cytogenetics. Under the RFI, CMS is seeking stakeholder input on how it should “address new innovative technology and current practices in the laboratory related to anatomic pathology and Clinical cytogenetics.” CMS is seeking input whether and how CLIA personnel qualifications should apply to histotechnology professionals.
ASCP has repeatedly called on CMS to set personnel standards for individuals providing the complex histotechnology services required for the review of anatomic specimens by pathologists. ASCP will be urging support for such a requirement when the Society submits formal comments on the proposed rule in September.
CMS is also seeking information on how the CLIA regulations should be revised to allow pathologists to examine histopathology and cytology slides/images at a remote testing location as well as how such a policy might apply to clinical cytogenetics. ASCP, which was instrumental in securing from CMS the ability for pathologists and laboratory professionals to review digital images remotely during the public health emergency, has and will continue to urge CMS to maintain this policy. For more on this issue, click
here.
In addition to commenting on the individual proposals affecting pathology and laboratory medicine, ASCP is working with the AMA to urge Congress to protect the PFS against medical inflation.
As a result, ASCP urges all members and their colleagues to use this
link to send Congress a message.
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