advocacy 101: what residents need to know - webinar slide · 7/27/2016 · tier 2: grassroots...

Advocacy 101

What Residents Need to Know

Emily E. Volk, MD, MBA, FCAPJoe Sanfrancesco, MDJuly 27, 2016

Overview

• Council on Government and Professional Affairs

• Now and Future Policy Agenda

• Deciphering the Health Policy Language

• Medicare Payment Basics

• Medicare Access and CHIP Reauthorization Act (MACRA)

• Getting Involved in Advocacy: PathNET, PathPAC, and beyond

© 2016 College of American Pathologists. All rights reserved. 2

Welcome

Emily E. Volk, MD, MBA, FCAP

• Chair, Council on Government and Professional Affairs (CGPA)

• Member, PathPAC Board


Welcome

Joe Sanfrancesco, MD

• CAP Residents Forum Executive Committee Member

• Former Resident Member of CGPA and Policy Roundtable


Council on Government and Professional Affairs

Council on Government

and Professional

Affairs

Federal and State Affairs Committee

PathPACEconomic

Affairs Committee

Policy Roundtable


CGPA Responsibilities

CGPA

U.S. Congress

White House

HHS (CMS &

FDA)

50 State Legislatures

AMA HOD/RUC

Clinical Laboratory Coalition

Patient Groups Cancer

Leadership Coalition


CGPA Now and Future Policy Agenda

Protect the value of

pathology services

Protect the value of

pathology services

Ensure pathologists can adapt to

the new value based

payment models

Ensure pathologists can adapt to

the new value based

payment models

Sustain a favorable laboratory regulatory

environment

Sustain a favorable laboratory regulatory

environment


Major Health Care Reform Bills

HITECH 2009 ACA 2010

PAMA 2014 MACRA 2015

Drivers of Health Policy Agenda


Health Policy Language Can Be Intimidating…

Resident?????PAMA

EHR MU

MIPS

TC-PC

LCDsLDTs

ACOs

APMs

Part A –Part B

CLFS

CLIA


Deciphering and Demystifying the Language

Medicare Payment

PAMA

Medicare PFS

Part A/Part B

CPT Codes /RVUs

TC/PC

CLFS

Quality Payment Adjustments

MIPS

EHR MU

PQRS

ACOs-APMs

Medicare Coverage of

Services

LCD

NCD

MAC

NCCI

Regulation of Clinical

Laboratories by CMS/FDA

CLIA

LDT


Medicare Physician Payments to Pathologists: Understanding The Basics

Part A: From

Hospital

CLFS: Clinical Lab

Part B PC + TC

© 2016 College of American Pathologists. All rights reserved.

Total Medicare Part B Payment to all Pathologists = $2.3 billion in 2016

11

Medicare Physician Payments to Pathologists: Understanding The Basics

CMS identifies pathology service as potentially misvalued

CAP recommends value of pathologists’ services to AMA RUC

Value of service comprised of professional

component (PC) and technical component

(TC)

RUC recommends value of PC and TC to

CMS

CMS annually updates value of

pathologists’ professional services

CMS annually provides global update to the Physician Fee

Schedule (previously via SGR)



Protect the value of pathology servicesProtect the value of pathology services


47% of pathology CPT codes have been targeted by CMS since 2006



Medicare payments for pathology codes by CMS increased 51% since 2006


2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016Ind Lab $673 $1,087 $878 $970 $1,039 $1,057 $1,073 $818 $714 $823 $897Path $942 $948 $1,007 $994 $1,069 $1,129 $1,210 $1,141 $1,077 $1,316 $1,421Total $1,615 $2,035 $1,885 $1,964 $2,108 $2,186 $2,283 $1,959 $1,791 $2,139 $2,318

+26% -7% +4%

+7% +4% +4%

-14%

-9%

+19% +8%

$0

$500

$1,000

$1,500

$2,000

$2,500Su

m o

f Allo

wed

Cha

rges

(Mill

ions

$)

Pathologists' Medicare Professional Payments 2006-2016

Proposed 2017 Medicare Physician Fee Schedule Released on July 7

• CMS proposed increases sought by the CAP for pathology services

– Pathology add-on services

– Microslide consultations

– Prostate G-code

– Tumor immunohistochemistry

• CMS proposed decreases to some services– Flow Cytometry professional and technical component

– Anatomic pathology technical component© 2016 College of American Pathologists. All rights reserved. 17

Proposed Professional Component Payment for Pathology Add-on Services

• Due to the CAP’s advocacy, the CMS again increased the value of add-on services for immunohistochemistry, immunofluorescence studies, and in situ hybridization

– This proposed policy change represents a $2.93 million increased payment to pathologists based on Medicare volume

– $2.75 million of this impact is attributed to CPT code 88341



Ensure pathologists can adapt to the new value based payment models

Ensure pathologists can adapt to the new value based payment models


Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

• Ended the broken Sustainable Growth Rate (SGR) formula

• Established a new framework for rewarding health care providers for giving better care not more just more care

• Combined existing Medicare quality reporting programs (PQRS, VBM, and EHR MU) into one new system (Merit-based Incentive Payment System, or MIPS)

• MIPS effective in 2019, existing programs remain in place until then


Pathways Under MACRA

Two pathways/tracks are offered under MACRA:


MACRA

MIPS

Quality (previously

PQRS)

Resource Use

(previously VBM)

Advancing Care

Information (previously EHR MU)

Clinical Practice

Improvement Activities (new

category)

APMs

Advanced Alternative Payment

Model

Physician Focused Payment

Model

21

Performance Categories


In 2015, pathologists avoided $13.5 million in PQRS penalties by using CAP-developed measures for pathology

$4.40

$5.25

$3.80

$2.47

$3.65

$4.63

$0.00

$1.00

$2.00

$3.00

$4.00

$5.00

$6.00

CY2009 CY2010 CY2011 CY2012 CY2013 CY2014

CM

S Pa

ymen

ts ($

Mill

ions

)EAC Measure Creation Successes: PQRS Bonuses Paid to Pathologists


Securing Relief from EHR/MU Penalties

• Grassroots and lobbying efforts from CAP to secure relief for pathologists

• In 2014, more than 100 members of Congress urged CMS to provide pathologists permanent relief from any EHR/MU penalties

• In 2015 and 2016, CMS provided relief from penalties


Pathologists: Foundation of CAP Advocacy

Member of Congress

PathNET(2,200

members)

Lobbyists (3 CAP staff)

PathPAC(850

contributors)


Why Get Involved?

• Regardless of what setting you practice in, advocacy matters

• Legislation and regulations impact much more than just payment

• If we don’t speak for our profession, no one else will


What is PathNET?

• Grassroots advocacy network of CAP members who:

– Advocate for patients and our profession

– Tell our story

– Build relationships with legislators

• Access to tools and resources to help you become an effective advocate


PathNET Opportunities for Engagement


• Action Alerts• Social Media• Letters to the Editor

Tier 1: Grassroots Advocate Level

• Lab Tour• In-District Meetings• Town Hall Meetings

Tier 2: Grassroots Activist Level

• Fly-In• Policy Meeting• Attend Fundraiser

Tier 3: Grassroots Ambassador Level

• PathNET Recruitment• Join State Pathology Society

• State Path Society Leadership

• Health Care Advisory Committee

PathNET’s Impact: Case Example

• In 2013, CMS proposed to drastically reduce 39 pathology services for 2014 Physician Fee Schedule

• PathNET went to work, generating:– Over 4,900 emails to Capitol Hill

– 10,200 comments to CMS

– Over 40 face-to-face meetings in DC with members of Congress and over 40 face-to-face meetings in-district meetings with members of Congress

• Result: 113 members of the House and 40 members of the Senate sent letters to CMS opposing the proposed cuts

• Outcome: CMS withdrew its proposal© 2016 College of American Pathologists. All rights reserved. 29

What is PathPAC?

• Political action committee solely dedicated to representing pathologists at the federal level

• Allows pathologists the opportunity to amplify their voice in Washington by engaging in the political process

• Positions us to protect the relationships we buildwith elected officials


PathPAC Contribution Guidelines

• Hard money (individual, non-corporate funds)

– Direct candidate support

– $5,000 maximum per calendar year

• Soft money (corporate funds)

– Political Education Fund (PEF)

– Unlimited amount per calendar year

– Activities in support of the Policy Meeting, Fly-Ins, grassroots training, etc.

• All PathPAC and PEF contributions are done on a voluntary basis by CAP members


Common Misconceptions

• “Why can’t the CAP just pay for this?” / “I pay dues and attend the annual meeting, why not use that money?”

• “I’m a Democrat/Republican and I love/loathe Congressman X.”

• “I don’t have a lot of money.”


How Do I Give to PathPAC?


Contribute online via the e-store

Check payable to PathPAC or

Political Education Fund (PEF)

Fill out a contribution

form

33

Policy Meeting and Annual Hill Day

• Engage with health care policymakers and CAP leaders and policy experts

• Learn about the regulatory and legislative challenges facing the specialty

• Advocate for your profession by meeting with members of Congress on Capitol Hill


Policy Meeting and Annual Hill Day

• Since 2012, 705 Hill visits to members of Congress

• Issues lobbied: SGR, Self-Referral, EHR-MU, Graduate Medical Education, LCD Reform

• Results:

– SGR repealed

– MACRA contains language regarding flexibility for non-patient-facing physicians

– EHR-MU penalties not applied to pathologists

– LCD legislation introduced in House

• Message: Grassroots political activism works! © 2016 College of American Pathologists. All rights reserved. 35

State Pathology Societies

• Valuable strategic alliances for advocacy efforts –independent from CAP but often work closely together

• Issues often start in the states – ability to influence legislation at the state level is vital to success at the national level

• State legislators are the next Congressmen and Senators – begin to build relationships early in their careers


AMA Membership

• AMA delegates are apportioned based on primary specialty designation

• Robust delegate representation ensures the CAP’s leadership role in the Pathology Section Council


The Future Belongs to You!Begin to Invest in Your Profession Today

• Become a PathNET Grassroots Advocate

• Become a PathPAC supporter

• Attend the 2017 Policy Meeting and Annual Hill Day– April 24-26, 2017, Washington, DC

• Join your State Pathology Society and the AMA

• Attend the Advocacy workgroup at the upcoming Residents Forum meeting

– September 24, 2016, Las Vegas, NV


Stay Informed Through the CAP

• Follow CAP on social media– Twitter @Pathologists

– Facebook.com/capathologists

• Visit CAP.org > advocacy

• Read STATLINE


Questions?


advocacy 101: what residents need to know - webinar slide · 7/27/2016 · tier 2: grassroots...

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