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ASCP continues to beat the drum to urge the Centers for Medicare and Medicaid Services (CMS) to reduce burdensome requirements in reporting quality measures to allow more pathologists to participate in payment and delivery reform through Medicare.

The Society has also applauded the Agency’s efforts to expand quality reporting programs, and encouraged CMS to further expand the merit-based incentive payment system (MIPS) to account for the work of non-patient facing clinicians, like pathologists, whose work significantly impacts patient care.

“The practice of pathology is inherently collaborative and impacts the entire spectrum of patient care,” ASCP Immediate Past President Kimberly Sanford, MD, MASCP, MT(ASCP), wrote in a September 13 letter to CMS Administrator Chiquita Brooks-LaSure. “Pathologists routinely work closely not only with other healthcare practitioners and facility staff, but also at the institutional or health care system levels, caring for both individual patients and populations. Pathologists are uniquely positioned at the forefront of patient care and are experts in quality improvement, care coordination, and collaboration. However, pathologists have faced difficulty in participating in CMS’ quality improvement incentive programs in the past.”

Overall, CMS is making incremental progress. One step the Agency has taken is to use the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) to streamline quality improvement and value-based care implementation through the Quality Payment Program, or QPP. In her letter, Dr. Sanford praised CMS’ acknowledgement of the “unique variation in clinician practices, and (its) extensive work to further refine program requirements, respond to stakeholder feedback, reduce reporting burden, encourage meaningful participation, and improve patient outcomes.”

ASCP’s recommendations and concerns with the CMS 2022 proposed rule include:

• Urging CMS to consider the needs of specialists and non-patient facing clinicians when making policy changes. Many current measures cannot be attributed to pathologists; hence, they do not receive the credit that patient-facing physicians do. Additionally, meeting the requirements of the program is overly burdensome and difficult for pathologists, especially for those in small and/or rural practices.
• Encouraging the Agency to work with stakeholders to develop a framework for the MIPS Value Pathways (MVPs) that is inclusive of all clinicians. Currently, the MVPs are based on a category (promoting interoperability, which is a foundation of the MVP) that pathologists are not able to participate in. ASCP recommends CMS give pathologists credit to use laboratory information systems.
• Urging the Agency to remain vigilant about overall applicability to pathology and laboratory medicine in the transition from traditional MIPS to MVPs. The MVPs are designed to move away from siloed activities and connect activities across quality, cost, promoting interoperability (PI), and the improvement activities MIPS categories. ASCP supports CMS’ vision for the MVPs and believes that streamlining program requirements and connecting activities across disparate categories will benefit participants and reduce burden.

CMS’ 2018 awarding of the three-year MACRA cooperative agreement to ASCP is an indication that the Agency is trying to be more inclusive. The cooperative agreement allowed ASCP to work toward the development of pathology-specific QPP measures around diagnostic accuracy, assessing team-based care, and overuse.

While CMS incentivizes pathologists to use Qualified Clinical Data Registries (QCDRs) in order to meet QPP requirements, ASCP believes CMS’ additional requirements to measure testing and validation are too restrictive and negate the flexibilities that are already built into the QCDR program. In her letter to CMS, Dr. Sanford urged the Agency to make non-patient facing clinicians a priority when making policy decisions around program requirements and participation criteria.

The Society has expressed concern that pathologists will continue to experience difficulty in meeting QPP requirements. MIPS, which is part of the QPP, only consists of six quality measures in the Pathology Specialty Measure Set. Those measures are identified by CMS as being topped out, and do not drive quality improvement or impact patient care in the way that a more robust measure set could. In 2021 and thereafter, pathologists have to participate in the quality category to meet MIPS reporting requirements, whereas previously, they could just submit improvement activities. The implication is that if pathologists perform well, they can receive up to a nine-percent bonus. Otherwise, they may receive a reduction.

Another challenge pathologists face is that they use laboratory information systems (LIS) in their practices, which means they cannot attain Certified Health Record Technology (CEHRT) status. Hence, pathologists are unable to meet the requirements for health information technology in both MIPS and Alternative Payment Models. Additionally, pathologists are not eligible for bonuses offered to other clinicians in the promoting interoperability category simply because they utilize LIS (which pre-date many EHRs) instead of the narrowly-defined CEHRT. ASCP has urged CMS to consider other technologies such as LIS and reward pathologists for the critical work they perform using this technology.

As CMS continues to address these matters, ASCP will be following the legislation and regulations related to the QPP and reporting back to ASCP members with any updates via email, its ePolicy newsletter and social media. ASCP members can also reach out to Liz Waibel, ASCP Director of Quality Initiatives and Health Policy, at elizabeth.waibel@ascp.org or Raven Garris, ASCP Senior Manager of Health Policy and Quality Initiatives, at raven.garris@ascp.org if they have questions.