For example, the CAP and its leaders provided input on national testing strategies and contributed to public health guidance, mitigation, and support for the COVID-19 vaccine. The CAP further provided leadership on issues to improve patient health outcomes and reinforce public health guidance from the Centers for Disease Control and Prevention and other agencies.

Throughout the year, the CAP addressed ongoing pandemic-related responses and began looking ahead in terms of lessons learned and future pandemic preparedness. For instance, the CAP’s advocacy on supply shortage issues helped identify the need for dedicated programs to address supply chain problems affecting laboratories in communities across the country.

The primary thrust of these initiatives is to enable a better understanding of the social determinants that drive health care disparities, which hinges on gathering better health care data on underserved populations. For example, the CAP sent letters of support to Congress on the Improving Social Determinants of Health Act and the Social Determinants Accelerator Act and advocated for both bills to pass.

To assist Americans without health insurance, the CAP aligned with the American Medical Association in supporting the expansion of Medicaid through simplifying and expanding enrollment to reduce the number of uninsured. The CAP also supported Medicaid reforms that would ensure adequate physician payment rates to facilitate robust patient access to care.

The FDA Network of Experts is a vetted network of partner organizations and their member scientists, clinicians, and engineers. They provide the FDA with rapid access to expertise when it is needed to supplement existing knowledge within the administration’s Center for Devices and Radiological Health and the Center for Drug Evaluation and Research. The goal of the program is to allow FDA staff to tap into a virtual network of scientific experts after defining a scientific question that must be addressed quickly.

Overall, the movement toward digitization of the health care system—combined with a consumerism movement toward patients’ right to control their health—has sought to empower patients with access to, and control of, their own health information. The CAP engaged with a variety of federal health agencies on HIT-related regulations and interoperability issues. Advancing interoperability will continue to affect laboratories and pathologists, as well as future artificial/augmented intelligence initiatives.

After successfully mitigating Medicare cuts to pathologists in 2021, the CAP fought throughout the calendar year to further protect its members from cuts threatening pathologists’ pay in 2022. Hundreds of pathologists spoke with the offices of their members of Congress throughout the year to persuade lawmakers to mitigate cuts that totaled about 10%. Congress responded to the CAP’s advocacy by passing the Protecting Medicare and American Farmers from Sequester Cuts Act.

The inaugural Pathologists Leadership Summit in the spring culminated with the CAP’s annual Hill Day, which set a new record for pathologists participating in meetings with their representatives and senators. In 270 virtual meetings with congressional offices, pathologists urged their lawmakers to mitigate the future Medicare payment cuts. Pathologists confidently made their cases while speaking with legislative staff members and received support for our cause. Hill Day ended the four-day virtual Pathologists Leadership Summit, where hundreds of pathologists attended the House of Delegates, educational courses, and advocacy sessions. The CAP’s relentless advocacy continued throughout the year. In October, for example, more than 65 pathologists participated in a “virtual fly-in” and met with federal policymakers to lobby Congress to mitigate the cuts.

For example, the CAP engaged with UnitedHealthcare to cease implementation of a “Designated Diagnostic Provider” program because of its increased burden and the confusion it would create for pathologists and patients. Under the program, outpatient diagnostic laboratory services would only be covered for fully insured commercial plan members when delivered by laboratories with the new insurer-created designation.

The CAP also countered Cigna on its plans to deny the professional component of clinical pathology services. Discontinuation of reimbursement for these services would prove detrimental to patients and to the integrated delivery of care, to which laboratory diagnostic services are central. The insurer responded by acknowledging the value of these services.

Today, more than 1,000 pathologists use the Pathologists Quality Registry for their quality reporting in the Medicare program. All participants have met or exceeded Medicare Merit-based Incentive Payment System (MIPS) thresholds to avoid penalties since 2017.

In 2021, the Pathologists Quality Registry obtained benchmark status for qualified clinical data measures for pathology. It is the first pathologists’ registry to do so. Pathology quality measures with benchmark status allow pathologists to earn more points toward the MIPS final score.

The CAP advocated for the inclusion of new and improved codes and values for pathology clinical consultation services on the Medicare fee schedule. The CAP worked with the American Medical Association’s (AMA) CPT Editorial Panel to create the new pathology clinical consultation codes and develop new payment rates through participation in the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The CAP leads all reviews of pathology services that go before the RUC.

As a 501(c)(6) nonprofit, the CAP is the only association with a federal political action committee strictly representing the interests of pathologists. In this capacity, the CAP advances the legislative agenda set by the Council on Government and Professional Affairs.

During 2021, PathPAC created additional opportunities for pathologists to engage with their representatives and senators on the political issues concerning the specialty. PathPAC raised $205,087 and disbursed $209,000 to 81 congressional candidates. The political action committee also gained 102 first-time contributors—a 351% increase from the number of first-time supporters in 2020. In addition to donating to PathPAC, CAP members also attended several virtual events with members of Congress and their legislative staffs.

This strategic state pathology society initiative provides additional support to help societies grow and thrive. In 2021, societies from around the country used the CAP’s virtual platform to host meetings in lieu of in-person events. The CAP also developed several tools and resources to assist societies in recruiting and retaining members, raising funds for lobbying, and preparing society members to engage on state-level advocacy activities.

The ongoing COVID pandemic challenged state pathology society partners’ ability to offer accredited education. In 2021, the joint providership program served 17 organizations with 46 accredited CME activities, impacting more than 1,931 physicians and 454 nonphysicians. The CAP provided expert assistance and collaborated with partners in converting their live programs to virtual CME meetings, allowing them to offer much needed education to their member pathologists.

The CAP collaborated with several societies to protect the pathologist’s scope of practice and patient access to pathology services. Key highlights include the following:

• In Mississippi, the governor enacted two amended bills by the Mississippi Association of Pathologists and the CAP on the use of autopsy images for teaching, training, and pathologist supervision over medical examiner investigators. In Missouri and Texas, the CAP opposed legislation burdening pathologists providing autopsy services.
• In Florida, the state enacted several amendments backed by the Florida Society of Pathologists and the CAP that protect pathologists from adverse genetic privacy legislation, establishing property rights for DNA samples. The state of Arizona also enacted amendments supported by the Arizona Society of Pathology and the CAP protecting pathology practices from genetic testing privacy burdens and property rights restrictions.
• The Tennessee Society of Pathologists and the CAP successfully backed several amendments repealing laboratory licensure in that state. These amendments exempted hospital-based laboratories from licensure, administrative burdens, and costs and retained rebate, fee-splitting, and anti-markup provisions for pathology and laboratory services. In Georgia, the Georgia Association of Pathology supported a laboratory licensure repeal law, which was enacted.
• The North Carolina Society of Pathologists and the CAP successfully opposed adverse out-of-network legislation displacing the federal No Surprises Act and establishing low out-of-network payment rates for pathologists. The North Carolina Society of Pathologists also successfully amended pharmacist scope-of-practice legislation, while in Rhode Island, the Rhode Island Society of Pathologists and the CAP successfully amended genetic counselor scope-of-practice legislation.
• The New Hampshire Society of Pathologists and the CAP successfully amended direct access testing legislation, which passed the state House, mandating direct access testing be subject to proficiency testing.

While this represented an improvement since last year, shortages still placed a substantial burden on those laboratories diagnosing COVID-19 and require national attention to mitigate disruptions. The CAP communicated these findings to Congress and federal agencies when advocating to solve shortages.

The CAP also fielded the Practice Leader Survey, a primary source of basic data on pathology practices. The survey, last fielded in 2018, targeted those in leadership or administrative roles with specific knowledge of the practice’s financial, operational, and billing information. Key statistics include the following:

• Nearly 75% of respondents reported that members in their practice perform or oversee onsite COVID-19 testing in their primary/laboratory setting. On average, nearly half of this testing is performed for screening, 45% is for diagnosis, and 6% is for surveillance.
• One-fifth of respondents whose practices provide COVID-19 testing perform sequence or genotypic analysis for identification of COVID-19 variants.
• Nearly 30% received CAP-advocated federal funding for screening and/or surveillance COVID-19 testing. Another 4% have applied for the funding but have not yet received it, while 30% were unsure of whether they had received or applied for such funding.