Members discussed how Congress can mitigate Medicare cuts, alleviate medical workforce shortages, and ensure funding for future pandemic preparedness. The CAP scheduled more than 300 virtual meetings with congressional offices to discuss these priority issues for patients and the pathology specialty.

The first hybrid Pathologists Leadership Summit met April 30 through May 3 both virtually and in Washington, DC, where participants attended special learning sessions, heard from keynote speakers, and prepped for meeting with their legislative representatives on Hill Day. Meeting content focused on new and emerging technologies, payment models, regulations, and issues currently impacting the specialty. The Pathologists Leadership Summit arms pathologists with the information they need to know as advocates and leaders in pathology, their community, and in their practices. Engagement and feedback from the meeting were overwhelmingly positive, with 99% of attendees saying they were satisfied or very satisfied with the experience and 96% reporting they would recommend the event to a colleague.

Throughout 2022, the CAP fought to protect the value of pathology services by urging Congress to pass legislation stopping 2023 Medicare cuts of about 4% to pathologists. In addition to Hill Day, the CAP activated its grassroots network, planned another lobbying event in November, and utilized its political action committee, PathPAC, to reinforce our message and spur lawmakers to act. As a result, Congress opted to mitigate the cut by 2.5 percentage points in 2023 and to mitigate similar cuts planned for 2024 by 1.5 percentage points. Lawmakers also decided to delay Medicare cuts to clinical laboratory fees that were set to take effect in 2023 by one year.

Pathologists also discussed the impact of COVID-19 on laboratories and pathologists and urged Congress to support the PREVENT Pandemics Act, which would strengthen the nation’s public health, medical preparedness, and response systems in the wake of the COVID-19 pandemic. The bill was enacted later in the year.

The Board of Governors adopted policies to increase access to health care coverage and recognize the role of SDOH on care disparities and inequities of care for patients. As experts of diagnostic testing and stewards of laboratory data, pathologists are uniquely positioned to both identify health disparities and develop plans to mitigate them in their communities. Collection, access, distribution, and utilization of SDOH data can help to reduce health disparities among patients and improve medical decision-making, health outcomes for patients, and public health.

As the registry continues to grow, it is also developing and maintaining quality reporting measures that create a scoring advantage for pathologists as Medicare’s Merit-based Incentive Payment System (MIPS) program gets more stringent. CAP experts also provided registry users with practice-specific guidance on MIPS reporting to ensure that the CAP’s registry is the market leader for pathology practices.

The new codes will help pathologists, pathology practices, and laboratories providing digital pathology digitization procedures report these services appropriately. The new digital pathology Category III CPT codes will be used to report additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis. The AMA CPT is also adding new guidelines in the Category III section to define digital pathology digitization procedures. To help pathologists report the codes correctly, the CAP developed educational resources for members. The new codes went into effect on January 1, 2023.

Under the memorandum, the CAP will collaborate with the CDC, government agencies, and other partners to support surge testing capacity when public health threats and emergencies arise. The CAP will serve as a communications hub between CAP member experts, CAP committees, and entities participating in the MOU. For example, the CAP can leverage its accredited laboratories to assist with external surge testing capacity. The CAP can also collect capability data from laboratories to identify those with the capacity to support a national response, including community-based testing for vulnerable patient communities.

In its grant application, the CAP proposed to improve diagnostic excellence by first understanding, and ultimately improving, the patient experience with pathology reports. In partnership with colorectal cancer advocacy groups, the CAP will engage patients to identify areas of concern and confusion in pathology reports for the diagnosis of colon cancer.

Those concerns include delays, burdens on laboratories, and costs. Dr. Volk and Dr. Myles specifically requested input from the FDA on how they plan to address delays, as new submissions can take up to a year for review; how to increase and improve communication with laboratories; the regulatory process for COVID-19 laboratory-developed tests (LDTs) when the EUA process is rescinded; and how the CAP can engage with the FDA on solutions. As a result of the meeting, the CAP and FDA presented a webinar on the topic for CAP members.

Many provisions in the Verifying Accurate Leading-edge IVCT Development (VALID) Act aligned with the CAP’s long-held position for LDT oversight: ensure quality tests for patients, allow for innovation, and minimize burden on laboratories. The CAP lobbied for key provisions in the bill to achieve these goals, such as mandates to avoid regulatory duplication between federal agencies and streamlined regulatory pathways for new tests that maintain patient access while also ensuring quality. Importantly, the CAP worked with patient groups to support the bill and kept its members informed on the bill’s progress.

PathPAC is nonpartisan and represents the interests of pathologists on Capitol Hill through political and financial means. As a 501(c)(6) nonprofit, the CAP is the only pathologists’ 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.

As part of this initiative, the CAP has developed several tools and resources to assist societies to recruit and retain members, raise funds for lobbying, host virtual meetings, and prepare society members to engage on state-level advocacy activities.

In 2022, the CAP collaborated with societies from across the country to protect pathologists’ scope of practice, patient access to pathology services, and fair pay. Key highlights include the following:

• Direct-to-Consumer Testing: New Hampshire became the first state to an enact a law requiring direct-to-consumer clinical laboratory tests be subject to mandatory proficiency testing. The law, which was supported by the New Hampshire Society of Pathologists and the CAP, established a precedent for states and aligns with long-standing CAP policy.
• Exemption from Information Blocking Rule: The Kentucky Society of Pathologists and the CAP worked to amend legislation to remove administrative burden and legal risk on pathologists in response to the 21st Century Cures Act information blocking rule prohibitions. The new law mandates certain pathology reports and test results shall be delayed for 72 hours by a person or entity administering the electronic health record before patients can access the result. In addition to removing administrative burden and liability on pathologists, the measure mitigates the risk of potential emotional distress to patients who may read a test result prior to conferral with the ordering physician.
• Network Adequacy: Amendments supported by the Washington State Society of Pathologists and the CAP were enacted to strengthen department of insurance network adequacy review of health insurance plans and protect equitable reimbursement to pathologists.
• Scope of Practice: State pathology societies and the CAP worked together to protect and defend the pathologist’s scope of practice throughout 2022. In Arizona, amendments were enacted in pathologists’ assistants’ scope of practice legislation to preserve pathologist oversight of personnel and protect against independent practice. In Rhode Island, genetic counselors’ scope authority to interpret complex genetic testing was successfully removed from their newly enacted licensure legislation.
• Demographic Reporting: The New Jersey Society of Pathologists and the CAP successfully inserted statutory fixes to ameliorate a 2021 demographic laboratory reporting law that put non-compliance risk on pathologists and clinical laboratories when patients declined to provide certain demographic information.

In order to promote local education in laboratory medicine, the CAP offers joint providership to other nonprofits for educational activities related to pathology or laboratory science. In 2022, the joint providership program served 22 organizations with 51 accredited CME activities, impacting more than 2,100 physicians and 800 nonphysicians.

Over 1,100 board-certified pathologists responded to the 2022 survey. Key statistics included the following:

• In 2022, 59% of practice leaders intended to hire at least one pathologist. On average, these practices sought to hire 3.1 pathologists per practice, up from the 2.4 pathologists per practice being sought by practice leaders in 2021. Just over one-third of these positions were new.
• Practice leaders reported difficulty hiring laboratory staff, with nearly 80% reporting that it was “difficult” over the last 12 months to hire medical technologists, medical laboratory technologists/clinical laboratory scientists, and histotechnologists/histotechnicians, and nearly 60% or more reporting that it was “difficult” to hire phlebotomists, cytotechnologists, pathologists’ assistants, biopsy technicians/grossing technicians, and accessioners.
• Overall, 20% of practice leaders—and 37% of practice leaders based in academic medical centers—reported that their practice digitizes slides for whole slide imaging (WSI). The most prevalent uses of WSI among all respondents were for education and training (22%), research (16%), and interdepartmental consultations (15%); 12% were currently using WSI for primary diagnosis.