Advocacy

Direct Billing

For the 2013 legislative year, the MSP has again decided not to actively campaign for Direct Billing or Anti-Markup legislation given the stiff opposition to it in the first four years we backed bills.  Forty-one states have had success passing Direct Billing, Anti-Markup or Disclosure legislation, so at some time in the future we may reconsider the issue.

To garner support for our causes, the 2 Resolutions below will be introduced at the Missouri State Medical Association’s House of Delegates’ Meeting in Kansas City on 4/5/13 with a final action expected on 4/7/1:

RESOLVED the MSMA will direct the Council on Ethical and Judicial Affairs to definitively rule, within the calendar year 2013, whether MSMA physicians who mark up and client bill for pathology services are behaving unethically.

RESOLVED the MSMA will support, with full force and vigor, any and all efforts to pass direct billing legislation for pathology services in the state of Missouri.

Federal Regulations

As you know by now the big news from CMS was two-fold as written in the 11/1/12 Special Issue of CAP’s STATLINE: "Most notably, the agency lowered the technical component (TC) of the surgical pathology code 88305 by 52%, although it raised the professional component (PC) by 2%, beginning Jan. 1. This change alters the global payment for this code, which will decrease by 33% as a result of this revaluation. The agency also announced that the newly developed molecular pathology CPT codes would be placed on the Medicare Clinical Laboratory Fee Schedule (CLFS). A new CMS HCPCS II G-code was created for situations requiring physician interpretation and reporting of these tests for Medicare beneficiaries."

Also essential to physicians was that the expected 26.5% cut in Medicare reimbursement was held off by another one year fix to the SGR at the same time that the fiscal cliff was obviated by stop-gap measures.  This is also further detailed in the 1/2/13 Special Issue of CAP’s STATLINE:  "Medicare physician payments will not be cut ….. now that the House of Representatives passed the American Taxpayer Relief Act (H.R. 8) by a vote of 257-167 last night following contentious debate. The Senate approved this fiscal cliff deal, which delays the Medicare physician fee cuts under the sustainable growth rate (SGR) for a year, by a vote of 89-8 early yesterday morning.  Under this package to avert tax increases and deep spending cuts in health care as well as defense spending, the sequestration cuts will be deferred for two months. Physicians are facing a 2% cut in Medicare cuts under the budget sequestration process."

Electronic Health Records (EHR)

Please refer to the story on this issue originally reported in CAP’s 7/7/2011 STATLINE and then again in the MSP’s 11/23/2011 Newsletter. “Missouri laboratories donating 85% of the cost of EHR software to a referring physician could be violating the state’s anti-kickback laws if the referrals from the physician to the laboratory are either established or increased and the intent is to induce referrals paid for by the state’s medical assistance program, MO HealthNet, according to a recent letter clarifying certain EHR donations from the Assistant Attorney General (AG) Linda Lemke……..”

The MSP believes at least one national laboratory that has decided not to “donate” their EHR package to Missouri clients that it offers to clients in other states and we think it is because of the AG opinion sought by a combined MSP/CAP effort.  There are also implications for local and regional laboratories in Missouri that offer EHR packages to their clients. Please review the AG’s opinion when considering “donation” of EHR to clients.

Clinical Laboratory Personnel Licensure Bill

The MSP reached a compromise with proponents that closely adhered to the CAP Model Criteria for State Licensure of Clinical Laboratory Personnel published in December, 2008.   The Bill’s advocates have not been able to get much traction so far on the issue in the legislature, but it was reintroduced as SB544 in 2012 and had a hearing on 2/6/12 before the Senate’s Financial and Governmental Organizations and Elections Committee.  The Bill died without further action in the 2012 session.

Advocacy Fund

The MSP asks for contributions to sustain important efforts. 

All contributions are relevant and greatly appreciated.  The Board realizes that every pathologist and group practice is different.  Adjust your donation using these suggested giving levels:

Resident:                                             $25

Academic Pathologist:                            $100

Solo Private Practice:                             $200

Group Practice:          $ 200/member                                                                    

The donations are not a quid pro quo, but do help build access to legislators when our lobbyists, you or MSP leadership approach them to discuss issues.

Please send checks payable to the “MSP Advocacy Fund” to: Missouri Society of Pathologists, Attn:  Jeffrey L. Craver, M.D., 200 Portland St., Columbia, MO  65201