CAP Lobbies for 6.6% Medicare Rate Hike

CAP Lobbies for 6.6% Medicare Rate Hike

CAP Lobbies for 6.6% Medicare Rate Hike

 The College of American Pathologists (CAP), as well as the American 
Medical Association (AMA), are lobbying Congress to pass a bill that 
would hike Medicare payments to pathologists and other physicians by 
6.6%. The potential rate hike would become effective April 1, and would 
more than offset the 2.8% rate cut that took effect January 1, 2025.

CAP Lo Co o 6.6% M R Hk (cont’d from page 1) The bipartisan bill is called the Medicare Patient Access and Practice Stabilization Act of 2025 (H.R. 879). This bill would raise the conversion factor (CF) used to set Medicare rates for all physicians by 6.6% to $34.49 effective April 1. It would reverse the 2.8% payment cut that took effect on January 1, while also granting a payment adjustment for inflation plus a bump to reflect the lower CF in effect during the first quarter of 2025.

With the federal government facing a March 14 funding deadline, the best opportunity for passage is for this bill to be packaged with a larger spending bill to keep the government open, CAP President Donald Karcher, MD, tells Laboratory Economics. He says that the House could certainly pass it as a standalone bill because representatives have overwhelmingly supported similar Medicare payment increases for physicians in the past. But getting it through the Senate by itself would be challenging.

In addition to CAP and AMA, dozens of other physician groups support the bill, including the Medical Group Management Association (MGMA), the California Medical Association and the American Society for Clinical Pathology (ASCP).

The bill was introduced by Rep. Greg Murphy (R-NC) on January 31 and currently has 49 cosponsors (25 Republicans/24 Democrats).

If passed into law, Medicare Physician Fee Schedule reimbursement for CPT 88305 (Level IV, tissue exam) would rise by 6.6% to a global rate of $74.14 from its current rate of $69.54. The Medicare rate hike would impact other pathology services as well as influence the rates paid by Medicaid and private health insurance plans.

Physician groups argue that a rate hike is needed to offset inflationary pressures. CMS has estimated that the Medicare Economic Index (MEI), a cumulative measure of the individual costs of running a practice, will increase by 3.5% this year after a 4.6% increase in 2024.

Why Does Big Pharma Support LDT Regulation?

Why Does Big Pharma Support LDT Regulation?

Why Does Big Pharma Support LDT Regulation?

Friends of Cancer Research (FOCR-Washington, DC) has been a steadfast advocate for FDA regulation of LDTs (both the VALID Act and the FDA’s final rule). FOCR contends that FDA regulation will reduce variability in diagnostic tests used to identify cancer patients who are most likely to benefit from cancer therapy.

The nonprofit FOCR has a mission “to accelerate policy change, support groundbreaking science, and deliver new therapies to patients quickly and safely.” A Laboratory Economics’ analysis of FOCR’s Form 990 tax statements shows that it gets most of its funding from major pharmaceutical companies.

Twelve pharmaceutical companies and their trade organization, the Pharmaceutical Research & Manufacturing Assn. (PhRMA), contributed a total of $2.9 million to FOCR in 2021, according to FOCR’s latest publicly available Form 990 tax statement. This accounted for 58% of the total contributions and grants received by FOCR in 2021.

Over the three-year period (2019-2021), the biggest contributors to FOCR have included BristolMyers ($1.2 million), Merck ($986,500) and Astra Zeneca ($850,075). PhRMA also contributed $430,000.

The pharmaceutical companies supporting FOCR are developing expensive oncology drugs targeted at cancer patients with specific genetic mutations. For example, in November 2023, the FDA approved Bristol-Myers’ Augtyro to treat adult patients with locally advanced or metastatic ROS1-positive non-small cell lung cancer. The wholesale price for Augtyro is $29,000 per month/$348,000 per year. There is no FDA-cleared test to detect ROS1 rearrangements for selecting patients for treatment with Augtyro. LDT test panels for ROS1 include LungOI (PLA 0414U; Medicare rate: $706) performed by the Imagene Lab (Phoenix, AZ).

Laboratory Economics thinks that big pharma may be concerned that some LDTs have erroneously high cut-off values—the benchmarks that determine a positive or negative test result—that can limit patient access to cancer drugs.

FOCR President Jeff Allen, PhD, gave testimony on LDTs before the U.S. House of Representatives’ Committee on Energy and Commerce, Subcommittee on Health on March 21, 2024. Allen said that FDA regulation of LDTs was necessary to “Establish uniform performance standards, regulatory processes, and transparency for all diagnostic tests to ensure accuracy of results.”