Are patients’ best interests being represented in the radical shifting landscape of healthcare? Is your practice being fairly compensated for the work you do? Join your colleagues as we examine the issues facing pathology and learn how you can become a part of the solution.
S1620 MACRAscopic Analysis of the New Quality Payment Program: Maximize Reimbursement While Demonstrating Value
Faculty: W. Stephen Black-Schaffer, MD, FCAP and Diana M. Cardona, MD, FCAP
In this CAPcast, Dr. Diana Cardona discusses what pathologists need to know about the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA. Dr. Cardona, the Medical Director of the Surgical Pathology and Immunopathology Laboratories at Duke University Medical Center.
2.5 CME/SAM CREDITS
Will your practice be subject to a 4% penalty next year? In March 2015, Congress passed HR 2, the Medicare Access and CHIP Reauthorization Act of 2015, which not only repealed the sustainable growth rate (SGR), it also replaced the prior quality programs with a new quality payment program (QPP) that created two payment pathways: 1) the Merit-based Incentive Payment System (MIPS) and 2) the Alternative Payment Model (APM). The reporting requirements for these programs started January 2017. Physicians will start feeling the impact of their performance in 2019, with bonuses or penalties of up to 4%. In 2020, the potential swing is 5% based on 2018 performance, and these potential impacts will continue to increase to a maximum of 9% in 2022. These programs are constantly evolving. The CMS will propose changes to the 2019 program in the proposed rule that will be published in June 2018. This course will explain the program and its implementation and provide current information on the ways you and your practice can successfully participate in the current and upcoming year to avoid a penalty and potentially receive a bonus.
You will learn to:
• Describe the history and purpose of pay-for-performance programs
• Explain who is subject to QPPs, MIPS, and APM
• Identify ways to successfully participate in the MIPS program
• Measure the utility of using a Qualified Clinical Data Registry (QCDR)
• Assess the potential ramifications for not successfully participating
STA008 How Is My Payment Determined for Pathology Services?
Presenters: Jonathan L. Myles, MD, FCAP and Mark S. Synovec, MD, FCAP
CME/CE NOT APPLICABLE
In this highly interactive program, learn about the important concepts of payment of services on the Medicare Physician Fee Schedule (PFS) and current procedural terminology (CPT) coding. You will be provided with an overview of how current coding and payment policies are developed and how the Centers for Medicare & Medicaid Services (CMS) determines the payment amount for codes on both the PFS and clinical laboratory fee schedule (CLFS). Faculty also will discuss how CPT codes are modified and how modification can lead to Medicare payment changes. As a result of participating in this course, participants will understand the fundamentals of the current systems to better comprehend the changing payment environment and to predict future trends.
This course provides a review of concepts in CPT coding, Medicare PFS valuation, CLFS payment policies, and payment policy challenges that pathologists currently face.
You will learn to:
- Explain CPT, AMA/Specialty Society Relative Value Scale Update Committee (RUC), resource-based relative value scale (RBRVS), PFS, and Relative Value Units (RVUs)
- Describe how a new code is initiated, developed, valued, and put into practice
- Explain how existing codes are modified
- Distinguish between Medicare PFS valuation and Medicare CLFS valuation
- Identify the differences and similarities in coding between Medicare and private payers
STA010 The CAP’s Policy and Advocacy Agenda
Presenters: Donald Karcher, MD, FCAP, Emily Volk, MD, MBA, FCAP, W Black-Schaffer, MD, FCAP, and Assad Saad, MD, FCAP
STA011 The Role of Pathologists in Population Health: An Interactive Discussion
Presenters: David Gross CAP Staff, Myra Wilkerson, MD, FCAP (tentative), Tarush Kothari, MD, MPH, and Robert L. Hunter, MD, PhD, FCAP
Population health management is an emerging approach to health care delivery that focuses on how to improve the overall health outcomes of a defined population of individuals, based on the preservation of health, prevention of disease, and management of acute and chronic disease among members of the group. In 2017, the CAP’s Board of Governors charged the CAP’s Policy Roundtable with gaining a better understanding of population health and to help define the roles of pathologists in this area. This session reports on recent research on the opportunities and challenges for pathologist involvement in population health. The session also features four real-life examples from pathologists who have been involved in population health in very different kinds of settings. The session offers ample time for attendees to share their own experiences and concerns about how pathologists can engage in this emerging area.
What you need to know about the CAP’s Pathologists Quality Registry
Presenter: Emily Volk, MD, MBA, FCAP
The session will provide an inside peek at the Pathologists Quality Registry, explain what the Registry can do, who it is for, and its overall strategic value to pathologists and the specialty of Pathology.
Round Table Discussions—Lunch Included
Join the experts for lunch! Exchange information and share solutions in a relaxed setting with your peers. You will learn to improve your ability to identify solutions to common problems through interactive sessions with colleagues. An additional fee applies.
R1691 Current Payment Policy Challenges in Pathology Practice
Faculty: Jonathan L. Myles, MD, FCAP
1.0 CME/CE CREDIT
Learning Pavilion Presentations
Understanding and Maximizing Your MIPS Score
While 2017, the first year of the Merit-based Incentive Payment System (MIPS), was deemed a “transition year” with fairly flexible compliance requirements, going forward the CMS is requiring full compliance with all relevant MIPS program requirements in order to avoid future payment penalties. The CMS will continue to increasingly adjust Medicare payments by as much as +/- 9% based on clinician performance in MIPS through 2022.
A MIPS Composite Score determines payment adjustments for pathologists participating in MIPS. With the transition year ending and the threat of increasing payment adjustments on the horizon, it is imperative that pathologists fully understand compliance requirements as well as scoring under the MIPS program, and the reporting options available to optimize their performance in MIPS for 2018 and beyond.
Participants attending this session will learn more about CAP strategies for reducing the burden of complying and how to optimize scores in MIPS, including education on the various factors that contribute to their MIPS score, and how MIPS Composite Scores are calculated.
PathPAC Networking Reception
Join your fellow colleagues and mingle with CAP leadership for some great networking and fun while we recognize all contributors to PathPAC. Dedicated to issues facing pathologists, PathPAC secures resources to support elected officials who are supportive of pathology and laboratory medicine and with whom we have relationships. Help us make PathPAC stronger for you. For first-time contributors, a small donation will be requested.
“Only at this meeting can I learn what is going on behind the scenes at the federal and state level right from those who are doing it.”
“We have a lot of changes happening in healthcare and this impacts how we get reimbursed. The CAP does a great job of explaining how this affects us and what our options are.”