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PATH News Network Daily Edition
Medicare Fee Schedule Proposes Pay Reductions
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Pathology spending takes a hit under the newly proposed physician fee schedule. Plus, making a lasting impact one guideline at a time. We hear from a pathologist whose body of work has strengthened the field and patient care. This is Path News Network Daily Edition from the College of American Pathologists. I'm Elizabeth McMahon. It's Thursday, July 16th.
Elizabeth McMahonMedicare reimbursement for pathologists will be cut by 2.4% next year under the newly proposed Medicare Physician Fee Schedule issued by the Centers for Medicare and Medicaid Services, or CMS. The CAP strongly opposes the reductions and will provide comments to CMS within the next 60 days. Among other changes, the CMS proposal released this week accepts the American Medical Association’s recommended revisions for fine needle aspiration codes used for biopsies. CMS is also seeking public comments on whether one of the most widely used surgical pathology code families is potentially misvalued and whether action should be taken in 2027 or beyond. The CAP will strongly advocate to protect the value of these pathology services. You can learn more about the CMS’s proposals – including the changes to the performance-based payment model known as MIPS – at an August 12th webinar. The link to register is in our show notes. Path News Network will continue to cover this story. More than 30 states have now reported infections from the diarrhea-causing parasite cyclospora. The CDC has confirmed about 1,645 cases but more than 5,000 suspected cases have been reported, mostly in Michigan. Investigators have identified a likely epidemiological link among cases in Michigan, Ohio, Kentucky and West Virginia pointing to lettuce or salad greens as a potential culprit. The CDC issued a national health alert urging clinicians and public health officials to consider cyclosporiasis in patients with prolonged G-I illness and to specifically request testing because it’s not included in routine tests. Dr. Christopher Attaway, a member of the CAP’s Microbiology Committee, says that testing may be appropriate for someone with persistent watery diarrhea, especially if they have recently eaten food linked to an outbreak, but he also notes stool examinations may not always detect the parasite. The worst year in the U.S. for infections was 2019, when about 4,700 illnesses were reported. You can learn more about cyclospora infections and testing at the CAP newsroom’s FAQ page. Making an impact on patient care and treatment can be one of the most rewarding parts of practicing pathology. But not all pathologists can say their life’s work has changed the field itself.
Elizabeth McMahonDr. Kay Washington is one person who can. A gastrointestinal pathologist and professor at Vanderbilt University, Dr. Washington has played a central role in developing evidence based guidelines that have strengthened pathology practice and laboratory medicine. Her contributions and service to the CAP Center Guidelines Committee will be honored in October with the C-A-P Laboratory Improvement Program Service Award at CAP26.
Elizabeth McMahonA mentor recruited Dr. Washington early in her career to the CAP cancer committee where she dug into standardizing cancer case reporting. She quickly realized the work could make an impact and gradually rose through the ranks on national and international cancer reporting organizations. But she says her contributions to CAP guidelines are some of her proudest accomplishments.
Dr. Kay WashingtonOur practice is getting so complex and I really feel for the community practice pathologists out there who have to deal with all these different cancers and know what to order on each case and how to work each case up. So the Center Guideline Committee has really tried to offer guidance in these complex areas, especially for cancer biomarker ordering and reporting. So I think that will ultimately have some of the biggest impact of the work I've done.
Elizabeth McMahonDr. Washington played a pivotal role in the landmark 2016 guideline that established HER2 testing as essential for identifying patients with gastroesophageal adenocarcinoma who may benefit from targeted therapy. She says guideline work is a challenging team effort involving diverse perspectives and judgment calls.
Dr. Kay WashingtonI think the thing that I find most interesting about the guideline is once you've looked at the data, then you have to make some value judgments about your recommendations. Do you value test sensitivity over specificity? So you weigh what's the harm of a false positive versus a false negative? And that value judgment can also help guide your final guideline recommendations. So I find that part of the guideline development really the most interesting part of it.
Elizabeth McMahonDr. Washington says she’s now focused on recruiting junior colleagues to CAP committees and task forces, hoping they can make their own mark on the field. The benefits, she says, extend far beyond committee room doors.
Dr. Kay WashingtonWhat I've really valued about my CAP committee work is the opportunity to get to know pathologists from all sorts of different practice settings. And I've learned so much from them. As a lifelong academic, I say I've never really had a job. I've always more or less done what I wanted to. And to hear the challenges they face in their everyday practice, and many of them are general surgical pathologists, and I'm just in awe of them
Elizabeth McMahonDr. Washington is one of more than 20 meritorious service awardees who will be honored at CAP26 in October at the Wynn Las Vegas. Stay tuned to the Path News Network to hear from more 2026 CAP award winners this summer.
Elizabeth McMahonThe nation’s forensic pathologist shortage is reaching a breaking point, but there are signs of hope. In an opinion piece this week in STAT News, Dr. Gregory MacDonald, chair of the Department of Forensic Medicine and Pathology at Philadelphia College of Osteopathic Medicine, says the compounding effect of the Covid 19 pandemic, retirements, and an unprecedented caseload fueled by the opioid epidemic has overwhelmed medical examiners’ offices. With only about 850 forensic pathologists currently practicing nationwide, Dr. MacDonald writes that many states are facing delays in cases impacting justice and public health. With just a single medical examiner overseeing hundreds of deaths, families often wait months for answers. He says institutions are starting to think creatively about bolstering the trainee pipeline, however. One solution is engaging trainees early in medical school and residency where they can work with medical examiners to see how the specialty impacts communities.
Elizabeth McMahonThat does it for today’s Daily Edition. Be sure to check the show notes for more information on today’s stories. Got a story you’d like us to cover on the Daily Edition? Write to us at stories@cap.org. We’re back at 5 a.m. Eastern for another episode of the Daily Edition. I’m Elizabeth McMahon. Have a great day.