Stephen N. Bauer, MD
Some CAP members have suggested that we are putting too much emphasis on transformation when we should be focused on advocacy. Health care reform should have our undivided attention, they say. We should be thinking Washington first, transformation later.
The trouble with this position is that our health care reform initiatives and transformation are intimately related. Consider the interaction of advocacy and transformation through the lens of accountable care organizations, or ACOs, the regional provider networks expected to manage the care of Medicare patients under health care reform. The idea is to have networks of providers collaborate on the care of a population of patients, yielding efficiencies, reducing costs, and improving outcomes. Development of the program is moving forward at lightning speed, and it is scheduled to go into effect on Jan. 1, 2012. The CMS is expected to publish its final rule on ACOs this year, and several private-payer demonstration projects are already coming online.
How can pathologists secure a place on an ACO launch team? We make our interest known to medical staff leaders who are likely to be aware of what may be in the works. We create systems in our current practices to improve test selection and reduce diagnostic errors due to failure to order, report, or follow up on laboratory results. We explain that while laboratory testing represents just three percent of health care spending, laboratory test results influence more than 70 percent of health care expenditures. In short, we create our opportunities by showing what we can do and making our interests known. This is transformational pathology.
ACOs present pathologists with risks and opportunities. We are well suited to the task at hand, but the window of opportunity is narrow and now. It is critical to be involved locally, in the planning stages, and to ensure we are included when decisions are made about the roles of pathologists. If we step back and let others take the lead, we may live to regret it. I am reminded of the old expression: “Not to decide is to decide.”
The CAP Division of Advocacy is developing a network of pathologists involved in ACO formation. We must identify members with personal ACO experience who can share what they learn as they go. The College will make use of their experience to develop relevant training and information for all CAP members. If you are working on an ACO launch or taking part in a medical home/coordinated care demonstration project, please contact the Washington office via e-mail at firstname.lastname@example.org.
The new mandate for physician quality measures based on practice guidelines also adds urgency to our transformation efforts. The new law expands the Physician Quality Reporting Initiative by increasing financial incentives for physicians who report on approved quality measures as well as penalties for failure to do so by 2015. Although two of the quality measures we proposed for pathology have already been approved and five more have been submitted, the approval process has been lengthy and difficult to navigate. We expect that guidelines developed through the CAP Pathology and Laboratory Quality Center will significantly reduce the time needed to develop quality measures in conformance with the new requirements.
The CAP continues to pursue advocacy activities to curtail physician self-referral abuses, a top priority on our advocacy agenda for some time. We are partnering with the American Clinical Laboratory Association to fund a study by a Georgetown University researcher examining utilization data tied to in-house pathology arrangements. We expect that the data will confirm what our anecdotal reports have long suggested: that these arrangements result in overutilization and are a disservice to patients. We were recently encouraged to learn that Congress had asked the General Accounting Office to examine this question as well. The Georgetown study should conclude this year; the GAO report is due out in the spring. We expect that these studies will support new limitations on abusive joint venture arrangements. In addition, our transformation efforts are focused on developing new revenue and service models that are less susceptible to commoditization and disintermediation by positioning pathologists to fill key value-added roles on the evolving health care team.
The College also represents pathologists on the AMA/Specialty Society RVS (relative value scale) Update Committee. This body, also known as the RUC, advises the CMS on potential changes to the physician fee schedule. With the new law empowering the HHS secretary to work outside the RUC process to adjust payment on high-volume codes such as 88305, the CAP’s Economic Affairs Committee will work tirelessly to defend the value of pathologists’ work in any new administrative reviews that are developed.
To ensure that CAP members stay informed of the day’s pressing policy issues, the College produces a biweekly e-newsletter, “Statline,” which is sent to all members. More detailed updates are available to those who join the Pathology Advocacy Network (PathNet). Members can join PathNet (at www.cap.org/advocacy or 202-354-7100) and will receive action alerts when grassroots action is urgently needed. PathNet members are invaluable in ensuring that pathologists’ voices are heard on Capitol Hill. Join today!
Finally, I must remind every member of the importance of PathPAC, the only political action committee that exclusively represents pathology. We are going to build a million-dollar war chest this year. It’s an ambitious number, but there are 17,000 of us and every one of your contributions brings us closer to our goal. Add your contribution at www.cap.org/advocacy.
While not all political advocacy relates to transformation, transformational pathology is grassroots advocacy at its best. When we communicate with one another, collaborate more closely with other physicians, learn new technologies, host lab tours, help to launch ACOs, and participate in the political process, we do so as advocates for our specialty. In all of these roles, we protect the health and safety of our patients. And that’s what transformation is really all about.
Dr. Bauer welcomes communication from CAP members. Write to him at email@example.com. To contact your state pathology society, please go to the CAP home page, click on the “Advocacy” tab, and scroll down to “State Pathology Societies” under “State Advocacy.”