College of American Pathologists
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  Six CAP groups pitch into tough pathology issues


cap today



April 2006
Feature Story

Tony Sullivan

The CAP this year added six new committees to its governance structure to lend a hand to pathologists who have to manage practices and profession-related risks and be paid for their services. What benefits they receive as CAP members and how the proficiency testing program can reach peak performance are on the agenda too. “It’s an all-out effort to make the organization indispensable to its members,” says CAP president Thomas M. Sodeman, MD.

The Member Benefits Committee is one of two new committees formed when the former Membership Committee was split into two separate areas, benefits and member development. That decision was made so more attention could be paid to myriad membership-related issues, says C. Dean Pappas, MD, of Lawrence Memorial Hospital in Medford, Mass., who chairs the committee.

“There was so much involved with membership that the CAP wanted to pay more attention to benefits to ensure that the College is providing the right benefits to the right groups. And this could be accomplished only by breaking the member benefits area out and giving it special attention,” Dr. Pappas says.

The Member Benefits Committee has two charges: to design, evaluate, recommend, and monitor appropriate benefits for CAP members and to inform members about these benefits and activities through personalized communication aimed at specific member segments, Dr. Pappas says. The six-member committee’s primary goal for 2006 is to examine the CAP’s entire list of member benefits and conduct a cost-benefit analysis of each, Dr. Pappas says. Based on the results of the analysis, the Member Benefits Committee will recommend new member benefits and suggest which benefits should be eliminated or phased out.

The aim of the Member Development Committee, chaired by Dennis O’Neill, MD, of Manchester (Conn.) Memorial Hospital, is to recruit and retain CAP members. “Our main goals are to increase the number of junior and fellow members that we have and to improve our market share numbers with regard to the total number of pathologists who are represented by the College,” says Dr. O’Neill, who previously chaired the single Membership Committee.

The Member Development Committee will also identify and address ethical issues affecting the practice of pathology and review and make recommendations on all applications the CAP receives for membership, including all membership status changes and credentialing matters, Dr. O’Neill says. The committee will also manage the CAP’s awards process by reviewing award nominations, recommending recipients, and developing new awards when appropriate.

Though the Practice Management Committee isn’t entirely new this year, it has a new scope of activities and a heightened emphasis on the practical practice management issues pathologists face day to day. The reworked charge of the committee, now chaired by Edward Catalano, MD, of Palmetto Richland Memorial Hospital, Columbia, SC, is to focus on strategies, resources, education, and materials to help pathologists develop, improve, and manage their medical practices, Dr. Catalano says. The committee will also work to establish the CAP as the leading resource and communicator on the economics and management of pathology practices.

The former Practice Management Committee had the same responsibility, but it was charged in addition with addressing practice management advocacy issues facing pathology practices, a charge that has been shifted to another CAP committee.

“This new committee gets at the practical operations of pathologists and the common issues they face in the daily operations of their practices,” Dr. Catalano says. “We will offer pathologists tools and resources tailored to meet their immediate needs and help them successfully run their medical practices on a day-to-day basis.” The group consists of pathologists from diverse practice types and professional practice managers.

The committee will focus initially on the operational needs of pathology groups with six or fewer pathologists, Dr. Catalano says. “We believe those groups have particularly significant challenges in dealing with operational pressures and delivering quality in that environment,” he explains. “The challenges they face seem to be expanding, so we want to develop the practice management tools they need to be able to survive and thrive.”

He says the committee will not impose a particular operating style on pathologists to manage their practices, but adds: “We want to enable them to take advantage of opportunities presented by economies of scale that they cannot take advantage of on their own as small group practices.”

As its first step, the committee conducted a broad environmental scan to determine if other medical associations or practice management consulting groups are doing anything to address the practice management needs of small pathology groups, Dr. Catalano says. Based on the results, the committee will determine whether it can apply its findings to benefit pathologists in the practice management arena and may explore the feasibility of developing programs with these other organizations.

Advocacy for CAP members on issues affecting their practices and the profession as a whole is the focus of the new Professional Affairs Committee, chaired by David Henkes, MD, of Pathology Reference Laboratory and Christus Santa Rosa Hospital, San Antonio. This activity and others the Professional Affairs Committee is involved in were conducted previously by the Practice Management and Economic Affairs committees, he says. High on the new committee’s list of priorities is monitoring and addressing payer issues, particularly advocating for appropriate recognition and reimbursement of anatomic and clinical pathology services from insurance companies, Dr. Henkes says. “This committee is totally focused on advocacy,” he adds. “A lot of that has to do with relationships with insurance companies. We have a challenge in making sure the insurance companies understand not only the way pathology services should be paid for but the importance of the pathologist in the oversight and administration of the clinical laboratory.” Insurers don’t understand well what a pathologist does, he notes, and adds: “We will try to help pathologists communicate this information to insurance companies and other payers.”

Also on the committee’s agenda are scope-of-practice issues and the ways in which pathologists can use pathology assistants, medical technologists, and other practitioners to their advantage, Dr. Henkes says. In addition, the new committee will monitor the types of practices that are emerging, such as pod and condo laboratories, and provide information on their pros and cons. The committee also will maintain the CAP’s practice characteristics survey and address state and federal compliance issues.

The new Reproductive Medicine Committee has as its focus new technologies in reproductive medicine and optimizing andrology-related tests for clinical laboratories. Chaired by Patricia Devine, MD, of Lowell (Mass.) General Hospital, the group will operate ancillary to the CAP’s Hematology/Clinical Microscopy Resource Committee as part of the Hematology Cluster.

The committee will develop effective fertility-related proficiency testing products for reproductive medicine laboratories and modify current semen proficiency tests, including sperm morphology, for hospitals and clinical laboratories. It will also make recommendations to the CAP’s Commission on Laboratory Accreditation for the Reproductive Laboratory Accreditation Program checklists as new technology and procedures emerge in reproductive medicine.

Among the new products planned for this year: a sperm motility CD-ROM, a new addition to the CAP’s Semen Analysis and Embryology Surveys. This will consist of a real-time microscopic film that will slowly scan several fields to make it possible for technologists to interpret the motility percentage for two different specimens. “This new method is intended to help reduce the variability we often see in participant results within this particular Survey,” Dr. Devine explains. “The use of a standardized film for all participants will help obtain more consistent results by providing clear images at two different magnifications.”

The new Survey also will include a wet sample that will be provided to Survey participants once a year. “Testing an actual sample remains an important factor of proficiency testing,” Dr. Devine says. “The committee would like to ensure that technological advancements do not replace the previous Survey entirely. They feel strongly about assessing the proficiency of the laboratory’s specimen preparation methods as well as identification and interpretation.”

Further into the future are plans to develop additional products for semen analysis and embryology, which Dr. Devine says should be on CD-ROM as well. “With the extensive knowledge and continued hard work of the RMC, the group is enthusiastic about beginning the production of many new products for the College,” she says.

The Risk Management Committee will identify and make recommendations to eliminate, mitigate, or control risks faced by the CAP, the pathology profession, and laboratory medicine in general. Chair Andrew Horvath, MD, of Presbyterian Hospital, Albuquerque, NM, says the committee will develop the process and tools for identifying and managing risks throughout the College, particularly those that may have a sizable effect on the pathology profession. The committee intends to drive home the point that identifying and discussing potential and existing risks and those already being addressed by the CAP and its members should be part of every CAP council and committee meeting, he says.

“For risk management to work, a culture shift is necessary such that risk identification and conscious risk management become part of the very fabric of the organization, across the member leadership and staff organization,” Dr. Horvath explains. The Risk Management Committee is composed of CAP governors who are knowledgeable about and experienced in working with the College’s laboratory improvement programs, membership services, and advocacy initiatives, Dr. Horvath says. And three of the committee’s members also sit on the Strategic Planning Committee, an intentional overlap designed to minimize duplication of effort and ensure that strategic activities are aligned.

The new committee met in February, at which time it began to sort through the issues the CAP faces. It also identified eight primary tasks for the group, chief of which is to establish a risk identification framework to be used by all CAP business units and councils for identifying, evaluating, and managing the risks.

The committee does not intend to assume the responsibilities of other CAP councils and committees to identify and manage risk associated with their own areas of responsibility. “In fact, by providing a framework and analysis tools, we intend to facilitate their management of risk and increase organizational awareness of issues and solution plans,” he says. It’s the systematic, integrative approach that the group members believe can help set priorities for issues and allocate resources so as to mitigate or control the impact that risks may have on the College or the profession, he adds.

“We intend to establish a framework to be consistently used across the organization in which issues more easily rise, receive broader input, and are allocated resources commensurate with their probability and impact,” Dr. Horvath says.

Back after a hiatus of several years, the CAP’s Surveys Committee will address matters related to proficiency testing, says chair Washington Winn Jr., MD, of Fletcher Allen Health Care, Burlington, Vt. It will be an overseer of and facilitator for the scientific resource committees in matters related to proficiency testing

In carrying out its oversight role, the Surveys Committee will focus on general proficiency testing issues that involve the resource committees, but it will pay particular attention to matters pertaining to contracts with vendors, safety of proficiency testing for participants and the public, and appropriateness of proficiency testing challenges, says Dr. Winn, who expects these functions to be performed directly by the Surveys Committee or by establishing protocols for the scientific committee staff to follow.

“The ultimate goal of the Surveys Committee is to enhance to the greatest extent possible the efficiency of the [scientific committees], the educational mission of the College, and compliance with regulatory requirements,” Dr. Winn says.

A key function will be to serve as a clearinghouse for a discussion of ideas that might improve the overall organization and efficiency of these activities, Dr. Winn says.

“We want to improve the performance of our proficiency testing program, but we want to do it collaboratively,” he says. “It’s important that we not be perceived as policemen or obstructionists.”

Tony Sullivan is a writer in Wheaton, Ill.