College of American Pathologists
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May 2008

Letter 1 PQRI bonus payments

Is anyone else insulted by the entire concept of the Physician Quality Reporting Initiative? This system assumes medical professionals are not doing their jobs so we will pay everyone a minimal Medicare rate and give a small bonus to those who can prove they deserve it. The concept is backward and professionally offensive. The overwhelming majority of professionals are doing quality work, and one should not receive a bonus for doing one’s job. Medicare reimbursement should be appropriate to begin with and not subject to repeated cutbacks. If there are rare hospital-based pathologists whose reports do not include medically necessary data, it would be an issue for the hospital’s oncology staff, and there are ample quality assessment and feedback measures to rectify the problem. It is professionally inappropriate and dangerous to tie this to reimbursement. I suppose we should just be happy for the small bonus and not care how we get it, but it seems to me that professional principles are being eroded here, and I fear the CAP may be part of the problem.

Steven P. Bondell, MD
Chairman, Department of Pathology
Atlanta (Ga.) Medical Center

David L. Witte, MD, PhD, chair of the CAP Patient Safety and Performance Measures Committee, replies: Congress mandated that the Centers for Medicare and Medicaid Services develop a voluntary physician pay-for-reporting program. The secretary of Health and Human Services supports this development. Private payers have also embraced pay-for-performance programs. Many organizations are invested in developing, endorsing, and implementing performance measures, including the AMA, the National Quality Forum, and the AQA. This policy arena was moving forward with or without the CAP’s participation. The CAP decided to participate.

Letter 2 A mentoring option

The column by Jared N. Schwartz, MD, PhD, regarding mentoring was very timely (February 2008, page 11). The residents at the recent House of Delegates meeting in Denver expressed their concern about lack of transition from training to their first “real” job.

As a clinical professor of pathology I have been able to bring my practical experience as a hospital-based pathologist to residents and fellows in their academic settings. I am not sure how many academic institutions offer that option.

Fellow pathologists in private practice often express the desire to be involved in academia but lack available time away from their busy practices. Many retired members I interviewed when I was chairman of the CAP task force on emeritus members said they had the time but did not know how to go about obtaining an academic position.

It seems there is an unfulfilled mentoring need and an option to be explored in the large (and growing) pool of emeritus members. The emeritus pool includes renowned pathologists who could mentor in their areas of expertise as well as former community hospital pathologists who could mentor in other areas such as the business of pathology or how to be successful in the hospital setting.

Perhaps this could be explored further by formally surveying the academic and emeritus community.

Alvin M. Ring, MD
Clinical Professor of Pathology
University of Illinois
College of Medicine
Medical Director of Laboratories
Silver Cross Hospital
Joliet, Ill.