Two pathology pay-for-performance measures may be applicable for pathologists reporting on quality measures with their 2008 Medicare claims.
The measures received final approval Oct. 18 from the AQA, a multi-stakeholder payer-supported organization, and should be included in the final 2008 physician payment rule from the Centers for Medicare and Medicaid Services.
"The College is pleased to lead development of pay-for-performance measures for the specialty of pathology," said CAP president Jared Schwartz, MD, PhD. "We are confident our first two measures are based on sound science and promote high-quality health care."
The pathology measures were developed by the College and the American Medical Association Physician Consortium for Performance Improvement, based on CAP breast and colon cancer protocols. The AMA designated the College in 2006 as the lead organization for the development of pathology measures.
Members of various College committees convened a working group in 2006 for ongoing development of measures. Proposed measures undergo an internal review and final approval before they are submitted to the AMA consortium.
From there, the measures are submitted for various external reviews, with final approval sought by the AQA. The CAP working group is developing measures now for 2009 and beyond.
Though the bonus in 2008 will be based on reporting on the measures, not performance, the CMS plans to make the performance data publicly available.
"The College will continue to proceed with cautious optimism while it develops further measures for consideration," Dr. Schwartz said.
The Massachusetts Society of Pathologists, with the CAP's support, voiced strong opposition to legislation that would establish state licensure of clinical laboratory personnel during a hearing Oct. 10 before a joint State House and Senate committee on public health.
No person or organization provided testimony in support
of the legislation. Donald Ross, MD, president of the Massachusetts Society
of Pathologists, testified that the Clinical Laboratory Science Protection
Act would substantially limit entry into, and advancement within, the
clinical laboratory workforce and have a negative impact on laboratory
quality and patient care in Massachusetts.
"There is no justification for licensure based
on a dispassionate review of workforce facts from states with licensure,
and the quality data that is available," Dr. Ross said. "There is, however,
a growing body of documented evidence that licensure is detrimental in
that it can exacerbate clinical laboratory workforce shortages and, consequently,
degrade and jeopardize laboratory quality."
In its testimony, the MSP highlighted a 2005 state
licensure law passed in New York̵the only state in the 15 years since
CLIA was implemented to enact laboratory personnel licensure—as
a warning against unnecessary regulation.
The New York State Department of Health assailed the
licensure law in 2006 comments to the New York Department of Education,
which is the agency that administers the law. The health department cited
the law's negative impact on laboratory operations and diminished flexibility
for lab directors in hiring qualified staff.
The CAP is united with the Massachusetts pathology
society in condemning the legislation. Others in opposition are the Massachusetts
Medical Society, Massachusetts Hospital Association, American Association
of Bioanalysts, and American Clinical Laboratory Association.
The final 2008 physician fee schedule from the Centers for Medicare and Medicaid Services includes a CAP recommendation that effectively puts an end to pod labs.
The CMS adopted the recommendation on the anti-markup
provision of the rule by focusing on where the service is performed, regardless
of who performs the service. If a physician or group orders a test and
bills for a service not performed in the physician's office, then the
anti-markup rule will apply to the technical and professional components.
This will effectively end pod labs.
However, because the provision does not apply to independent
contractors performing services in the physician's office, problems remain
with other abusive contractual joint ventures. The CMS has committed to
working with the College to address such CJVs in a separate rulemaking.
Under the final rule, all physicians will face a 10
percent decline in Medicare payment because of the flawed sustainable
growth rate formula the CMS uses to calculate payment to physicians. The
College is working closely with the American Medical Association on a
legislative solution to repeal the SGR.
Pathologists will face an additional two percent reduction
owing to the five-year review and the impact of changes to CMS' method
for estimating practice expense. Hospital-based pathologists will see
the largest negative impact due to the practice expense formula and could
experience declines of up to four percent next year and 18 percent by
2010, over and above the SGR effects.
The PE method was first implemented this year and will
be transitioned over four years. The College will continue to work with
the CMS on a separate rulemaking to address PE changes.
The College and coalition partners continue to fight to preserve key functions of the Armed Forces Institute of Pathology, located now on the campus of the Walter Reed Army Medical Center.
Recent efforts culminated in language in the House
and Senate versions of the defense authorization bills for fiscal 2008
that essentially renames AFIP as the Joint Pathology Center and relocates
it to the National Naval Medical Center at Bethesda.
As the defense authorization bills head to conference,
the coalition sent a letter Oct. 4 to Senate and House Armed Services
Committee members urging that the Joint Pathology Center be created and
that AFIP functions critical to military and veteran health care be preserved.
The letter contained these recommendations: o Mandate
the establishment of the Joint Pathology Center as provided for in the
House language. o Ensure the preservation and modernization of the existing
AFIP Tissue Repository as provided for in the Senate bill. o Clarify that
diagnostic pathology consultative services referenced in both House and
Senate provisions include secondary consultative services to members of
the civilian, veteran, and Department of Defense communities.
The CAP reiterated its call for the Centers for Medicare and Medicaid Services to publicly release medically unlikely edits in response to the agency's request for comment on current policy restricting distribution.
In its Sept. 25 letter, the College shared the concerns
it has about nonpublic release, including the inability of medical societies
to educate members on MUEs and modifiers and the policy's inherent contradiction
of CMS' goal of transparency. The College also signed on to an AMA letter
sent to the MUE contractor, echoing similar concerns about the need for
transparency and public disclosure.
In support of restricting public release, the CMS has
said the potential exists for providers to game the system. The College
disagrees because the units of service are driven by the specimens or
test requests that referring physicians submit. General financial incentive
does not exist for providers to change the number of test requests or
specimens sent to labs based on MUEs.
The governor of California signed legislation Oct. 13 to expand the scope of the state direct billing law from cytological to anatomic pathology services.
The bill, spearheaded by the California Society of
Pathologists and supported by the College, will prohibit clinicians from
billing patients and third-party payers for anatomic pathology services
they don't perform or supervise directly.
Current law in California prohibits clinicians
from billing patients or third-party payers for cytological services relating
to the examination of gynecological slides. Additionally, current California
law, which will remain in effect even with enactment of S.B. 661, prohibits
markups on all other clinical laboratory services.
Justin Herman is CAP manager, Communications
for Advocacy, Washington, DC.