College of American Pathologists
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  President’s Desk Column


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Let’s learn from each other about CP pay

May 2005
Mary E. Kass, MD

I recently heard a comedian on the radio say he preferred broadcast to live comedy because when he worked in radio he could tell himself that every joke worked every time.

I’m not looking to make people laugh, but I know the feeling. Sometimes this column feels like a message in a bottle. You say what you have to say and let it go. The bottle floats out, moving with the current. Best case, those who read it are like the salt in the ocean, lifting the message, flavoring it, sending it on. But there’s not a lot of feedback. You’re never sure how it’s playing in Peoria.

So I got a tremendous lift from your letters in response to my March column, where I asked whether you thought the College should try to develop strategies for conversations with payers about compensation for clinical pathology services. There is a lot of energy in the feedback—a clear sign that this issue is as important to you as it is to me. There were thoughtful letters relating experiences. There were earnest letters proposing solutions. I felt we had struck a chord.

Your letters will frame the agenda for a new workshop at CAP ’05. We are planning an interactive session for pathologists who want to develop strategies and tools with which to illustrate and evaluate the value of clinical pathology services. I’ve persuaded Harry J. Zemel, MD, who chairs the Council on Scientific Affairs, to join me as co-chair. The workshop will bring together people who wrote to share their experiences in advocating for fair compensation and people who want to learn more. We might try small group discussions; perhaps we’ll work with case studies. I expect some excellent brainstorming.

In framing the workshop, we will begin with fundamental messages:

  • The pathologist accepts responsibility for what happens in the clinical laboratory. That accountability should be compensable.
  • He or she provides knowledgeable, hands-on quality control and quality assurance throughout the hospital, from blood bank to point-of-care testing station.
  • Proper payment for clinical pathology protects the patient’s right to efficient, effective laboratory services and the clinician’s access to medically sound consultation.
  • Clinical pathology contributes in measurable ways to high-quality patient care.

Then we’ll discuss tools to advocate for proper payment and what I’ll call the four p’s: preparation, persuasion, persistence, and patience.

Preparation is mostly evidence collection. Your letters demonstrate that people who are getting paid for clinical pathology know their business. They go into the first meeting with facts and figures. They know how many tests they did last month and last year. They know how many interpretative reports they wrote, how many their partners wrote, and for whom. They know how much time they spent on the phone talking to clinicians, and how much time they spent in conference. They can document what was required to persuade a department head not to insist on bringing in a boutique test. They can identify who spent how many hours calibrating and recalibrating equipment, supervising point-of-care training, reviewing unexpected results, and checking abnormal findings.

Preparation lays the groundwork for persuasion. Although medical consultation on test menus and test results is an integral element of quality care, some administrators may not realize those consultations take place. We may know our work contributes to a shortened length of stay, but is that clear to the decision makers? Although some of us might want to put our data in a nice binder and leave it with the administrative assistant, that’s not how negotiation works. It must be carefully presented.

Third and fourth are persistence and patience—the two go hand in hand. Advocates must be prepared to return once and again with more data and more specific anecdotal examples from a variety of departments. Administrators and payers need to see evidence that quality laboratory services contribute to patient satisfaction, efficiency, and effectiveness.

If people don’t value clinical pathology, it could be because they don’t understand what it is. If that is the case, expect resistance. Expect a few stalemates, stay flexible yet firm, and prepare to return in the morning. You’re not done talking until everyone can leave happy.

Your response to my March column shows that while clinical pathology may have hit rough terrain, reports of its demise are greatly exaggerated. The College is home to many excellent clinical pathologists, and we can continue to learn from one another.

I hope many of you will join us at CAP ’05 and will enroll in the interactive workshop. The College is only as strong and as relevant as its members choose to make it. Those who continue to engage, to support their peers, and to look to the future will shape our collective agenda.

Two months ago, I wrote a column to ask what you thought, and you told me. The message in that bottle bobbled along until it hit home. If there were a way to bottle the satisfaction I felt when reading your letters, we could corner the market on mood enhancement. Pathologists really are terrific. Please keep writing. I’ll see you at CAP ’05.

Dr. Kass welcomes communication from CAP members. Send your letters to her at