Posted January 30, 2007
Dear Fellow Delegates,
I have recently returned from the November Board of Governors meeting and want to provide you with an update on many of the issues being addressed by the College at this time.
In addition, as discussed at the fall House of Delegates meeting, four ad hoc committees have been established and members appointed to develop recommendations for consideration by the House at the spring 2007 meeting on March 31 in Dallas, Texas. I hope to see you all at that meeting as we continue to define the future of the House of Delegates.
The Board postponed referral of the second resolve clause of Resolution F2006-2 House of Delegates/Member Forum Communication Tools, to the Information Science and Technology Committee until after the House Ad Hoc Committee on Tools and Technology completes its work.
The Board approved Resolution F2006-3, State Licensure of Laboratory Personnel, which resolved that the CAP continue to educate regarding the risk of state licensure of laboratory personnel and continue to assist state pathology societies in defeating the passage of laws pertaining to the licensure of medical laboratory personnel.
The Board approved Resolution F2005-5, Program on New Practice Options, Innovations in Pathology, Time Savings and Efficiency, which resolved that the CAP develop a program for CAP ’06 dealing with new pathology practices, useful innovations in pathology, practical practice options, realistic time saving methods and efficiency.
If you attended CAP ’06, then you are probably aware that the College has collaborated with the American Society of Clinical Oncology (ASCO) to publish a joint clinical practice guideline to improve the accuracy of HER2 testing for breast cancer patients.
The guidelines will be published on both organizations’ web sites during the first week for December and will subsequently be published in ASCO’s Journal of Clinical Oncology and the College’s Archives of Pathology and Laboratory Medicine.
This collaboration represents a tremendous accomplishment. The CAP has stepped out of the laboratory to work hand in hand with the clinical side of medicine to improve the treatment of patients with breast cancer. This project is likely the first of many such collaborations that will occur as molecular testing and pharmagenomics advance.
The guidelines were developed because the current state of HER2 testing is providing inconsistent level of care for patients. These guidelines provide practical guidance for the medical community on how this testing should be conducted and reported and they demonstrate that pathology is a vital component of patient care.
If you run or work for a lab that performs HER2 testing, you need to know that beginning in 2007, the College will require all of its accredited laboratories to participate in HER2 proficiency testing if they wish to conduct HER2 testing. In addition to PT, CAP-accredited laboratories will also be required to adhere to the rest of the guidelines when conducting and reporting HER2 testing. This will give clinicians a clear indication as to the quality of the HER2 testing being performed.
For more information out the guidelines, please see Dr. Sodeman’s President’s Desk column in the October issue of CAP Today.
New Member Benefits
Two new member benefits are targeted for launch in the first quarter of 2007. The first is a Pathology Practice Management Directory. The directory of firms offering pathology practice management services will be available as an online searchable directory to CAP members. As a prerequisite for being listed in the directory, firms must submit three referrals, two of which must be from CAP Fellows. To have a pathology practice management firm invited to be listed in the directory, please contact Doug Knapman, Director of Practice Management, at 800-323-4040 ext. 7738.
The second new member benefit is an online set of 20 downloadable anatomic pathology information sheets. The information sheets will include text and images and will provide pathologists with an opportunity to help their clinicians and the patients they are treating understand their diseases, immediately when they are diagnosed, in easy to understand language.
The Centers for Medicare and Medicaid Services (CMS) issued its final physician payment rule on November 1. The final rule results in an 11% cut for pathology which includes a five percent cut for the 5-year review segment, a one percent cut in practice expenses, and a five percent cut under the sustainable growth rate (SGR).
There is still an opportunity to influence Congress to halt the cut based on the SGR and provide physicians with a positive payment update for 2007. It is critical that we urge our congressional representatives to halt the five percent physician fee cut and overhaul the sustainable growth rate. To do so, you can call the AMA grassroots hotline at 800-833-6354, which will connect you directly to the House of Representatives and the US Senate. For additional information on the SGR, please visit the AMA’s web site.
The CMS final physician payment rule did not include changes to the self-referral rules, however, CMS officials indicated that they are taking comments—including those from the College—into consideration and will issue a proposed notice of rulemaking on this issue in the future. The College continues to work with CMS to influence the final regulation and is confident that CMS will take up some of our recommendations to deter pod labs.
Medically Unlikely Edits (MUEs)
Phase two of the MUEs was released last week. Although the CAP will need to comment on some areas, the list is much more manageable and reasonable than the initial release. The Economic Affairs Committee is evaluating the pathology and laboratory codes included in phase two. The CAP will be working with pathology and laboratory groups to develop comments on these edits by January 8 for implementation April 2007.
Pay for Performance
In 2007, CMS wants performance measures to be in place for most medical specialties and for physicians to report voluntarily on at least three to five quality measures per physician. The College has been named the lead by the AMA Physicians Consortium to develop those performance measures for pathology through its Pathology Working Group. The initial set of pathology measures was approved by the CAP Board in November. They have been submitted for review by Pathology Working Group.
On September 21, legislation was introduced in the US House that would suspend the current punitive federal cytology PT program and instead make the program educational by requiring annual CME. Companion legislation was introduced in the Senate on November 14. The College supports this legislation.
For more information on these and other advocacy issues, please watch for Statline or visit the CAP’s web site to read past issues.
The College has launched its Competency Assessment Program, which provides a systematic, online approach to helping laboratories meet CLIA-mandated competency assessment regulations. The program includes competency assessment courses, customizable training, reassessment courses, and comprehensive management tracking and reporting. Responses to the program have been overwhelmingly positive.
Inspection Team Leader Training
Mandatory inspection team leader training was implemented this year and to date, nearly 1000 team leaders have been trained. However, there is always a need for more team leaders so please be sure to participate in training if you are an inspection team leader or team member. Team member training will be required in 2007.
Inspector Selection and Assignments Project
The College is rolling out an improved inspector assignment process that should result in better matches of like laboratories for inspections teams. Team leaders will be matched to prospective assignments while screening against multiple criteria including completion of training, identified conflicts of interest, geographic distance, contract type, and size of respective laboratory.
If you have questions about House business, please email me or contact Shannon Peterson at 800-323-4040 ext. 7393.
Thomas J. Cooper, Jr., MD, FCAP
Speaker, CAP House of Delegates