College of American Pathologists
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December 2, 2011
© 2011 College of American Pathologists
Special Report

In This Issue:

This Week in Washington: Will a Crowded Docket Delay Action on SGR?
CAP Members Continue Pressing for TC-Grandfather Extension
Rep. Tom Rooney (R-FL) Visits Pathology Lab at Highlands Regional Medical Center

This Week in Washington:
Will a Crowded Docket Delay Action
on SGR?

When the Super Committee failed to reach agreement on a deficit reduction plan just before Thanksgiving, it caused a host of programs that were set to expire on December 31st to vie for a place on the full Congressional agenda, forcing them to compete for precious time and funding on the year-end Congressional schedule.

This means that the physician payment issues including the 27.4% Medicare physician pay cut scheduled to go into effect on January 1, 2012 under the sustainable growth rate (SGR), and expiration of key Medicare provisions such as the technical component (TC) “grandfather”, will likely vie for support against a backdrop of Congressional belt-tightening and other pressing issues of broad voter interest, such as extending the payroll tax cut, extending unemployment insurance benefits for the long-term jobless, patching the alternative minimum tax and passing a bundle of expiring tax provisions known as tax extenders.

This makes for an especially crowded and dicey docket, particularly because Congress must vote by December 16 to keep the government funded into next year.

Nevertheless, this week, members of Congress expressed broad support for quickly addressing the “doc fix” before turning to other issues. House Speaker John Boehner said the House had begun bi-partisan discussions on SGR, and Sen. Orrin Hatch (R-Utah), the top Republican on the Senate Finance Committee said he still hoped to find a permanent fix for the SGR. Hatch predicted, however, that lawmakers will likely end up with a short-term patch. A permanent fix, according to Congressional Budget Office (CBO), would cost upwards of $300 billion.

Rep. Harry Waxman (D-CA), ranking Democrat and former chairman of the House Energy and Commerce Committee said this week that he too would press Congress to take action on the SGR before it adjourns in December. To leave the problem unaddressed would be unacceptable to “our doctors, their patients and to the Medicare program.”

Members of the House physician caucus, Rep. Phil Roe, MD (R-TN), Rep. Tom Price, MD (R-GA), and Rep. Michael C. Burgess, MD (R-TX), met with physician groups yesterday to give their own update on the SGR. The physician members of Congress are pushing for the longest patch possible given budget constraints, but acknowledged that the demise of the Super Committee process left little time to consider a more permanent solution. They emphasized their commitment to halting the cut before Congress adjourns for the year. Ideally, a 2 year fix would provide more time to consider what needs to be done to repeal the SGR and provide a workable new approach.

Making the task more difficult are the new numbers that came out from CBO increasing the cost of patching the SGR — a 2 year patch initially scored at $26 billion will now cost $38 billion. A one-year patch is less costly at around $21 billion, but this would put the issue back in the play in what is sure to be a difficult election environment. Options range from a freeze, to an increase based on the Medical Economic Index or a 1% increase – of course an increase based on the MEI or a 1% increase will be more costly.

How the patch will be paid for is still up in the air. The SGR fix may be packaged with a number of other issues – some of which are controversial – such as whether and how to pay for an extension of unemployment insurance and the payroll tax cut. If included in a larger measure, negotiations on the larger package could hold up action on the SGR fix despite bi-partisan support for a fix, and the efforts of the House physicians caucus.

The sheer size of any short-term or permanent SGR fix, coupled with the impact physician pay cuts could have on Medicare providers and patients, help to make it an important issue in Congress. However, caught up in budget and time constraints, Congress may not be able to all the Medicare extenders, such as the TC-grandfather, before year-end. The TC grandfather is dwarfed in comparison to larger provisions, which is why CAP member fly-ins on this issue continues to be critical. In meetings this week, two CAP members met with nearly a dozen lawmakers and their staffs to urge their support for extending the TC-grandfather provision.

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CAP Continues Push for TC-Grandfather Extension
CAP members from Florida and Kansas, including a member of the CAP Board of Governors, met with members of Congress and their staffs to urge support for extending the TC-Grandfather provision.

Richard Gomez, MD FCAP
On Thursday, CAP Governor Richard Gomez, MD, FCAP, met with lawmakers from his home state, Kansas, to urge their support for legislation introduced by Kansas Representative Lynn Jenkins (R-KS), which would make the TC-Grandfather provision permanent.

Dr. Gomez is a partner in the Topeka Pathology Group, in Topeka Kansas. His practice works with six 10-20 bed rural hospitals that qualify for the TC-grandfather. Overall Kansas has more than 50 hospitals that qualify for the TC grandfather.

In addition to meeting with Representative Jenkins, who is a member of the House Ways and Means Committee, Dr. Gomez worked to educate and shore up support from freshman members of the Kansas delegation, including Rep. Mike Pompeo, Rep. Kevin Yoder, Rep. Tim Huelskamp, and Senator Jerry Moran.

Statline: Dr. Gomez, what did you hope to accomplish in Washington this week?

Gomez: There is a bill in the House, H.R. 2461, that would make the TC-Grandfather provision permanent, and Representative Lynn Jenkins was one of the bill’s first sponsors. I want to get every member of the Kansas delegation to support the bill and help us reach House and Senate leaders who ultimately will decide the fate of the TC Grandfather.

Statline: What was your main message in your meetings on Capitol Hill?

CAP Governor Richard Gomez, MD FCAP, with Representative Lynn Jenkins (R-KS)

Gomez: So many patients in Kansas live in rural communities and are served by small rural hospitals. The TC Grandfather helps sustain those hospitals and allows them to offer quality care to patients in or near their communities. We need for every Kansas lawmaker to understand the importance of this provision to their constituents.

Statline: Did you get any assurances from the Members of Congress or their staff? What feedback did you get?

Gomez: We didn’t get any firm assurances, but we were able to educate the members and their staff about the issue, and they were open to our entreaties. This isn’t the last time we’ll be talking with them on this subject, it is just the beginning of the conversation.

Statline: Had you met any of the Representatives or Senators before your meeting?

Gomez: I knew Representative Jenkins, of course, and I have met Senator Moran as well. In fact, I serve on both of their Health Care Advisory Task Forces. Members of Congress often assemble in-state task forces to serve as advisors on key healthcare issues. In the case of Representative Jenkins, there’s a quarterly conference call with health care providers including physicians, nurses and administrators, where we discuss issues impacting health care in Kansas. I’ve also served on the Topeka YMCA Board of Directors with Representative Jenkins.

Statline: What would you want other CAP members to know about your lobbying Congress this week?

Gomez: It’s important to be engaged. Whether it is at the local, state or national level, I would urge every pathologist to get to know your elected officials, stay aware of the issues impacting your profession, and make yourself available to serve as a resource and advisor.

James O. White, MD FCAP
On Wednesday, Dr. James White, MD, FCAP of SaraPath Diagnostics in Sarasota, FL, met with the staff of House Speaker John Boehner (R-OH), and Florida Senator Marco Rubio (R-FL), a member of the Senate Committee on Small Business and Entrepreneurship. Dr. White also met with Reps. Pete Sessions (R-TX), Vice Chairman of the House Rules Committee; Rep. Vern Buchanan (R-FL) and the staff of Sen. Bill Nelson (D-FL).

Dr. White’s practice at Sarapath Diagnostics, founded in 1975, is one of the oldest and largest independent pathology and laboratory practices operating on the west coast of Florida. It employs nine pathologists, and provides comprehensive anatomic pathology and specialty clinical testing services, as well as laboratory medical director services. Dr. White has been with Sarapath for over 30 years. The lab works with three hospitals; two are rural, 100-bed facilities, the other an urban 800-bed facility. All qualify for the TC-grandfather provision. Medicare patients account for approximately 65% of the inpatient anatomic pathology and surgical pathology services Sarapath provides.

Statline: Dr. White, why is this issue so important to you?

James White, MD FCAP, with Rep. Pete Sessions (R-TX).

White: We are an independent laboratory that provides anatomic pathology services for three “grandfathered” hospitals. Loss of the “grandfather provision” in practical terms would mean spending months and considerable resources to re-negotiate our contracts with three hospitals and develop mechanisms for billing each of them for the technical component. This would greatly increase the cost and complexity of billing for the hospitals and for us. Loss of this provision would significantly increase the cost of providing patient care, and have a major adverse effect on these hospitals and the citizens of our county.

Statline: What was your main message in your meetings on Capitol Hill?

White: The annual suspense over whether there will be an extension of the “grandfather provision” inhibits independent laboratories, as small businesses, from planning for the future. We can’t bear the cost of replacing our LIS or making another capital expenditure if we cannot predict what our income will be. If the TC Grandfather were to go away permanently, that would have a profound effect on our practice as a small business, and on patients who rely on us.

Statline: Did you get any assurances from the Members of Congress or their staff? What feedback did you get?

White: We received no assurances, but the Congressmen we met with had backgrounds in business, and were sympathetic to our situation. They understand how the current cliffhanger scenario hinders the operation of small business.

Statline: How would you describe the tenor of your meetings?

White: The meetings were pleasant, interesting conversations. Everyone recognizes this is a very challenging time to pass legislation and little time remains until year end. The Congressmen and the staff members we met with were quite knowledgeable about the technical component and SGR.

Statline: What would you want other CAP members to know about your lobbying Congress this week?

White: The physical presence of a person in a Senator or Congressman’s office creates an impact. Traveling to Washington makes a statement on an issue’s importance to constituents, and provides a opportunity to create a personal relationship and discuss specific legislation and policy. Establishing a personal relationship is very important. I believe that these lobbying efforts are important and effective, and I encourage CAP members to participate.

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Rep. Tom Rooney (R-FL) Visits Pathology Lab at Highlands Regional Medical Center

CAP Fellow-Inspector George, Leidel, MD, FCAP in the lab with Rep. Tom Rooney (R-FL)On the Friday after Thanksgiving, CAP fellow George Leidel MD, FCAP hosted Florida Congressman Tom Rooney at Highlands Regional Medical Center (HRMC) medical laboratory in Sebring, Florida.

During the hour-long visit, the Congressman noted that in visiting the 128-bed HRMC, he had visited every hospital in his district, but the HRMC laboratory was his first medical lab.

“It was interesting to see the different diagnostic tests conducted on a daily basis at Highlands Regional Medical Center,” said Representative Rooney following the tour. “Everyone would benefit from a better understanding of the vital role pathologists play in our nation’s health care system.”

It appears visiting the day after Thanksgiving had its blessings. It was a quiet day in the hospital, and Rep. Rooney was able to experience a range of laboratory services, from hematology and blood banking, to anatomic pathology and the lab’s new immunostainer. It also afforded time for Dr. Leidel to share his concerns about physician self-referral and the need to extend the TC-Grandfather provision.

“I wasn’t sure a tour of a small rural hospital lab would matter to a member of Congress, but he couldn’t have been more down to earth. I think he’d have spent more time if he could have. It was the perfect time for establishing a relationship. The next time I see him, I think he’ll remember me and his visit to this lab.

U.S. Rep. Tom Rooney (R-FL) currently serves on the House Armed Services Committee, the Agriculture Committee, and the Select Committee on Intelligence. He is the Chairman of the House Agriculture Subcommittee on Livestock, Dairy and Poultry. He also serves as a Deputy Whip for the Majority.

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