College of American Pathologists
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  STATLINE — CAP’s Bi–Weekly Federal and
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August 18, 2011  •  Volume 27, Number 17
Next Issue: September 1, 2011
© 2011 College of American Pathologists

In This Issue:

Fla. Congressman Southerland (R) Visits Tallahassee Pathologists
Rep. Bass (R-NH) Tours Dartmouth Hitchcock Pathology Lab
Commonwealth Fund Study Finds Data Key to Managing Risk in ACOs
CAP Supports Medicare Data Release Safeguards
CAP Members, Lawmakers Interact at National Conference of State Legislatures
In Brief
Keep Up with the Latest CAP Advocacy News on Twitter

Fla. Congressman Southerland (R) Visits Tallahassee Pathologists

CAP members Drs. Manning and Sarback lead Rep. Southerland on a lab tour in early August. Florida Rep. Steve Southerland (R) recently toured KWB Pathology Associates in Tallahassee. The tour was led by CAP members Charles Manning, MD, FCAP and Stephen Sarbeck, MD, FCAP.

Located in the Florida Panhandle, KWB Pathology has 14 pathologists on staff and provides both laboratory cytology and surgical pathology services.

Rep. Bass (R-NH) Tours Dartmouth Hitchcock Pathology Lab

New Hampshire Congressman Charles Bass (R) recently toured Dartmouth Hitchcock Medical Center’s anatomic and clinical pathology laboratory in Lebanon. Rep. Bass is a member of the House Energy and Commerce Committee.

The tour was led by Candice C. Black, DO, FCAP, associate professor of pathology and residency program director at Dartmouth Hitchcock’s Norris Cotton Cancer Center.

Commonwealth Fund Study Finds Data Key to Managing Risk in ACOs

Many providers interested in participating in accountable care organizations (ACOs) do not currently have the infrastructure required to take on and manage risk, according to findings from a recent Commonwealth Fund-backed study on risk-sharing in eight private ACOs.

One key element lacking in this infrastructure is data, such as laboratory data; providers don’t have the data they need about the clinical or financial experience of their patients to manage patient care and financial risk effectively, reported the study’s authors. The study, “Promising Payment Reform: Risk-Sharing with Accountable Care Organizations”, summarizes research on ACO shared-risk models conducted by the Catalyst for Payment Reform and Booz Allen Hamilton for the Commonwealth Fund.

Unfortunately, information technology (IT) systems tend to remain siloed, commented Stuart Guterman, Vice President for Payment and System Reform at the Commonwealth Fund, regarding the study’s findings (he was not an author). Linking data from the laboratory and other sources to primary care physicians’ and specialists’ offices—as well as hospitals and patients—should be easier and more common with the emergence of electronic health records (EHRs). “Health IT systems need to link data that pathologists and labs provide into a broader, connective system so every provider can access what they need to treat their patients effectively,” he said.

In addition, decision support tools based on comparative effectiveness research can help to more clearly define what tests are needed and when—and what treatment works and for whom. Indeed, better information should help coordinate efforts among specialists and enhance the role of the pathologist as a member of the health care team, Guterman added.

Managing Risk

As noted in this Commonwealth study, private payers, as well as CMS, are more closely looking at payment methods placing a portion of the financial risk on the provider. This is viewed as a way to create stronger incentives to participate in coordinated care models as opposed to offering just shared savings. Indeed, the proposed CMS ACO rule includes two risk-sharing models. The Medicare Shared Savings Program’s one-sided risk model calls for no loss potential for the first two years of the ACO’s formation, while the two-sided risk model offers higher rewards for savings and some financial liability for losses.

Not surprisingly, this recent study found that there are varying definitions of shared risk. This variance may yield little guidance to providers weighing whether to participate in a local ACO. However, Commonwealth’s Guterman believes that both payers and providers crafting ACO agreements need to focus on risk sharing as responsibility sharing. “A lot of thought needs to go into structuring these ACO agreements so there is the right balance of responsibility without providers taking on undue risk,” he told Statline. “The goal should be to develop a health care financing system that encourages, rather than punishes, providers who care appropriately for their patients and take responsibility for the quality and outcomes of that care.”

Don’t miss the ACO luncheon at this year’s CAP ’11, to be held Tuesday, Sept. 13 at 11:45 a.m. – 1:15 p.m. The program, “Risks and Rewards: Lessons Learned From the Front Lines of Accountable Care”, will feature a panel discussion with Humana’s National Medical Director, Bryan Loy, MD, and the company’s Director, Network Relations and Provider Engagement Marcia James. A top official from the Brookings Institution’s Engelberg Center for Health Care Reform is also expected to participate on the panel, which will be moderated by CAP ACO Network Steering Group Chair Donald S. Karcher, MD, FCAP.

CAP Supports Medicare Data Release Safeguards

The College joined other health care provider groups in urging CMS Administrator Donald Berwick, MD, to ensure that certain safeguards are in place when the proposed rule on releasing of Medicare data for performance measurement is implemented beginning Jan. 1, 2012.

This proposed rule moves forward a statutory requirement of the Affordable Care Act requiring the release of Medicare claims data to qualified entities for the purpose of performance measurement. However, this data release program must address several critical issues for physician measurement and public reporting to be effective; most importantly, that the information is accurate and appropriately risk-adjusted, noted a letter to Dr. Berwick signed by the AMA, the CAP, along with other physician groups and state medical societies.

“If done correctly, public reporting has the potential to help provide appropriate and accurate information to patients, physicians, and other stakeholders that can improve quality at the point of care,” stated the letter. “If not approached thoughtfully, however, public reporting can have unintentional adverse consequences for patients.”

The letter also called for the program to allow physicians the opportunity to review any data that forms the basis for any public report. “Physicians and other providers must have the opportunity for prior review and comment, along with the right to appeal, with regard to any data or its use that is part of the public review process,” the letter stated.

CAP Members, Lawmakers Interact at National Conference of State Legislatures

CAP members and state legislators interacted at the annual National Conference of State Legislatures Legislative Summit, held this year in San Antonio at the Texas Henry B. Gonzalez Convention Center from August 9-11. With approximately 5,000 legislators and staff in attendance, this annual event is an important opportunity to build political visibility for the CAP and greater public understanding of the practice of pathology.

CAP member Dr. Laucirica meets with Bill Callegari, member of the Texas House of Representatives, at this year’s NCSL in San Antonio. This year, the CAP delegation was represented by members of the Texas Society of Pathologists: Rodolfo Laucirica, MD, FCAP, from Houston’s Baylor College of Medicine and Francis Edward Sharkey, MD, FCAP, from the University of Texas Health Science Center at San Antonio. Drs. Laucirica and Sharkey, as well as Mikael Troubh, Manager, CAP State Affairs, highlighted the College’s mission and advocacy agenda to legislators, along with programs that support patient care including CAP’s My Health Test Reminder and

CAP’s participation at NCSL Legislative Summit is important, as the vast majority of legislative issues affecting pathology are initiated at the state level, explained Dr. Laucirica. “At this annual event, we have the opportunity to educate state legislators about our specialty and how, as physicians, we serve a vital role in the diagnosis, management and therapeutic decisions of a variety of disease processes,” he added.

In Brief

CMS Extends Deadline for Complex Laboratory Test Demonstration to Sept. 6

Medicare officials have extended the deadline to participate in this demonstration. Those interested must now submit supporting information to request the necessary code to participate by Sept. 6. Outlined in the health care reform law, this demonstration allows laboratories to bill Medicare directly for certain complex laboratory tests performed on patient specimens collected at a hospital, but performed after discharge, that would otherwise be included in the DRG reimbursement. Payment for the two-year demonstration project is limited to $100 million; reimbursement begins Jan. 1, 2012. Details on participating in the demonstration project can be found online.

AMA Offering Workshops on 2012 CPT Changes

In December, the AMA will offer six CPT Changes Workshops around the country, in Atlanta, Baltimore, Dallas, New Jersey, San Diego, and Las Vegas. In addition to the 2012 CPT changes, the workshops will also cover the transition to ICD-10-CM.

Keep Up with the Latest CAP Advocacy News on Twitter

CAP Advocacy is now on on Twitter. Follow CAP Advocacy’s daily “tweets” to keep pace with regulatory and legislative news affecting the pathology industry. For the latest health care news, be sure to check out what we are following on Twitter.


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