College of American Pathologists
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September 3, 2009  •  Volume 25, Number 18
Next Issue: September 17, 2009
© 2009 College of American Pathologists

In This Issue:

Public Opinion Heats Up On HealthCare Reform Agenda as Congress Returns
From Recess

CAP Responds to CMS’ Proposed Medicare Physician Payment Schedule for 2010
CAP Leaders and State Pathology Society Presidents Meet to Discuss Healthcare Reform and CAP’s “Advocacy Now” Agenda
CAP Advances Role of Pathologist-Initiated Consultation in Response to CDC Report

Public Opinion Heats Up On HealthCare Reform Agenda as Congress Returns From Recess

When Congress returns from its August recess, one of the key barometers of who scored best in the healthcare debate will come from recent polling. Although polls can be partisan and not always accurate, they have been conducted on about every aspect of healthcare reform, and some will have a direct influence on policy on policymaker behavior. Here’s a snapshot of what we’ve found so far.

Most polls show a majority of Americans continue to support healthcare reform, but that percentage has declined since Congress went into August recess.

Interestingly, however, is the public increasingly admits that while their support for reform has waned, their understanding of what healthcare reform is and how it will affect their own quality and cost of treatment is significantly low.

In a recent Kaiser Health Tracking Poll released in August, results demonstrated that a slim majority of Americans, 53 percent, continue to favor moving forward on healthcare reform despite the intensity of public debate on the issue. This is a decline from a 61 percent majority from the same tracking poll conducted in June.

Possibly contributing to this slip in support could be that a vast majority of Americans admit to being confused about the specific details of the healthcare reform issues. According to a recent CBS News poll, 67 percent of respondents state they do not have an understanding of healthcare reform, and 60 percent feel that the President has not done enough to explain it. (This might explain why President Obama has announced he will give a speech about healthcare reform to Congress next week.)

Despite public information campaigns to explain the individual components of the healthcare reform agenda to the public, however, delivery system reform, or “changing the way doctors and hospitals deliver care and are paid,” was listed as the least important aspect of legislation, with only 9 percent of those surveyed identifying it as most important to them.

Though even when the complex details of reform are misunderstood, the public has a clear opinion on how their families will fair under a new system compared with how they feel others will benefit.

A paradox has opened, according to the Kaiser tracking poll, where only 34 percent of Americans feel the cost of healthcare will improve after reform when it comes to themselves and their families, while at the same time 40 percent feel costs will improve for the rest of Americans. These numbers shadow the question of will the quality of healthcare services improve, as 29 percent feel it will for themselves and family, and 37 percent feel it will for other Americans.

While the complexity and raw emotions surrounding the healthcare reform debate are likely only to increase in the coming months, one trend has remained steady throughout the polls—Americans feel that the most trusted decision-makers for recommendations on the course of the future of healthcare are physicians. In a July Gallup poll, for example, 70 percent of respondents rated doctors as their most trusted source of information.

To find out more information on how you can make your voice heard and help educate decisionmakers on the critical role of pathologists in patient care, contact Chris Sherin.

To view the polls cited in this article, visit:

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CAP Responds to CMS’ Proposed Medicare Physician Payment Schedule for 2010

The College provided the Centers for Medicare and Medicaid Services recommendations Aug. 27 on its proposed revisions to the Medicare Physician Payment Schedule for 2010, focusing on provisions addressing the practice expense, the Physician Quality Reporting Initiative, the Sustainable Growth Rate Formula and consultative services.

The proposed revisions from CMS, published in the July 13, 2009 Federal Register, included acceptance of data from the Physician Practice Information Survey (PPIS), a scientifically controlled undertaking between the AMA and CAP, together with other specialty societies.

In its comment letter, the College supported CMS’ proposal to accept the findings of the PPIS in order to update the data utilized to establish practice expense (PE) relative value units. Acceptance of these findings are crucial, as the practice expense data and physician hours currently used are from the outdated 1995-1999 AMA Socioeconomic Monitoring System (SMS) survey.

The phase-in of the new PPSI survey data will result in a change in the indirect/direct ratio, which gives greater weight to indirect practice expense costs. This change is responsible for eliminating the payment reduction for professional component pathology services from anticipated decline, culminating in the final phase-in year.

CMS also proposed pay-for-performance revisions that would eliminate claims-based reporting for the PQRI after 2010, and institute a minimum patient sample size.

The College requested that CMS not remove the claims-based mechanism for reporting in the PQRI program until registries and electronic health records (EHRs) have been more widely adopted. CAP disagreed with the proposed minimum for sample sizes, as this will reduce the number of pathologists that can participate in the PQRI.

While CMS noted that it expects the ongoing costs associated with PQRI reporting to decline based on increasing familiarity with the program and educational efforts, the low number of reporters in certain specialties indicates that the reporting burden may be higher than CMS estimates.

To remedy this, CAP urged CMS to work with physician organizations to educate their members about requirements that must be met to successfully report in 2010.

Addressing the SGR, CAP had previously advocated for the removal of the physician-administered drugs from the calculation of the formula. CMS’s proposal achieves this by proposing to remove them from the calculations retroactive to the 1996/1997 base year.

CAP also expressed concerned with CMS’ proposal to budget neutrally eliminate the use of inpatient and office/outpatient consultation codes by increasing the work RVUs for new and established office visits, initial hospital and initial nursing facility visits.

The proposed rule also indicates that the associated physician work is clinically similar for both inpatient consultation and office/outpatient consultation services and for initial hospital care and new patient office/outpatient visits.

While CAP understands that there has been much confusion generated by the use of these codes, it remains concerned about CMS circumventing the AMA CPT and RUC process. The College asked CMS to consider applying any budget neutrality adjustment across the physician fee schedule if the agency finalizes its statement that the work is indeed clinically similar.

To view the complete comments from the College, visit the CAP Advocacy website under “Letters to Policymakers.”

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CAP Leaders and State Pathology Society Presidents Meet to Discuss Healthcare Reform and CAP’s “Advocacy Now” Agenda

The College held its State Pathology Society Presidents Quarterly Conference Call Aug. 26, providing CAP leaders and state pathology society presidents an important opportunity to discuss healthcare reform and CAP’s Advocacy Now agenda, including issues that will impact pathologists now, and shape the practice of pathology for years to come.

“It is critically important for CAP and the state pathology societies to work together, particularly during the current healthcare debate, to ensure the long term strength of our specialty,” said Andrew Horvath, MD, FCAP, Council on Government and Professional Affairs chair, who provided an update from the CAP Board of Governors. “The input we receive from the state leaders on strategic issues is invaluable, and we depend on them to communicate with their members about issues we discuss on these calls.”

The “Advocacy Now” topics discussed amongst the group were:

  • Sustainable Growth Rate Formula: Expected to be corrected in the short-term, if not completely replaced in the long-term due to health care reform efforts
  • Physician Quality Reporting Initiative: CAP is working for pathologists to be able to avoid penalties for non-participation in until the necessary measures are approved
  • Physician Self-Referral: CAP has requested that Congress extend it’s Stark Law disclosure requirement to laboratory testing
  • TC Grandfather: A permanent extension in health care reform legislation may not be an option at this time due to budget and timing, forever a short-term extension is expected

Agenda items addressing the future of pathology included the call for a demonstration project to assess the value of incentivized pathologist-initiated consultations, the creation of Accountable Care Organizations, and private sector advocacy.

Along with state society presidents from around the country, also participating in the discussion was Richard Gomez, MD, FCAP, chair of the CAP Federal and State Affairs Committee, as well as expert CAP staff in both the Washington, D.C. and Northfield, Ill., offices.

For more information on the State Society Presidents’ Quarterly Conference Call, contact State Affairs manager Mike Troubh.

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CAP Advances Role of Pathologist-Initiated Consultation in Response to CDC Report

The College supported calls for open communication and key system improvements outlined in the Centers for Disease Control-funded supplemental Chapter to “Laboratory Medicine: A National Status Report” entitled Patient-centered Care and Laboratory Medicine, however the College expressed concern with assertions within the chapter that may promote the practice of medicine by non-physician laboratorians.

The College underscored the role of pathologists as physicians within the laboratory in its Aug. 15 response to the supplemental chapter of the report, which was drafted by the Lewin Group, and further offered a framework for advanced pathologist-initiated consultations as a means to improve patient care and increase efficiency.

In the letter, CAP highlighted that while all “laboratorians” play a critical role in delivering high-quality care, it is concerning that the report does not adequately distinguish between consultation services that constitute the practice of medicine and other laboratory services provided by non-physician laboratorians.

“Non-physician laboratorians have no medical training to provide consults on diagnostic test selection, test interpretation, and direction on optimal therapy options to patients and clinicians,” CAP stated. “Moreover, this type of activity is not consistent with the current scope of work for clinical laboratory technologists as provided under CLLA and under state laws regulating the clinical laboratory and laboratory personnel.”

CAP then provided a framework for incentivized pathologist-initiated consultations that would improve patient care and increase efficiency by enhancing collaboration between clinicians for test selection and therapy management as a method to improve patient care and increase efficiency.

To achieve this goal, the College advanced the idea of a demonstration project that would assess these advanced consultations under the premise that a pathologist is uniquely qualified to improve patient-centered care by not only providing a definitive diagnosis but by recommending optimal treatment options for the patient and delivering on the promise of personalized health care.

To view CAP’s complete comments, visit the Advocacy website under “Letters to Policymakers.”

View the draft Supplemental Chapter to the “Laboratory Medicine: A National Status Report” here.

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