Grassroots
College Represented at National Conventions
The College sent members and staff to both the Democratic and Republican National Conventions this year, where they met with legislators and delegates at multiple events co-hosted by the CAP—with partners including the American Medical Association and the American Dental Association—some of which raised money for American Red Cross efforts for Hurricane Gustav.
Regulatory Affairs
CAP Responds to Proposed 2009 Physician Fee Schedule
The College submitted comments to the Centers for Medicare and Medicaid Services Aug. 29 on the proposed Physician Fee Schedule for 2009, supporting CMS’s efforts to end financial incentives for ordering lab tests, while cautioning against publicly reporting the results of the Physician Quality Reporting Initiative until independent labs can participate.
In the proposed rule CMS-1403-P, “Medicare program; Revisions to Payment Policies Under the Physician Fee Schedule and other Revisions to Part B for CY 2009,” CMS offered two alternative approaches for revising the current anti-mark-up provision—which aims to limit the ability of an ordering practice to profit from laboratory tests.
The College strongly urged CMS to adopt the approach that applies the anti-markup provision to all technical component and professional component diagnostic tests that are ordered by the billing physician or other supplier unless the physician who performs and supervises the pathology services is dedicated solely to that physician organization.
The College urged CMS to except from application of the anti-markup provision single specialty pathology physician groups and independent laboratories, however, who generally do not order tests and utilize pathology/laboratory CPT codes for at least 75 percent of their billings. The CAP also asked CMS to exclude anatomic pathology from the in-office ancillary services exception to the physician self-referral regulations.
This method would both protect legitimate multi-specialty group practices that employ their pathologists on a full-time basis, while closing down the “in-office” loophole that allows for financially exploitative “Pod labs.”
The College applauded CMS for proposing substantive changes to the Reassignment Rule and the Physician Self-Referral Regulations to address a number of the existing abuses in the billing and payment for pathology services, and urged prompt action to finalize bright-line tests specifying the level of involvement in laboratory testing required before a referring practice can bill for lab tests that they order.
CMS also requested feedback on how PQRI data may be used by physicians, consumers, and other stakeholders in a public reporting system—the CAP believes, however, it is premature to report PQRI performance data in a public reporting system for several reasons, including the inability of independent laboratories to participate until at least 2010.
Pathologists employed by independent laboratories have been told by carriers that their computer systems cannot accept the necessary quality data from the labs required for reporting, a glitch which CMS reports was not a policy decision but an oversight—a problem the College is working with CMS to resolve.
Additionally, public reporting of participation might imply a lack of interest in quality of non-participants, when in fact they may simply not practice in the medical specialty areas in which PQRI performance measures available, such as cytopathology.
As a result of the passage of Medicare legislation earlier this year, CMS will be required to implement in its final 2009 physician fee schedule rule the legislative fix that requires the budget neutrality adjustor be applied to the conversion factor rather than the Work RVUs.
In the comments, the College praised this change and urged CMS to also remove the Budget Neutrality adjustor from the work RVU indirect practice expense formula to ensure the intent of the law is carried out. CMS’s initial 2007 implementation, which was opposed by CAP and the American Medical Association, resulted in reduction in payment to pathologists—with the greatest impact faced by hospital based pathologists.
The complete comments are available on the CAP Web site:
College Advises CMS on Clinical Validity of Testing for
Warfarin Metabolism
The College advised the Centers for Medicare and Medicaid Services Sept. 3 that there is evidence for the clinical validity and utility of pharmacogenomic testing for warfarin in predicting variability in patients’ response to therapy with the metabolism.
The College’s comments cited recent findings issued by the Brookings Center, which summarized the likely improvements in outcome and healthcare cost savings in pursuing this strategy.
The comments came in response to CMS’ request for feedback on a proposed National Coverage Analysis, aimed at determining if the use of pharmacogenomic testing for warfarin is reasonable, effective and necessary for the Medicare beneficiary population.
The College stated that prospective outcomes clinical trials are underway, and the results of the trials are anticipated to corroborate and enhance support for implementation of the testing.
According to the College, “The improved outcomes related to pharmacogenetic testing include a decreased time to achieving optimal therapeutic range of warfarin, and a decreased time outside the therapeutic range, with the consequent expected benefits of fewer major hemorrhagic and thrombotic events.”
Furthermore, the College advised that if CMS determines current evidence from completed studies is insufficient to reach a decision, CMS should delay the National Coverage Analysis until the completion of another clinical trial which is already underway, sponsored by the National Heart, Lung, and Blood Institute.
The College’s complete comments can be found on the Advocacy Web site.
HHS Proposes New ICD-Code Sets and Electronic Transaction Standards
The Department of Health and Human Services announced two proposed regulations Aug. 15 that would update the ICD-9-CM code sets now used to report healthcare diagnoses and procedures, and adopt new updates for electronic transaction standards. Public comments are due on October 21, 2008.
HHS’ proposal would replace the ICD-9-CM code sets with greatly expanded ICD-10 code sets effective Oct. 1, 2011, accommodating new procedures and diagnosis with 138,000 additional codes. The transition is intended to enable implementation of electronic health records by providing more details in the electronic transactions.
The proposal for updating electronic transactions consists of the adoption of the X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0. These updates are critical for use of the proposed ICD-10 code sets.
The College and the American Medical Association sent a letter to the Office of Budget and Management July 18 in anticipation of the proposals, cautioning that such an update of that magnitude would require: a comprehensive impact analysis of all covered entities; adoption of Version 5010 before implementation of ICD-10; development of a test-pilot program; and adequate time for training and aggressive outreach.
The College will continue to work with internal and external stakeholders to develop official comments for the Oct. 21 deadline.
PSO Common Formats Version 0.1 Beta Now Available
The Department of Health and Human Services’ Agency for Healthcare Research and Quality has released Common Formats for collecting and reporting patient safety information, including adverse events, near misses, and unsafe conditions.
The Common Formats, now available for download through AHRQ’s PSO Web site, provide common definitions and reporting formats that health care professionals can use to collect and track patient safety information.
These Common Formats were authorized by the Patient Safety and Quality Improvement Act of 2005, and they facilitate Patient Safety Organizations’ collection of patient safety work product from providers in a standardized manner. The formats will be used by providers and PSOs to report a comprehensive range of patient safety concerns, capturing both structured and narrative information.
AHRQ plans to issue updates and revisions to the Common Formats based upon feedback from users and other stakeholders. The Agency has contracted with the National Quality Forum to assist with gathering and analyzing feedback that will guide future versions of the Common Formats.
To learn more and to view AHRQ’s Common Formats Version 0.1 Beta, go to the AHRQ
Patient Safety Organization Web site.
Information Available From CMS On Hurricane State of Emergencies For Patients and Providers
The Centers for Medicare and Medicaid Services has provided online information to help answer your questions about the State of Emergency declared by the President and the Secretary of Health and Human Services as a result of Hurricane Gustav, or other storms that may affect patients and providers throughout hurricane season.
Advocacy Briefs
Rep. John Sullivan (R-OK), a member of the House Energy and Commerce Subcommittee on Health, is provided a demonstration of laboratory equipment by C. Terrence Dolan, MD, during a Congressional lab tour at Regional Medical Laboratory in Tulsa, OK, Aug. 26.
While the 110th Congress is winding down, it is not too late to host your Senator or Representative on a laboratory tour. For more information, contact Chris Sherin either by phone, 202-354-7129, or email.
(For Statline reprint permission, please contact Justin Herman.)
STATLINE Archive
Contact: statline@cap.org
202-354-7100 • 202-354-7155 (fax) • 800-392-9994 |
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