Read the Latest Issue of STATLINE
June 30, 2015
In This Issue:
- Pathologists in FL, CAP Will Urge First Coast to Withdraw IHC LCD
- Register for the CAP's Proposed Medicare Physician Fee Schedule Webinar
- CAP Engaged on Upcoming IOM Study on Diagnostic Errors
- IPAB Repeal Passes House, Faces White House Veto Threat
- Pathologists Discuss How to Host A Lab Tour During Upcoming Webinar
Pathologists in FL, CAP Will Urge First Coast to Withdraw IHC LCD
Florida pathologists and the CAP will strongly oppose the Medicare Administrative Contractor (MAC) First Coast Service Options, Inc., proposal to adopt a local coverage determination (LCD) policy to limit coverage on special histochemical stains and immunohistochemical (IHC) stains.
First Coast, which oversees Medicare administration in Florida, proposed an LCD that is similar to a coverage policy on special stains adopted by the MAC Palmetto. Palmetto implemented the LCD with little revision despite the CAP's objection and well-supported comments pointing out flaws throughout the LCD. The CAP called for the Palmetto LCD to be withdrawn and opposed its implementation in other Medicare jurisdictions throughout the United States.
In Florida, the proposed First Coast LCD does differ in just one area from the Palmetto LCD. First Coast proposes to add further restrictions to the gastrointestinal section. The restrictions appear to be inconsistent with guidelines. If the restrictions are adopted, Medicare patients in their 60s would be adversely affected even though they meet Bethesda criteria and/or have MSI-H histology.
The table below provides the status of the special stains LCDs from around the country. The CAP will continue to keep members updated on new developments regarding this policy in future editions in STATLINE.
Status of Special Stains LCD
|Palmetto||North Carolina, South Carolina, Virginia, West Virginia||Final, effective 3/16/15|
|Noridian||California, Hawaii, Nevada||Proposed draft, comment deadline was 3/30/15|
|Noridian||Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming||Proposed draft, comment deadline was 4/10/15|
|CGS||Kentucky, Ohio||Proposed draft, comment deadline is 8/3/15|
|First Coast||Florida||Proposed draft, comment deadline is 7/27/15|
|Note: Table updated on June 29, 2015|
Register for the CAP's Proposed Medicare Physician Fee Schedule Webinar
With Medicare's payment rule expected any day, CAP members are encouraged to register for the College's July 8 webinar "Understanding the 2016 Medicare Physician Fee Schedule Proposed Rule." Throughout this hour-long panel discussion, CAP experts will explain the changes proposed by the Centers for Medicare & Medicaid Services (CMS) regarding the 2016 fee schedule.
The proposed fee schedule will contain reimbursement changes affecting pathologists. During this session, attendees will learn about the proposed rule's pathology-related policies, the potential impact on pathologists, and the CAP's advocacy efforts to impact the CMS’ proposal prior to its finalization.
CAP Engaged on Upcoming IOM Study on Diagnostic Errors
In September, the CAP expects the Institutes of Medicine (IOM) will publish a consensus study on diagnostic error in health care. The CAP preeminence in quality improvement supports efforts to prevent errors in all stages of the testing process. Accordingly, the CAP supports studying the issue of diagnostic errors and working to ensure quality tests for patients.
The CAP is a sponsor of the IOM Report, along with the American College of Radiology, American Society for Clinical Pathology, and several other physician and patient organizations and foundations. Two CAP members, Michael B. Cohen, MD, FCAP, and Michael Laposata, MD, PhD, FCAP, are on the IOM study committee.
The IOM states that the study committee is examining the current definitions of diagnostic error and illustrative examples; the epidemiology, burden of harm, and costs associated with diagnostic error; and current efforts to improve diagnosis. "The committee will develop recommendations to reduce diagnostic error in health care," according to the IOM website. "Action items for key stakeholders may focus on education, the culture of health care, information technology, systems engineering, measurement approaches, changes in payment, and further research."
The IOM report will also study diagnostic errors by clinicians, in addition to radiology and pathology. The release date is anticipated to be this September.
In April 2014, the CAP submitted comments to the IOM. While errors can occur during every step of the testing process, the frequency of errors is low in the pre-analytic, analytic, and post-analytic phases, the CAP stated.
The CAP will continue to keep members informed about the IOM study in future editions of STATLINE.
IPAB Repeal Passes House, Faces White House Veto Threat
The House passed legislation to eliminate the Medicare Independent Payment Advisory Board (IPAB), but permanent repeal of the independent body that would recommend Medicare cuts to Congress when program costs exceed spending growth targets will be difficult to achieve in the Senate and White House.
The House passed the "Protecting Seniors' Access to Medicare Act of 2015" (HR 1190) 244-154 on June 23. Just 11 Democrats joined Republicans to vote for the bill after cuts to the Affordable Care Act were used to offset the $7 billion cost of eliminating the IPAB.
The Affordable Care Act calls for the creation of the 15-member board IPAB appointed by the president and confirmed by the Senate to study the Medicare program and ensure costs are contained. The IPAB would be similar to the current Medicare Payment Advisory Commission (MedPAC) which advises Congress on Medicare policy. Unlike MedPAC, Congress would be bound to IPAB's recommendations to curb spending or find alternative ways to make cuts.
To date, President Obama has yet to appoint members to the IPAB as per capita Medicare spending growth has yet to exceed spending targets.
On June 15, the White House stated the president would likely veto the bill if it had passed both the House and Senate. "The bill would eliminate an important safeguard that, under current law, will help reduce the rate of Medicare cost growth responsibly while protecting Medicare beneficiaries and the traditional program," the Obama administration said. "While this safeguard is not projected to be needed now or for a number of years given recent exceptionally slow growth in health care costs, it could serve a valuable role should rapid growth in health costs return."
Pathologists Discuss How to Host A Lab Tour During Upcoming Webinar
Register today for the CAP's "How to Host a Lab Tour" webinar will provide training for CAP members interested in hosting a lab tour for their member of Congress.
The presentation will cover the planning and logistical details, as well as provide case studies from CAP members who have conducted tours. The presentation will cover:
- What to expect when communicating with an elected official's office
- Developing a good itinerary for the tour
- Providing a hands-on experience in the laboratory