ePolicy News February 2013
Friday, February 1, 2013
ASCP Urges Changes to Meaningful Use Rules
On Jan. 14, 2013, ASCP wrote the National Coordinator for Health Information Technology, Farzad Mostashari, MD, ScM, restating the Society’s concerns about the inability of pathologists to meet the Meaningful Use Requirements.
ASCP’s letter, sent in response to a proposal outlining draft goals and measures for Stage 3 of the Electronic Health Records’ Meaningful Use Requirements, asserted that the program’s “‘one-size-fits-all’ approach … is neither appropriate nor realistic.” ASCP also said the program’s requirements “could result in anti-competitive effects on the market to provide anatomic pathology and clinical laboratory services, and could force small- and medium-size laboratories from the market to provide laboratory services.”
Commenting on the draft proposal from the Office of the National Coordinator (ONC), ASCP raised concerns about the agency’s desire to mandate goals and measures that have broad applicability. ASCP noted that this approach to the Meaningful Use program has resulted in pathologists being subjected to clinical measures designed for physicians who regularly have direct, face-to-face encounters with patients. While the Department of Health and Human Services (HHS) has provided a temporary exemption to the requirements, it lacks the authority to grant permanent relief for pathologists. Thus, a legislative fix will likely be necessary.
Most of the proposed changes in the Stage 3 measures would increase the reporting thresholds on existing measures, such as substituting a 60-percent compliance requirement in Stage 3 for a 30-percent compliance requirement in Stage 2. ASCP cautioned ONC against increasing the Stage 2 thresholds, as the threshold requirements have yet to be implemented, and it is unclear if the lesser Stage 2 requirements are attainable. ASCP also raised technical concerns about the agency’s plans regarding abnormal test results. The Society noted that defining an abnormal test result depends on the methodologies used to calculate the result and that review of a raw result may complicate determinations of abnormal results.
ACOs Gain Traction, Docs and Hospitals Partner for Medicare Beneficiaries, Cost Savings
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced that doctors and healthcare providers have formed 106 new Accountable Care Organizations (ACOs) in Medicare. This will ensure that the nearly four million Medicare beneficiaries will have access to high-quality, coordinated care. “Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the high-quality care they expect and deserve,” Ms. Sebelius said. “Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare.”
Physicians and other healthcare providers can establish ACOs to collaborate on providing higher-quality care to their patients. Since passage of the Affordable Care Act, more than 250 ACOs have been established. Beneficiaries using ACOs always have the freedom to choose doctors inside or outside of the organization. ACOs share any savings generated from lowering the growth in healthcare costs with Medicare, while meeting standards for quality of care.
ACOs must meet quality standards that ensure cost savings are achieved through improved care coordination and administration of care that is appropriate, safe, and timely. The Centers for Medicare & Medicaid Services (CMS) has established 33 quality measures. These include care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. The estimated savings from this initiative could be up to $940 million over four years.
The new ACOs include a diverse cross-section of physician practices nationwide. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately 20 percent of ACOs include community health centers, rural health centers, and critical access hospitals serving low-income and rural communities.
This new crop of ACOs also includes 15 Advance Payment Model ACOs, which are physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination. Medicare will recoup advance payments over time through future shared savings. In addition to these ACOs, last year CMS launched the Pioneer ACO program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time.
HHS has also issued a new report showing that Affordable Care Act provisions have already begun to have a substantial effect on reducing Medicare spending. Growth in Medicare spending per beneficiary hit historic lows between 2010 and 2012, according to the report. The Office of the Actuary at CMS and the Congressional Budget Office both project that Medicare spending per beneficiary will grow at approximately the same rate as the economy over the next decade, breaking a decades-old pattern of spending growth outstripping economic growth.
NIH Genetic Test Registry to Integrate AMA’s CPT Codes
The National Institutes of Health (NIH) recently announced an agreement with the American Medical Association (AMA) to include Current Procedural Terminology (CPT) codes for molecular pathology tests in the
Genetic Testing Registry (GTR). The GTR, which is operated by the National Library of Medicine’s National Center for Biotechnology Information (NCBI), serves as a comprehensive resource for genetic test information. The database provides a central location for voluntary submission of genetic test information by providers, and includes the test’s purpose, methodology, validity, and utility, as well as laboratory contacts and credentials.
Under the agreement, AMA’s CPT codes for molecular pathology tests will be integrated into GTR, which will benefit from the new, more highly detailed codes developed for molecular pathology which took effect last year. The new codes reflect the latest advances in genetic testing and molecular diagnostic services for reporting and tracking purposes. Inclusion of the CPT codes in GTR further enhances the database’s interoperability with electronic
health records and laboratory information management systems.
Health Profession Coalition Recaps Congressional Action, Predicts Next Steps for 113th
At a recent meeting of the Health Professions and Nursing Education Coalition (HPNEC), participants received an update on several Congressional actions that affect funding for health professions training. Among them was President Obama’s signing of the American Taxpayer Relief Act of 2012, which narrowly averted the fiscal cliff. The law delays sequestration until March 27, 2013. (See
January edition of
ePolicy for a detailed discussion of the Fiscal Cliff). Debt ceiling negotiations and the fiscal year (FY) 2013 spending bills may provide additional threats to discretionary spending, which encompasses health workforce training.
In addition, in terms of the spending bills, Washington insiders speculate that there may be an FY 2013 omnibus appropriations bill, which would include the Labor-Health and Human Services-Education spending rather than extending the current continuing resolution for the remainder of the fiscal year. HPNEC, of which ASCP is a member, will likely circulate a letter to Congress, urging that funding for Title VII and Title VIII be preserved in whatever manner they choose to resolve the FY 2013 spending bills.
The new year has barely just begun, yet attention has already turned to recommendations that will be presented to Congress and the White House for FY 2014, emphasizing the importance of health professions training. Coalition members have been asked to contemplate what appropriations recommendations their organizations will make for FY 2014 and if those requests align with HPNEC’s activities.
Expanding Core Interventions Key to Eradicating AIDS
More than three decades after the AIDS epidemic began, policy makers and public health officials are now discussing how to end HIV/AIDS. Extensive advocacy efforts, lower HIV drug prices, significant advances in research, and an unprecedented international response have led to expanded global access to HIV care and treatment and improved capacity at all levels. New infections are decreasing, and more people are receiving treatment to live longer, healthier lives.
“We are at a critical tipping point,” said Deborah Birx, MD, Director of the Center for Global Health, Division of Global HIV/AIDS at the Centers for Disease Control and Prevention (CDC). Dr. Birx spoke at last month’s meeting of the Global AIDS Policy Partnership (GAPP), which brings together members of the global HIV/AIDS community to share information, discuss legislative strategy, and develop consensus positions to present to legislators. “If the focus and momentum of the past 14 months can be maintained and enhanced across countries, the course of the epidemic can be altered in the long run,” Dr. Birx said.
The most recent CDC data measuring the impact of U.S. global HIV/AIDS programs indicates that rapid scaling up of core interventions could change the course of the epidemic and save millions of lives. Significant progress continues to be made in many countries as a result of rapid scale-up of focused, evidence-based programming.
However, specific countries continue to lag, and it appears the coverage and intensity of key services is critical to controlling the epidemic. The fact that there are “successful” countries next to “lagging” countries indicates that the changing course of the epidemic can be attributed to programming.
In December, U.S. Secretary of State Hilary Rodham Clinton released a blueprint for achieving an “AIDS-free generation.” Mrs. Clinton’s plan,
PEPFAR Blueprint: Creating An AIDS-Free Generation, released on World AIDS Day on Dec. 1, 2012, seeks to build upon the President’s Emergency Plan for AIDS Relief (PEPFAR) initiative’s success to reduce global AIDS. The blueprint calls for partner countries to share the responsibility in leading efforts to eradicate AIDS. Each country must demonstrate political will and effective coordination of multiple partners that finance and implement interventions both within and outside of the health sector. Further, they must meaningfully engage those living with and affected by HIV in all aspects of the response.
ASCP Weighing in on California Proposed Laboratory Personnel Licensure Rules
The California Department of Public Health has released a proposed rule to revamp the state’s current regulations governing the licensure of
medical laboratory personnel. While the rule has not yet been officially released to the public, it has been sent to interested parties, including ASCP, for their review before it is made public later this year.
The proposed rule resumes a regulatory initiative the Department began in 2010. That rule, which had numerous flaws, was partly intended to eliminate licensing standards that “serve as barriers to licensure for qualified persons, especially those coming from outside the state of California.” Consequently, the Department received several thousand comments—the largest number it had ever received on a rule. Widespread concern and the complexity of the issues raised forced the Department to scuttle the rule and start over.
The new proposal addresses many of the concerns raised in 2010. As part of the recent alliances between ASCP and medical societies, such as the California Society of Pathologists, American Society for Clinical Laboratory Science, American Society of Cytopathology, and the American Society for Cytotechnology, the Societies collectively sent a letter that raised alarm about the Department’s treatment of accredited training programs and arbitrary barriers to individuals trained outside of California.
ASCP is currently reviewing the 200-page rule and plans to work closely with other laboratory organizations to identify and address issues that affect laboratory professionals and quality laboratory testing.
ASCP Honors Former First Lady Laura W. Bush and Barbara Pierce Bush for Healthcare Initiatives
ASCP recently presented former First Lady Laura W. Bush and her daughter Barbara Pierce Bush with the Society’s Patients’ Advocate Award for their respective work in global health care.
Mrs. Bush, a keynote speaker at the 2012 ASCP Annual Meeting, helped to launch the
Pink Ribbon Red Ribbon campaign, an initiative of the Bush Institute, to offer cervical and breast cancer
prevention and early detection in sub-Saharan Africa and Latin America. The $75 million campaign, which is being hailed by the United States Department of State, draws upon partnerships from the President’s Emergency Plan for AIDS Relief (PEPFAR), former President George W. Bush’s initiative, as well as the Susan G. Komen Foundation, President Obama’s Global Health Initiative, and the United Nations Programme on HIV/AIDS (UNAIDS).
Jeff Jacobs, Senior Vice President, ASCP Institute for Science, Technology and Public Policy, presented Former First Lady
Mrs. Bush with the Society’s Patients’ Advocate Award for her work as an exemplary global health advocate. Her daughter
Ms. Bush also received the Patients’ Advocate Award.
ASCP recognized Ms. Bush, Founder and CEO of Global Health Corps, a nonprofit agency, for her work in predominantly African nations to bring health care to those most in need. Global Health Corps partners with existing health organizations and government agencies to identify specific needs and then sends in two-person teams to address problems concerning logistics, supply chain issues, and information technology challenges.
Ms. Bush’s passion for global health issues began during her first trip to Africa in 2003. There, she met a 7-year-old girl who was in such poor health and so small that she was unable to walk. Ms. Bush was so moved by the child’s situation that she dropped an interest in architecture and switched her studies at Yale University to global health.
“I just couldn’t believe that little girl’s life couldn’t be different than what it was,” Ms. Bush said. “The more you learn about global health, the more you realize the numbers of people who are in the same situation as that little girl because they don’t have access to health care.”
U.S. Spends More on Health Care, Yet Lags Behind Wealthy Nations in Health
Americans are in poorer health and dying younger than citizens of 16 other wealthy countries, according to
U.S. Health in International Perspective: Shorter Lives, Poorer Health,
a new report from the Institute of Medicine (IOM) and the National Research Council. The United States ranked last among the 17 countries studied in terms of life expectancy for men, with American men living about four years less than men in top-ranked Switzerland. Among women, the U.S. ranked 16th out of 17; women’s life expectancy in the United States is about five years shorter than women in top-ranked Japan.
Despite spending more per capita on health care than any other country, the United States also ranks at, or near the bottom in infant mortality and low birth weight, injuries and homicides, teen pregnancy and sexually transmitted diseases, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability.
“We were struck by the gravity of these findings,” said Steven H. Woolf, Professor of Family Medicine at Virginia Commonwealth University in Richmond, Va., and Chair of the Panel that wrote the report. “Americans are dying and suffering at rates that we know are unnecessary, because people in other high-income countries are living longer lives and enjoying better health. What concerns our panel is why, for decades, we have been slipping behind.”
The Panel examined historical health trends covering several decades and determined that no single factor caused this country’s health disadvantage. Rather, the deficiencies are likely due to multiple causes and involve some combination of inadequate health care, unhealthy behaviors, adverse economic and social conditions, and environmental factors, as well as public policies and social values that shape those conditions. Without action to reverse current trends, the health of Americans will probably continue to fall behind that of people in other high-income countries. The panel recommended further research into what the other 16 countries are doing to improve their health status, so that those strategies could be adapted to this country. Yet it also warned policy makers not to wait for further research before taking action.
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