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ePolicy News June 2012

Thursday, May 31, 2012



ASCP Tells Congress: Self Referral, EHR Meaningful Use Reform Critical

In a May 27 letter to the U.S. House Ways and Means Republican leadership, ASCP outlined several policy recommendations to address the failures of the Medicare Physician Fee Schedule’s (PFS) annual update process. If not for Congressional intervention, the flawed sustainable growth rate (SGR) would regularly impose massive cuts in the PFS. Indeed for 2013, the SGR formula would trim the PFS by approximately one third!

ASCP’s letter urged Congress to close gaping loopholes in the In-Office Ancillary Services Exception (IOASE), suggesting that the policy could help pay for some of the cost of fixing the SGR. The IOASE, which includes such services as anatomic pathology, advanced imaging, radiation oncology, and physical therapy, allows clinicians to in-source these services. It is the inclusion of these services on the IOASE that has lead, according to volumes of academic literature, to significant overutilization of costly, sometimes invasive, medical services. ASCP, together with the Alliance for Integrity in Medicare—an organization composed of like-minded organizations representing pathology, advanced imaging, radiation oncology, and physical therapy—believes these services should be removed from the list of services found in the IOASE.

Additionally, ASCP provided support for Congressional efforts to infuse quality metrics into the PFS but urged that it provide the Centers for Medicare and Medicaid Services with sufficient authority to exempt those physicians or specialties that, through no fault of their own, cannot meet the requirements. ASCP pointed out that the Electronic Health Records (EHR) Meaningful Use Incentive Program, while serving the noble purpose of increasing the adoption of EHR systems, includes a framework that essentially singles out pathologists for reimbursement penalties that could exceed 3 percent. ASCP urged the Committee to support HR 4066, which would exempt pathologists from the meaningful use program’s reimbursement penalties.




Update on CMS Bundling Initiatives

In late April, the Department of Health and Human Services Centers for Medicare and Medicaid Innovation will begin seeking applications for four broadly defined models of care. Three of these models of care would involve a retrospective bundled payment arrangement, with a target payment amount [set by applicants (providers) and the Centers for Medicare and Medicaid Services (CMS)] for a defined episode of care and one model of care that would be paid prospectively.

The initiative is one of many programs mandated by the Affordable Care Act. Research has shown that bundled payments can align incentives for providers—hospitals, post-acute care providers, doctors, and other practitioners—to partner closely across all specialties and settings that a patient may encounter. As a result,the patient’s outcome often improves during a hospital stay in an acute care hospital and during post-discharge recovery.

Under the Bundled Payments initiative, CMS would link payments for multiple services patients receive during an episode of care. For example, instead of a surgical procedure generating multiple claims from different providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver healthcare services more efficiently while maintaining or improving quality of care. Providers will have flexibility to determine which episodes of care and which services would be bundled together.

In Model 1, the episode of care would be defined as the inpatient stay in the general acute care hospital. In this instance, physicians would be compensated through the Medicare Physician Fee Schedule.

In Model 2, the episode of care would include the inpatient stay and post-acute care and would end, at the applicant’s option, either a minimum of 30 or 90 days after discharge.

In Model 3, the episode of care would begin at initiation of post-acute care with a participating Skilled Nursing Facility, Inpatient Rehabilitation Facility, Long-Term Care Hospital , or Home Health Agency within 30 days of discharge from the inpatient stay and would end no sooner than 30 days after the initiation of the episode.

In both Models 2 and 3, the bundle would include physicians’ services, care by the post-acute provider, related readmissions, and other Part B services proposed in the episode definition such as clinical laboratory services; durable medical equipment, prosthetics, orthotics and supplies (DMEPOS); and Part B drugs.

Under Model 4, CMS would make a single, prospectively determined bundled payment to the hospital that would encompass all services furnished during the inpatient stay by the hospital, physicians, and other practitioners.




Kaiser Poll Finds Bipartisan Support for Spending on Global Health

Two-thirds of Americans say that the United States is spending too little or about the right amount on global health with one in five saying spending is too high, according to a new Kaiser Family Foundation survey on the public's views of global health issues.

Americans overall are divided about whether or not more spending by the United States and other major donors would lead to meaningful progress in improving health in developing countries. About 49 percent believe it would, while 47 percent believe it would not make much difference. Analysis of the survey shows that those who believe more spending will lead to progress are far more likely to support increased aid than those who think it would not make a difference—42 percent compared with 18 percent.

One likely reason for the public's mixed views on the potential impact of more spending is the perception about how much aid reaches the people who need it. On average, Americans say that less than a quarter (23 cents) of each U.S. tax dollar spent to improve health in developing countries is getting to where it needs to be on the ground, and that 47 cents of each dollar is lost through corruption.

“One of the strongest predictors of support was the belief that aid would make a difference,” said Foundation President and CEO Drew Altman in a press release. “This means that documenting the impact of assistance and then communicating that to opinion leaders and the public is absolutely critical for advocates of foreign aid and global health.”

When asked about spending “to improve health for people in developing countries,” two-thirds of the public says the United States is now spending too little (32 percent) or about the right amount (34 percent), while one in five (21 percent) say we are spending too much. Support for current spending is shared across party lines, with a majority of Democrats (74 percent), independents (66 percent) and Republicans (59 percent) responding that the United States spends too little or about the right amount on global health.

The survey also explores views on foreign aid in general, and finds that while the public continues to overestimate the amount the U.S. spends on foreign aid, providing accurate information can shift opinion. On average, Americans estimate that 27 percent of the federal budget is spent on foreign aid, when in reality is accounts for just 1 percent. After hearing that foreign aid represents about 1 percent of the federal budget, the share of people saying the United States spends too much on foreign aid drops in half (from 54 percent to 24 percent) and the share saying the United States spends too little doubles (from 17 percent to 36 percent).




Help Wanted: ASCP Vacancy Survey Launches

Every other year, the American Society for Clinical Pathology (ASCP) conducts a crucial service for its members and the profession: the ASCP Wage and Vacancy Surveys. These surveys, conducted for the past 22 years, have become the primary source of information for academic, government, and industry experts in defining the state of the nation’s laboratory professional workforce.

This year, the ASCP will begin with conducting its 2012 Vacancy survey of the laboratory professionals in the field. The new vacancy survey includes additional questions, specifically:

  • Have new testing technologies in their laboratories had a substantial impact on staffing needs? Has this resulted in a reduction or increase in staff?
  • What happens to unfilled positions? Are they eliminated or left open until filled?

As in the past, the survey will seek to collect staff- and supervisory-level data, as well as recruitment and retention information in the laboratory workforce.

The 2012 ASCP Vacancy Survey will launch on June 15, 2012, and will remain open until August 15, 2012.

The Wage survey report will be included in the November 2012 issue of LabMedicine while the Vacancy survey report will appear in the February 2013 issue of LabMedicine.


ASCP Seeks Inclusion of Laboratory Medicine on Health Advisory Board

ASCP recently submitted a letter to IBM concerning the desire to add laboratory medicine expertise to its newly formed Watson Healthcare Advisory Board. The board members include medical leaders with expertise in areas such as primary care, oncology, biomedical informatics, and medical innovation. The advisory board will specifically focus on medical industry trends, clinical imperatives, regulatory considerations, privacy concerns, and patient and clinician expectations around the Watson technology and how it can be incorporated into clinician workflows. ASCP maintained in its correspondence that given the vital role that pathology and laboratory medicine play in the delivery of health care, it is fitting that representation from the laboratory community on this advisory board would offer a wealth of knowledge and expertise in trend analysis, research, patient care, and testing.  



Laboratory medicine plays important role in the era of molecular medicine care

The Institute of Medicine (IOM), in partnership with the Center for Medical Technology Policy (CMTP), assembled a roundtable on translating genomic-based research for health care, education, and policy. The meeting brought together leaders from academia, industry, government, foundations and associations, and representatives of patient and consumer interests. Issues surrounding oncology and clinical utility were the main topics discussed between speakers and participants. The first session, which focused on stakeholder requirements for and evaluation of evidence called for identifying needs, gaps, and issues in guideline development processes, payer coverage policy, and provider/patient decision-making.

Another important perspective concerned comparative effectiveness research methodologies for cancer genomics. The panel for this session discussed the importance of proper statistical approaches for study design and analysis, so that the cost effectiveness and clinical utility of oncology-based molecular diagnostics may be assessed. Lastly, the group raised the topic of fostering partnerships to accelerate evidence development. The speakers explained that each group involved in the molecular diagnostics realm play a crucial role in moving forward.

As the medical landscape continues to evolve, the knowledge and expertise of laboratory medicine personnel will become increasingly valuable since the field will be involved in molecular diagnostic tests, payer coverage, and diagnosis. ASCP also supports the goals of comparative effectiveness research in ensuring patient-centered care. For more information on the workshop, please click here.

AHA recommends greater oversight of genetic tests

The American Heart Association (AHA) recently assembled a panel of experts to develop policy recommendations regarding genetic testing for cardiovascular medicine. The group recommends greater federal oversight on genetic testing to ensure it is applied in clinical care with proper safety and security. The authors also argue that “further patenting of the DNA sequences should not be approved in cases in which the invention is merely the observation of functionally unaltered human DNA.” For the link to the article, click here.



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