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ePolicy News March 2014

Monday, March 3, 2014



ASCP Partners with CMS Leadership to Expand the Scope of Quality Reporting

ASCP recently had the opportunity to meet with the leaders of the Centers for Medicare & Medicaid Services (CMS) to discuss the future of CMS-developed quality reporting programs and their application to the pathology specialty. On Wednesday, Feb. 26, ASCP leadership met with CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer Patrick Conway, M.D., and his team at the CMS Center for Clinical Standards and Quality (CCSQ). The Society offered suggestions to expand the scope of CMS-led quality assessment efforts so that they better capture existing quality improvement efforts across all specialty type providers. “The purpose of the meeting was to come together to figure out the best way that pathologists can meaningfully report on and improve quality,” reports Steven Kroft, MD, FASCP, ASCP President and Vice Chair for Clinical Pathology and Director of Hematopathology at the Medical College of Wisconsin.

The meeting was prompted by ASCP concerns that characteristics of the current CMS-developed quality reporting programs do not align with many of the unique traits of the pathology specialty, such as the lack of face-to-face patient encounters; the prominent role at the pre- and post-analytic phase of care delivery; and the typical system-wide quality improvement efforts. “This innate incongruence between the traits of our specialty and the traits of CMS’s quality reporting programs limits pathologists’ ability to participate in these programs and limits CMS’s ability to capture the full scope of quality improvement efforts across the laboratory and pathology community,” continues Dr. Kroft. “Our intentions were not only to ensure that these efforts are formally recognized by CMS, but to partner with the Agency so that these efforts can be appropriately targeted and documented in a meaningful way that informs quality improvement and positively impacts patient care.”

The meeting was initially set in order to discuss the details of a proposal submitted by the Society in December that outlined an alternate avenue by which providers could fulfill PQRS requirements, thereby avoiding negative payment adjustments and ensuring patient access to Medicare services. ASCP informed our members of the details of this proposal in a special edition ePolicy article, released in December. The proposal demonstrated ASCP’s proactive leadership on behalf of the pathology and laboratory community in two important ways that caught the attention of CMS authorities:

  • It cited evidence-based findings from an in-house quantitative analysis that utilized data provided by CMS to quantify pathologists’ difficulty participating in CMS-developed quality reporting programs.
  • Rather than simply complaining about the challenges that pathologists face when attempting to participate in existing quality reporting programs, the proposal offered a potential solution.

CMS was responsive to ASCP for these reasons and was further intrigued when ASCP requested the meeting remain on the books even after CMS verified that providers with zero applicable Physician Quality Reporting System (PQRS) measures will not be subject to a negative payment adjustment. This was clarified following publication of the CY 2014 Medicare Physician Fee Schedule Final Rule. CMS appreciated ASCP’s commitment and initiative, as the Society broadened the meeting’s focus from a specific proposal to protect pathologists from unfair penalties to a broader strategy to expand the scope of quality assessment to better capture existing quality improvement efforts across all specialty type providers.

“We are encouraged by CMS’s willingness to work with pathologists to address this challenge as soon as possible,” said Dr. Kroft. “We look forward to continued collaboration with CMS CCQS and the future development of this mutually supportive relationship.”

White House Responds to Recent ASCP Advocacy Efforts, Includes Stark Reform in FY 2015 Budget

ASCP is extremely pleased that the White House Administration has responded to our recent advocacy efforts in support of Stark reform. On March 4, the Administration released the President’s 2015 Budget, containing a proposal that aims to put an end to the harmful self-referral of certain complex ancillary services. In particular, the proposal would eliminate anatomic pathology, advanced diagnostic imaging, radiation oncology, and physical therapy services from the In-Office Ancillary Services (IOAS) exception to the Stark law.

The Administration’s public support for Stark reform that includes anatomic pathology services demonstrates the power of the pathology and laboratory community’s unified, consistent, and targeted advocacy efforts. Most recently, ASCP joined the College of American Pathologists and the American Clinical Laboratory Association for a meeting with the White House Office of Domestic Policy in November. The partner organizations shared with the Administration recently published research from the Government Accountability Office, Medicare Payment Advisory Commission, and Health Affairs. The studies provided consistent evidence that a clinician’s ability to self-refer for anatomic pathology services drives overutilization, increases costs, and potentially harms patients. As such, the organizations urged the Administration to promote Stark reform in the President’s 2015 budget and include anatomic pathology services on the list of services proposed for removal from the IOAS exception.

“ASCP believes that the Administration’s support for Stark reform further legitimizes our advocacy efforts on Capitol Hill,” says Steven Kroft, MD, FASCP, ASCP President and Vice Chair for Clinical Pathology and Director of Hematopathology at the Medical College of Wisconsin. He continues, “The Office of Management and Budget’s associated cost-savings estimate of $6 billion demonstrates that Stark reform would prove a viable financial offset for SGR Repeal legislation.” Accordingly, ASCP has launched a dual advocacy campaign, asking Congress to immediately repeal Medicare’s flawed Sustainable Growth Rate (SGR) payment formula while offering them a financial offset to do so in the form of Stark reform. The Society maintains that both initiatives are crucial to curbing the harmful overutilization of anatomic pathology services, ensuring the integrity and long-term sustainability of the Medicare program and protecting the patient community.

ASCP is currently reviewing the FY 2015 President’s Budget for additional proposals relevant to the pathology and laboratory community. We will report back to our members accordingly.

Administration Launches Global Health Security Agenda

Last month, the Obama Administration unveiled the Global Health Security Agenda (GHSA), a new initiative developed to boost global health security by improving the ability of low and middle income countries around the world to prevent, detect, and respond to outbreaks of infectious diseases, epidemics, and bioterrorism. Over the next five years, the United States will work with at least 30 partner countries (containing at least 4 billion people) on specific objectives to realize the vision of a world where all seven billion people are effectively protected against infectious disease threats.

"In 2012, we were really struck by the reality that more than 80 percent of countries did not meet the World Health Organization [WHO] deadline for being prepared for infectious disease threats," said Laura Hogate, of the National Security Council, at a briefing held at the Center for Strategic and International Studies. She referred to the revised International Health Regulations (IHR), which in 2007 set new standards for capabilities to detect and respond to disease and other health threats.

Despite tremendous advances in medicine and health care in recent decades, Americans are at greater risk than ever from drug-resistant infections, new infectious diseases, and potential bioterrorism agents, according to Thomas Friedan, MD, MPH, Director of the Centers for Disease Control and Prevention (CDC), the agency tasked with spearheading the initiative. "We face a real storm of vulnerability, from natural outbreaks like the H7N9 influenza, antimicrobial resistant pathogens, and intentionally created organisms that could be released accidentally or deliberately," said Friedan.

The GHSA will focus on the following core areas: prevention, detection, and response, with laboratories and laboratory professionals playing a major role in each area. Financed by $40 million in Defense Department and CDC resources this year, and an additional $45 million in new funds in FY2015, the U.S. intends to work in partnership with countries to create high tech laboratories and cadres of skilled physicians, veterinarians, biostatisticians, laboratory scientists, and field epidemiologists. Emergency operations centers will be established in each partner country and will be modeled after those already up and running in Uganda and Vietnam.

GHSA marks an important and promising turning point in U.S. policy as garnering participation of the some partners in the GHSA required significant diplomacy. Its long term success will depend on the results achieved, whether the U.S. and the partner nations continue to value staying engaged, whether there are sufficient resources to build capacity, and if the partners are will to step in and confront health threats beyond their borders.


As March 31 deadline looms, ASCP Hopeful Congress Will Repeal SGR Legislation

On Feb. 6, 2014, Congress introduced the "SGR Repeal and Medicare Provider Payment Modernization Act of 2014." The bipartisan, bicameral bill would completely repeal Medicare's Sustainable Growth Rate (SGR) payment update mechanism and replace it with "an improved payment system that rewards quality, efficiency, and innovation." Congress has released two identical versions of this bill in the U.S. House of Representatives (H.R. 4015) and the U.S. Senate (S. 2000).

ASCP has long advocated for complete repeal of Medicare's flawed SGR payment formula, which has called for drastic cuts to physician reimbursement since 2003. Accordingly, the Society is greatly encouraged by Congress's ability to reach bipartisan, bicameral consensus on the policy underlying SGR repeal. However, ASCP remains cautiously optimistic that Congress will be able to agree upon the financial offsets necessary to fund the legislation's $126 billion price tag prior to the expiration of the existing three-month payment patch on March 31. Failure to pass SGR repeal legislation, or legislation approving another short-term payment-patch, will result in a 24 percent cut to Medicare reimbursement on April 1.

In the interim, ASCP is committed to communicating the content of the bill to our members, building consensus in support of the bill, and advocating for its passage with the help of certain financial offsets.

Communicating the Content
The SGR repeal bill moderately resembles the bipartisan, bicameral legislative framework for SGR repeal, released jointly by the House Ways and Means Committee and the Senate Finance Committee in October 2013. ASCP submitted formal comments in response to this framework and also reported on its content in detail in the December ePolicy issue. Nonetheless, upon review of the legislation, it appears that Congress has responded to many of ASCP's concerns communicated in our comment letter. Click here for ASCP's response to the legislation's key provisions.

Building Consensus
Despite only moderate concerns with the potential implementation approaches to a couple of provisions within the bill, ASCP is fully supportive of its passage. Full SGR repeal will reinforce the sustainability of the Medicare program while easing provider payment and patient access concerns. Through passage of this bill, physicians will regain the financial security necessary to support significant long-term investments in improving patient care. Moreover, the bill's shift from a fee-for-service payment system to pay-for-performance, its integration of alternative payment models, and its focus on appropriate use will help to create a stable foundation for these investments. Accordingly, ASCP believes that two supporting policies not only offer themselves as potential sources of funding SGR repeal, but also further stabilize Medicare's market economy: Stark reform and the revaluation of the Clinical Laboratory Fee Schedule (CLFS).

Stark Reform: The removal of certain complex ancillary services from the In-Office Ancillary Services (IOAS) exception to the Stark law will effectively eliminate harmful self-referral of these services, curb overutilization, and reduce unnecessary costs. The President's 2014 Budget promotes Stark reform and estimated that it has the potential for substantial cost-savings.

Revaluation of Clinical Laboratory Fee Schedule: In response to the CY 2014 Medicare Physician Fee Schedule Final Rule, ASCP voiced significant concerns regarding CMS's failure to outline a detailed approach to revaluing the CLFS. As a result, ASCP has collaborated with partner organizations to develop legislation for inclusion in the SGR repeal bill that offers a fair and systematic approach to revaluation and directs cost savings toward SGR repeal.
Advocating for Passage
On Tuesday, Feb. 18, ASCP released an action alert, encouraging our members to contact Congress and urge them to pass SGR repeal legislation immediately. The action alert also promoted Stark reform as a viable financial offset to aid in the passage of SGR repeal legislation. Please continue to respond to this action alert!

On Friday, Feb. 21, ASCP submitted a formal letter of support for SGR repeal to the bill's sponsor, Congressman Michael Burgess. The Society also sent a formal letters of support to the leadership in the U.S. House of Representatives and the U.S. Senate, calling upon them to shepherd a united Congress through the passage of this bill.

ASCP will continue to collaborate with partner organizations within the Alliance for Integrity in Medicare (AIM) coalition to promote SGR repeal and Stark reform through frequent visits with Congressional leadership. The Society encourages our members to leverage this unprecedented momentum and advocate for SGR repeal and Stark reform in any way that you are able. For more information on the legislation and/or how to best utilize your knowledge and resources to advocate for this important initiative, please contact ASCP's Washington, D.C., office at (202) 347-4450.

ASCP Calls for Birx Nomination Hearing

ASCP joined a sign-on letter along with 20 other organizations of the Global AIDS Policy Partnership (GAPP) to Congress, requesting the scheduling of a confirmation hearing for Deborah Birx, MD, as the next U.S. Global AIDS Coordinator, a post responsible for leading the President's Emergency Plan for AIDS Relief (PEPFAR) and overseeing the U.S. relationship with the Global Fund to Fight AIDS, tuberculosis, and malaria. The letter was addressed to Sen. Robert Menendez (D-N.J.) and Sen. Bob Corker (R-Tenn.), Chairman and Ranking Member of the U.S. Senate Committee on Foreign Relations. After next week, Dr. Birx will be the only U.S. State Department nominee who has not had a hearing, prompting concern of a delay in her confirmation. Such a delay during budget negotiations could substantially disadvantage funding for PEPFAR programs.

Once confirmed, Dr. Birx will succeed Ambassador Eric Goosby, who was U.S. Global AIDS Coordinator between 2009 and 2013. Dr. Birx will be assuming this role at a critical time for the PEPFAR. Her leadership will be essential in achieving the goals laid out in the PEPFAR Blueprint for Creating an AIDS-Free Generation. Since 2009, Dr. Birx has served as the Director of the Division of Global HIV/ AIDS in the Center for Global Health at the Centers for Disease Control and Prevention (CDC). Her leadership galvanized support for laboratory strengthening initiatives across Africa leading to accreditation and enhanced laboratory infrastructure, essential to quality and timely patient care.




Stony Brook University CLS Program Receives Grant to Address Workforce Shortage in New York State

Kathleen Finnegan MS MT(ASCP)SHCM
Chair/Clinical Associate Professor
Clinical Laboratory Sciences
Stony Brook University

The High Needs Grant Program is an initiative of the State University of New York (SUNY) to identify academic programs that address specific workforce shortage needs of the state. This grant initiative supports professional programs that connect directly to occupations crucial to the economic vitality of New York, such as engineering, engineering technology and health care. Stony Brook University has received a $300,000 grant to develop a distance learning Clinical Laboratory Sciences (CLS) bachelor’s program to address the workforce shortage. The goal of the program is to expand the educational capacity of the University’s traditional CLS program through a distance learning program in order to increase the number individuals eligible for a full New York State license and to meet the demands for more laboratory personnel.

Laboratory professionals are a crucial part of the healthcare team, providing diagnostic test results that support the majority of clinical treatment decisions. The current shortage of qualified laboratory professionals in New York threatens the quality of patient care. The U.S. Department of Labor projects that 11,000 medical laboratory professionals will be needed through 2018, nationally. In New York State, approximately 640 new laboratory professionals are needed each year, while only 237 students graduate from accredited programs.

The Stony Brook Distance Learning CLS Program will target many different populations. These include working professionals with a limited or restricted New York State (NYS) license to obtain a full license; working professionals holding an associate’s degree seeking to advance to a bachelor’s degree; individuals holding a bachelor’s degree in biology or chemistry who are in need of the proper educational requirements to work in hospital laboratory and meet eligibility requirements for a full NYS license; and non-traditional students who are unable to attend college on a full time basis.

The grant-funded program will be a hybrid distance learning program. This distance learning program will include an online education piece for the professional courses and a hybrid piece for those courses that require a laboratory component. The online format will allow the students access to the courses on their own time, and the hybrid will allow the students with hands-on training but limit the times they need to return to campus.

The distance learning program will be supported by the grant funds for three years. At the end of the three years, the CLS Distance Learning Program will be self-sustaining. This distance learning program will increase the number of qualified laboratory technologists in New York State. Graduates of the program will be eligible for NYS licensure and will also be eligible for the ASCP certification examination.

ASCP, through its Clinton Global Initiative Commitment, supports efforts to increase access to training programs in an effort to alleviate the current medical laboratory workforce shortage in New York in order to meet the increasing healthcare demands of an aging population and support the emerging practice of personalized medicine.

ASCP to Present Workforce Report at AAMC Health Workforce Research Conference

ASCP will present the research of its 2013 report, Future of the Medical Laboratory Workforce Under Health Reform, at the Tenth Annual AAMC Health Workforce Research Conference, May 1-2, 2014, in Washington, D.C.The Society was invited to participate in a breakout session that provides a spotlight on multiple health professions. We will be joined by four other panel members who will discuss the roles of care coordinators, the long term care workforce, public health, and pharmacy in the Health Professions Spotlight panel.

The AAMC Health Workforce Research Conference is the premier opportunity for researchers, educators, and policymakers to meet and discuss state and federal workforce issues. This year, the topics to be discussed focus on: Workforce Implications of New Care Delivery Models and Health System Redesign; Health Workforce Supply and Demand (Physicians, NPs, PAs, allied health, other); Use of Technology (e.g. telehealth, virtual clinics, email, and phone visits); Rural/Underserved Communities; Diversity and Health Equity; Social Determinants of Health; Interprofessional Education; Productivity/Efficiency; Health Workforce Pipeline; Career Pathways; State Workforce Studies; Specialty Workforce Studies; and New/Innovative Uses of Data or Analytic Methods.

Link to the conference: Tenth Annual AAMC Health Workforce Research Conference




ASCP Takes the Choosing Wisely Message on the Road

This Spring, ASCP will continue to promote quality patient care through appropriate utilization of laboratory tests with a series of Choosing Wisely symposia. The success of ASCP's symposium, "Choosing Wisely: How California Pathologists Can Influence Appropriate Testing," in collaboration with the California Society of Pathologists (CSP) at their annual conference late last year in San Francisco prompted requests for similar sessions at a number of conferences around the country.

Look for ASCP's Choosing Wisely presentations at the following events:

APF 2014 Spring Meeting
ARIA Resort, Las Vegas, Nev.
March 28, 3 p.m. to 4 p.m. PT

Iowa CLMA/ASCLS Spring Meeting
Kirkwood Community College Hotel, Cedar Rapids, Iowa
April 2-4, Session date & time TBD

Pennsylvania Society of Pathologists Spring Meeting
Pennsylvania Medical Society Headquarters, Harrisburg, Pa.
April 5, Session time TBD

Executive War College
Conference on Laboratory & Pathology Management
Sheraton Hotel, New Orleans, La.
April 30, Session time TBD

Ohio Society of Pathologists
Embassy Suites Hotel, Columbus, Ohio
May 17, 8:30 a.m. ET

In addition to these events, a new online toolkit is now available that seeks to raise public awareness about appropriate test utilization and to assist patients in taking an active role in choosing care that is truly necessary. Pathologists and laboratory professionals are encouraged to use the toolkit resources, including articles, PDF guides, posters, podcasts, and handouts, to help inform and educate colleagues about appropriate test ordering.

ASCP was invited by the American Board of Internal Medicine (ABIM) to represent pathology in Choosing Wisely, a nationwide campaign to help reduce testing that is unnecessary and may even cause harm. ASCP is joined in the effort by more than 50 other medical specialty organizations across the country, which have each recommended five tests or procedures where there is overuse and waste.

Interoperability: Main Priority in the Future of Connected Health

Health Affairs held a briefing last month in Washington, D.C., on the successes and missing links in "connected health," using telemedicine, telehealth, and mHealth (mobile health). The meeting discussed the background of teleheath, where and how it is used; the privacy and liability involving telehealth; and connected health in rural states. A study conducted by Julia Adler-Milstein, of the University of Michigan School of Information, Ann Arbor, Mich., and coauthors indicate that 42 percent of U.S. hospitals have telehealth capabilities. Factors such as a teaching hospital, being part of a larger system, having greater technological capacity, and higher rurality were suggested to have a positive influence adoption rates. Shantanu Nundy, of Evolent Health, and coauthors examined a group of 74 adults and found that they are able to control their HbA1c glucose levels better while enrolled in an mHealth program. Patients participating in mHealth, showed improved health using texts and apps that manage their diabetes. In addition, there was an overall net cost savings of 8.8 percent within six months of the program's existence. Another study conducted by David C. Grabowski, of Harvard Medical School, Boston, and A. James O'Malley, of Geisel School of Medicine at Dartmouth University, Hanover, N.H., showed that facilities engaged in telemedicine could reduce hospitalizations and save $120,000 a year on Medicare.

Connected health will continue to expand especially with the rise of models such as accountable care organizations (ACOs), managed care, and integrated care. While many studies now demonstrate the benefits of utilizing telehealth, there are barriers and risks that need to be addressed for successful adoption. Robert M. Pearl, of the Permanente Medical Group, said that the two largest barriers to connected health are "lack of reimbursements under the fee-for-service system and the financial and other resources needed to truly integrate these technologies into existing models of care." In addition, privacy and security risks could affect patient safety if the mobile apps were to not function as intended. Rural areas also face challenges in implementing connected health due to licensing and credentialing, federal and state regulations, connectivity and bandwidth, and reimbursement. Interoperability between policy makers, industry, and healthcare providers must take priority in the successful adoption of connected health.

ASCP acknowledges tremendous benefit of further implementing health information technology into the healthcare delivery system. ASCP is committed to working with the government and others to assure that use of electronic medical records and other forms of health information technology to guarantee quality medical practice and patient safety.

Link to the briefing:

New IOM President Named

The National Academy of Sciences has announced that Victor J. Dzau, MD, has been selected to serve as the next President of the Institute of Medicine (IOM). Dr. Dzau is currently the Chancellor for Health Affairs at Duke University, Durham, N.C., President and CEO for Duke University Health System, and the James B. Duke Professor of Medicine at Duke University. He succeeds Harvey V. Fineberg, MD, who served as the IOM's President for 12 years.

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