Federal
ASCP, IOAS Coalition Meet with MedPAC to Discuss Markup of Pathology Services, Self Referral
ASCP met recently with the Medicare Payment Advisory Commission (MedPAC) to discuss the markup of anatomic pathology services by ordering physicians. ASCP and several of its partners in the in-office ancillary services coalition met with MedPAC staff on July 16th.
MedPAC, an independent agency of Congress and an influential player in Medicare policy, has recently issued several reports raising concern about the impact that self referral arrangements can have on the utilization, cost and quality of Medicare physician services. Most recently, it has raised concern about self referral arrangements involving imaging and physician-owned hospitals. Congress often plays close attention to MedPAC’s reports and many of its recommendations have been included in this year’s Congressional initiative to reform health care.
During the meeting, representatives from ASCP, ACLA, and CAP urged MedPAC to closely examine some of the arrangements that several physician specialties have developed to capture the revenues for anatomic pathology services. Many of these arrangements, such as the recent development of in-house histology laboratories, enable the referring provider to markup the cost of anatomic pathology services, usually biopsies, often without regulatory oversight by the federal government under the Clinical Laboratory Improvement Amendments of 1988 (CLIA).
As part of the meeting, ASCP and its coalition partners noted the problems that CMS has encountered trying to rein in abusive billing practice by ordering physicians. The coalition also provided an overview for MedPAC staff of some of the types of abusive contractual joint ventures, such as “pod” labs, that have been utilized by ordering physicians to capture pathology revenues.
Coalition members noted that a series of audits performed by the Office of the Inspector General (OIG) for the U.S. Department of Health and Humans Services found a significant increase in utilization and cost of Medicare services. The audits revealed that for three urology practices examined by OIG, the utilization of biopsies increased 699%, 230%, and 65%, respectively, in the year after the practices entered into arrangements to capture the pathology revenues for their referrals. All of these practices billed for significantly more biopsies than other providers in their local coverage area.
Stimulus-Related Grant Opportunities Now Available
Both the Department of Labor (DOL) and the Health Resources and Services Administration (HRSA) at the Department of Health and Human Services (HHS) recently announced the availability of new grant funds for the health professions.
On July 23, the DOL announced that funds are authorized for projects that provide training and placement services to help workers pursue careers within the health care sector. Eligible applicants include public entities and private nonprofit organizations. The grants are intended to fund projects that provide workers with training that will prepare them to enter and advance in the health care sector.
Earlier this year, ASCP alerted the laboratory professional training community that President Barack Obama’s stimulus package, the American Recovery and Reinvestment Act of 2009, would contain grants that prioritize training and placement for healthcare professionals in high-growth industries. To ensure that laboratory training programs were eligible for upcoming stimulus-related grants, ASCP President Barbara J. McKenna, MD, FASCP urged DOL to consider the critical role that laboratory professionals play in patient care.
ASCP has encouraged laboratory professional training programs and schools at risk of closure or programs seeking to expand to proactively examine this grant money from the stimulus package. These dollars are specifically available for health care professions training and for projects that provide training and placement services to help workers pursue careers within the high-growth health care sector. The purpose of the high-growth and emerging industries grants is to teach workers the necessary skills for, and help them pursue careers in, health care. The DOL intends to fund 45-65 grants ranging from approximately $2 million to $5 million. Grant applications must be submitted to the DOL no later than October 5, 2009. To obtain a copy of the grant announcement, please click here.
On July 28, the Department of Health and Human Services announced the availability of stimulus-related dollars to support grants, loans, loan repayment, and scholarships to expand the training of health care professionals. The funding, which will be administered through HRSA, may include funding that could assist students and allied health programs. Of the $200 million, $40 million will be available for scholarships, loans, and loan repayment awards to disadvantaged students in a wide range of health professions, and $1.2 million to health professions faculty from disadvantaged backgrounds. Fifty million dollars in grants will become available for health professions training programs to purchase equipment needed to expand programs and improve the quality of training. Additional information is expected on the HRSA website in the next couple of weeks.
ASCP Recommends Payment Rates for New Clinical Laboratory Tests
On July 14, ASCP provided payment recommendations to the Centers for Medicare and Medicaid Services during a public meeting on payment methodology for a series of new laboratory codes for 2010. To obtain a copy of ASCP’s recommendations for each of the new codes, click here.
Congress
Lawmakers Move Forward on Health Care Reform
House and Senate Committees are moving forward on legislation to reform the nation’s health care system. Leaders in both chambers of Congress have been meeting to iron out specifics and seek to reduce costs associated with President Obama’s initial proposal. A deal was reached in the House that, as described, would reduce the cost of the package and ensure more funding for rural hospitals; this concession, made to accommodate fiscally conservative Democrats, allowed the Energy and Commerce Committee, chaired by Henry Waxman (D-CA), to resume its consideration of the legislation.
The Senate Finance Committee, meanwhile, announced that a draft of its reform package would come with a lower-than-expected price tag of less than $900 billion over 10 years, which would be slightly less expensive than the new target for the House bill. The proposal, being touted by Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) has been negotiated for weeks and is said to cover 95% of all legal, non-elderly individuals. The Baucus-Grassley proposal is said to authorize the creation of non-profit health insurance co-ops rather than establishing a new public plan option. In addition, it would not impose a mandate on employers to offer health insurance coverage.
As expected, the Senate Finance Committee proposal would prevent a 21% Medicare physician payment cut that is scheduled for January 2010, but does not include a long-term replacement of the Sustainable Growth Rate formula.
ASCP has been monitoring the developments as Congress moves forward with health care reform legislation, working to assure that the needs of patients, pathologists and laboratory professionals are addressed in the final package. To date, the Society has weighed in by submission of letters and testimony to the Senate Finance Committee as well as the House Ways and Means Committees. For details regarding ASCP’s 2009 legislative agenda, see the July 2009 edition of e-Policy.
Society News
In Memoriam: ASCP Honors Dr. Robert Knapp, Cytopathology Leader and Coalition Builder
On July 13, Robert H. Knapp MD, FASCP, passed away at his home in East Grand Rapids, Michigan. Over the course of 2009, ASCP worked closely with Dr. Knapp in his role as a leader with the American Society for Cytopathology (ASC). Dr. Knapp was known as a pathologist who wanted all of the professional societies to work together in coalition to achieve our common goals. Recently he was appointed the new ASC Representative to the Pathology Section Council within the American Medical Association’s House of Delegates (HOD). At the recent AMA HOD meeting in Chicago, Dr. Knapp testified during the hearing to add a broader health care workforce component to a resolution focused solely on physicians. Most recently, ASCP was working with Dr. Knapp and ASC to address the laboratory professional workforce shortage.