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As Congress debates the merits of President Obama’s proposed $800 billion plus stimulus package, many in the health care arena are optimistic that the plan developed to jump start the nation’s economy will also provide a booster shot to an ailing health care system. Included in the proposed stimulus package are a number of provisions that address the country’s healthcare infrastructure: health professions workforce shortages and health information technology (HIT). Congress is also considering funding for SCHIP (the State Children’s Health Insurance Program). Both the workforce shortage and HIT are Level 1 public policy priorities for ASCP.

Workforce Shortage
The Senate Appropriations committee is currently combing through the Labor-Health and Human Services section of the economic recovery package. The proposal provides $600 million to the Health Resources and Services Administration (HRSA) to address health professions workforce shortages. The monies are to be disbursed through scholarships, loan repayment programs, grants to training programs for equipment and activities to foster cross-state licensure agreements. This funding includes specific programs such as the Title VII Scholarships for Disadvantaged Students, the Title VII Faculty Loan Repayment and the Title VIII Nursing Loan Repayment and Scholarships. ASCP has acknowledged the increasing need for laboratory professionals to fill the gap in the ever increasing laboratory workforce shortage (see related story in this issue of e-Policy concerning the results of ASCP’s Wage & Vacancy survey). The Society is optimistic that should such a provision remain in the stimulus package that it would begin to address the laboratory workforce shortage.

Health Information Technology
In addition, legislative language referring to health information technology (HIT) is in the economic stimulus package now being considered by Congress. The American Recovery and Reinvestment Act of 2009 features as a primary component substantial funding for health information technology adoption and use. The eHealth Initiative (eHI), of which ASCP is a member, is an independent organization dedicated to improving the quality, safety and efficiency of healthcare through information and information technology. The eHI has forwarded recommendations to both Congress and the Obama Administration outlining the need for federal funding of health information technology: “While there is considerable recognition of the benefits of health IT and health information exchange in addressing health care challenges, such efforts have been hampered by the costs associated with implementation, training, and effective use--including the transformation of work-flows necessary to achieve improvements in quality and efficiency. The economic stimulus package is an opportunity to begin building the infrastructure necessary to transform our health care system.”

The eHI suggests that funding could take the form of grants, loans and financial incentives to support provider adoption. In addition, technical assistance and workforce training programs are key to an effective HIT infrastructure. The eHI also outlined the need for a policy framework that addressed privacy concerns as well as patient safety. The cumbersome implementation of a health information technology infrastructure has perhaps been the stumbling block to full realization of a nationwide HIT system. Proponents are confident that with needed resources behind HIT implementation, goals of a more streamlined, efficient healthcare system could be realized.

State Children’s Health Insurance Program (SCHIP)
After being vetoed twice by the Bush Administration, Congress is once again considering increased funding for the State Children’s Health Insurance Program (SCHIP). The program, designed to provide health care coverage for children from lower income homes, presently, covers seven million children living near the poverty level who do not qualify for Medicaid and costs $25 billion. A version of the bill has passed both the House and the Senate and will now be considered by Conference Committee to iron out any differences between the two bills; lawmakers hope to have a bill for President Obama to sign into law soon. It is estimated that additional funding will help cover another four million children. Proponents say the need for a health-care safety net has become all the more urgent, given the dire state of the economy. Passage of the legislation as it stands means that there are still an estimated 4 million children without health care coverage. ASCP has continued to be a strong advocate of the SCHIP program, believing it to be a vehicle to providing quality health care to America’s children but also providing access to needed laboratory and diagnostic services.

As the Stimulus Package as well as SCHIP legislation continues to move through Congress, ASCP will keep its members informed via e-Policy on the latest Congressional developments.

The Centers for Medicare and Medicaid Services (CMS) has finally released draft regulations to modify the CLIA Cytology PT requirements. The release of this draft regulation comes after years of controversy within the pathology community about the CLIA-mandated program. Highlights of the proposed regulation include:

• Decreasing the testing frequency from once per calendar year to once every two calendar years.
• Increasing the number of cytology challenges per testing event for the first two testing events from 10 to 20 and requiring no more than 4 hours rather than the current 2 hours for completion of the test.
• Expanding test medium options to allow other potential media such as computer-based virtual slides or alternative testing formats, in addition to glass slide cytology challenges.
• Revising the scoring scheme for both technical supervisors (pathologists) and cytotechnologists.

For many years, ASCP has had an active dialogue with the federal government officials about ASCP's concerns about the CLIA Cytology PT requirements and implementation. On January 20, 2009 White House Chief of Staff Rahm Emanuel issued a memorandum stating that the new Obama Administration was set to review all new and pending regulations that had been issued in the final days of the Bush Administration. It is unclear at this time whether or not the Obama Administration review will affect the March 17, 2009 due date for all comments. ASCP has requested clarification from CMS regarding the status of the regulation in regards to the regulatory review.

ASCP succeeded in convincing CMS to increase the reimbursement it had planned to provide for several new CPT codes. The codes were part of a series of new CPT codes for 2009.

Following ASCP’s recommendation, CMS changed course to reimburse new CPT code 83951, Oncoprotein; des-gamma-carboxy-prothrombin, at $89.99, rather than at $43.32. Additionally, CMS followed ASCP’s recommendation to increase funding for new CPT code 85397, coagulation and fibrinolysis, functional activity, not otherwise specified (e.g., ADAMTS-13), each analyte, to $32.06. Initially CMS had planned to reimburse this test at $25.02.

“Advocates for the state licensure of laboratory personnel in Minnesota are fast at work trying to develop a consensus licensure bill to license laboratory practitioners here,” according to Junell Petersen, MS, MT(ASCP)^CMSH^CM. Ms. Petersen is a member of the ASCP Board of Directors and a member of a coalition in Minnesota working toward this goal. The measure may be the first bill to receive the blessing of the College of American Pathologists (CAP), which recently endorsed licensure of laboratory personnel.

This year, however, with CAP having outlined criteria for developing a personnel bill, things could work out differently. Last year, CAP opposed a similar effort to license laboratory personnel in Minnesota. The Minnesota coalition is working with the Minnesota Society of Pathologists, which last year opposed a similar effort to license laboratory professionals, to develop a consensus measure to license laboratory personnel.

As yet, the bill has not yet been finalized. But Ms. Petersen reports that the negotiations with the State Pathology Society have been positive and that the coalition hopes to finalize its bill soon so that it can be introduced in time for consideration by the Minnesota legislature this year.