Special Report
Don’t Close the Door on Laboratory Education
Advocacy Campaign to Save ASU Spawns Swift Action, Generates Dialogue
The American Society for Clinical Pathology recently launched an advocacy campaign geared toward saving the Clinical Laboratory Science/ Medical Technology program at Arizona State University (ASU) which is being considered for closure by the school’s leadership. In less than 12 hours ASCP members sent over 4,000 letters to the school’s President, Provost, Board of Regents and selected members of the Arizona House and Senate.
Their advocacy messages were clearly heard; ASU’s leadership requested that the campaign be halted as the large influx of letters was considered “disruptive” and “inconvenient.” Acting in good faith, the Society responded accordingly and suspended the letter writing campaign. Seeking to share their point of view both the University President and Board of Regents President drafted correspondence to be shared with ASCP’s members; in fact, ASU President Michael Crow sent personalized letters to all who had participated in the campaign. To read the full text of these letters, please use the following links: Fred Boice Letter and Michael Crow Letter.
In crafting its advocacy campaign, the Society worked closely with Diana Mass, the director of ASU’s CLS/MT program. The decision to launch a national campaign to save ASU’s CLS/MT program stemmed from a boarder prospective than a single training program. ASU represents a host of laboratory training programs that have either closed or are in danger of being shut down; with a laboratory workforce shortage that has already reached crisis mode, the Society felt it ill advised to shut the doors on the only accredited training program in the state. The laboratory workforce shortage is a top priority for the Society; which continues to educate legislators and the public about the critical role of the laboratory in the practice of medicine and to develop strategies for eliminating the shortage. ASCP maintains that when laboratory training programs are lost, lost too are opportunities to replenish the field with qualified laboratorians.
This message also seemed to have resonated with ASCP’s membership, as many shared personal stories about the closure of training programs or the shortage with ASU and the state legislators:
“As a lab manager it is increasingly more difficult to find qualified lab staff. If you were the patient and your life/treatment depended on the results of your laboratory test, as our oncology patients do, then you would want them to be correct. Help us to continue to train qualified individuals to work in this field.” Karla Little-Greenville, SC
“I was trained at ASU and have worked in the field since 1976. There has rarely been a time when there were enough Med Techs to fill the positions. With the increased testing available (genetic markers for cancers, diseases, bacterial resistance, immunoassays, etc.) this is not the time to decrease the education of the testing personnel. "Training on the job" does not result in quality, reliable results. We need to keep our educational edge in the field of medicine.” Sally Wirth-Mesquite, NV
“I am a practicing Pathologist and Medical Director of a Laboratory in Illinois. For the past 10 years I have watched the supply of well-trained medical technologists dwindle. We have a significant percentage of technologists who are within 5-10 years of retirement and, frankly, I have no idea how we are going to be able to replace them. Without enough technologists, our laboratory services would be drastically affected, particularly in light of the aging general population and their ever increasing needs.” Steven Jones-Effingham, IL
These quotes represent just a sampling of the personal reflections shared.
The ASU CLS/MT program has been in existence for over 50 years, graduating an average of 22 students annually; its incoming class boasts 23 students who were selected out of 37 applicants.
The immediate response from ASU officials to the Society’s campaign did not fall on deaf ears. ASCP weighed in and shared our intent and vision with President Crow. To read the letter sent by ASCP President Barbara J. McKenna, MD, FASCP, go to ASU Response Letter.
The program’s fate is still pending; ASCP remains hopeful that our advocacy efforts not only generated attention but also sparked a change of heart. ASCP will continue to monitor the deliberations surrounding the program’s closure and will alert its members once a decision has been reached.
Congress
Economic Stimulus Package Delivers Some Health Care Promises
When President Obama signed into law The American Recovery and Reinvestment Act on February 17, speculation ended as to whether health care would factor into the scheme designed to reignite the country’s economic engines. Well, it did. The law includes several provisions of interest to the laboratory community. These include: health information technology (HIT), comparative effectiveness research and the health professions workforce shortages.
Health Information Technology
President Obama considers the transition to a paperless administration of health care as critical to reducing health care costs, so much so that in The American Recovery and Reinvestment Act of 2009, $19.2 billion have been allocated for Medicare-incentive payments for physicians and hospitals to adopt health information technology. Assistance will be provided for physicians to offset the costs associated with HIT; they could receive between $40,000 and $65,000. Past efforts to get physicians to buy into the adoption of HIT has been the cost associated with implementation, training, and effective use--including the transformation of work-flows necessary to achieve improvements in quality and efficiency.
Some particular characteristics of the HIT portion of the law include:
- Eligibility of a hospital-based professional will be determined by the HHS Secretary’s definition of site of service, in spite of employment or billing arrangements ASCP is concerned that hospital-based pathologists are excluded from receiving Medicare electronic medical record incentives.
- Physicians who do not adopt or use a certified HIT system will face reductions in their Medicare fee schedule payments.
- In an effort to address issues of privacy, Federal privacy and security laws under HIPAA were expanded.
Workforce Shortage
As expected, money is allocated to address the health professions workforce shortages. Five hundred million dollars have been set aside for the training of primary care providers. Through discussions with policy makers, ASCP has learned that $200 million is to be divided between Title VII and Title VIII programs; the details are still vague at this point as to how this money will be split. As the Society gains more information about the allocation of funds through Title VII, updates will be provided.
Comparative Effectiveness
The icing on the cake appears to be research opportunities; the law provides for $1.1 billion for funding for comparative effectiveness research (CER). Some of the nuances of this provision consist of:
- The establishment of a Federal Coordinating Council for Comparative Effectiveness Research.
- The CER cannot mandate coverage, reimbursement or other policies of public or private payers.
- CER will also not include national clinical guidelines or coverage determinations.
- The Agency for Healthcare Research and Quality (AHRQ) is to receive $700 million; $400 million must be transferred to NIH to conduct or support CER.
- In addition, the Secretary has the discretion to allocate $400 million for CER to fast track the development and dissemination of research that will assess the comparative effectiveness of health care treatments and strategies.
ASCP will continue to report in e-Policy the implementation of these provisions contained in The American Recovery and Reinvestment Act.
Federal
ASCP Set to Comment on Cytology PT Draft Regulation
ASCP is in the process of finalizing its comments on the proposed revisions to the CLIA Cytology PT requirements. Comments are due by March 17th to the Centers for Medicare and Medicaid Services (CMS). The process to craft ASCP’s comments has included subject matter expert review and dialogue with organizations involved in the field of cytopathology.
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.
ASCP’s Appeal to CMS May Yield New CLIA PT Rule
CMS may soon revise its regulations on intentional proficiency test referral, thanks to the American Society for Clinical Pathology.
On August 28, 2008, ASCP wrote the Centers for Medicare and Medicaid Services (CMS), raising concerns about several of the agency’s recent determinations of intentional proficiency testing (PT) referral. ASCP questioned whether some of CMS’ recent determinations of “intentional PT referral” were inadvertent or accidental in nature. In its letter to CMS, ASCP urged CMS to reexamine its interpretation of the CLIA term “intentional PT referral” and to change its rules to focus on those instances intended to evade CLIA PT requirements. Click here (ASCP letter on Intentional PT Referral final CMS.pdf) to view ASCP’s letter to CMS.
These inadvertent or unintentional cases of PT referral can have profound consequences for laboratories, their owners, and their directors. Under the CLIA statute, a CMS determination of intentional PT referral requires the revocation of the laboratory’s CLIA certificate and bars the laboratory owner and laboratory director from owning or supervising a laboratory for two years.
As part of its response to ASCP, CMS recently hosted a conference call with ASCP and the College of American Pathologists to discuss the issue. Per ASCP’s request, CMS indicated that the agency is planning to revise its regulations for PT referral and that the Clinical Laboratory Improvement Advisory Committee (CLIAC) has been tasked to examine ASCP’s concerns. CLIAC will be forming a working group to study this issue and to recommend changes to the CLIA regulations, possibly as soon as September 2009.
As part of this effort, ASCP has nominated former CLIAC Member and Immediate Past Chair of the ASCP Board of Certification, Cynthia S. Johns, MSA, MT(ASCP)CMSHCM to serve on the CLIAC working group.
Society News
Survey Results Point to Worsening Scenario for Laboratory Workforce
The results of ASCP’s latest Wage and Vacancy Survey suggest a worsening shortage of laboratory personnel .The data further substantiates the Society’s contention that the laboratory workforce shortage has reached crisis mode and swift resolution is needed.
Nearly one-half of the clinical laboratories across the nation report experiencing difficulties hiring personnel. Western states struggle more with recruitment compared to other regions of the country, as notably fewer labs there report success in filling positions within six months. Shortages were reported for all the laboratory positions surveyed, but vacancy rates for certified medical technologists and histotechnicians were particularly high, at 10.4% and 8.0%, respectively.
Increased competition for qualified staff and lower compensation for laboratory work compared with other fields were the predominant reasons cited for the hiring difficulties. Recruitment and retention will be further challenged in the coming years as nationally, it is estimated that 13% of the current laboratory staff are likely to retire within the next five years.
ASCP’s Wage & Vacancy survey, which provides current wage data and information about the extent and distribution of personnel shortages within the nation’s clinical laboratory workforce, is conducted every two years. The Society first started tracking such data in 1988; this confidential survey of hospital, reference, and physician office laboratory facilities serves as the primary source of information for academic, governmental, and industry labor analysts in defining the state of the nation’s clinical laboratory workforce.
As in previous years, data pertaining to wages and salary trends encompass the gamut of laboratory professionals: medical technologists (MT), MT supervisors, MT managers, cytotechnologists (CT), CT supervisors, histotechnicians (HT), histotechnologists (HLT), HT supervisors, medical laboratory technicians (MLT), MLT supervisors, phlebotomists (PBT), PBT supervisors, laboratory assistants (LA), and LA supervisors. In addition, new position categories included in the 2008 survey were pathologist’s assistants (PA), PA supervisors, specialists in blood banking (SBB), and SBB supervisors. Information about vacancies, hiring practices and laboratory demographics was collected as well as data for non-waived versus waived testing facilities.
Look for the full report on the ASCP Wage and Vacancy Survey in the March 2009 issue of LabMedicine.
ASCP Announces Public Policy Fellowship/Internship Program
The American Society for Clinical Pathology’s (ASCP) Washington Office is seeking candidates for its public policy fellowship & internship program. ASCP policy fellows and interns will work in ASCP’s Washington, D.C. Office on laboratory and health care public policy issues. The program is a great opportunity for individuals interested in health policy, public health, and politics to learn more about these issues.
The ASCP fellowship program is suitable for undergraduate, graduate and post-graduate students as well as individuals who are not currently participating in an academic or clinical program. Participants will receive a stipend dependent on their availability. The fellowships and internships are expected to last between 8 and 12 weeks. Individuals interested in applying for the program may contact Matthew Schulze at (202) 347-4450 or matthew.schulze@ascp.org for details.