Federal

2009 Medicare Physician Fee Schedule Issued
ASCP to Study, Act on Anti-Mark-Up Provisions

On June 30, the Centers for Medicare & Medicaid Services (CMS) issued proposed changes to the Medicare Physician Fee Schedule (PFS) for 2009. This proposed rule is the first step in an annual process that will result in the publication of a 2009 Final Rule late this year.

ASCP is in the process of studying the proposed rule, especially changes and comments CMS is seeking related to Physician Self-Referral and Anti-Mark-Up. A detailed ASCP analysis will be published in the future.

ASCP will be commenting on the rule and working with the pathology community to ensure that strong provisions that protect patient and public health are implemented. The PFS can be accessed at the following website (pages 236-251): www.cms.hhs.gov

Congress

Senate Fails to Enact Medicare Package
ASCP Activists Flood the Senate with Messages

On June 26, Senate Democrats failed by one vote to gain cloture on the House-passed Medicare package (H.R. 6331). The Senate failed to proceed to and adopt H.R. 6331—the Medicare Improvements to Patients and Providers Act—by a vote of 58 to 40. Sixty votes were needed to pass the bill. The next opportunity for action appears to be after the Congressional July 4 recess, meaning around July 8. ASCP members used the ASCP e-Advocacy Center to send thousands of letters to the Senate over the past week first, to urge a "yes" vote on cloture and, second, to express disappointment with the vote outcome.

In a procedural move, Senate Majority Leader Harry Reid changed his vote to "No" so he could call the bill up at a future date. The implication of a failed vote is that a 10.6 percent physician payment cut is looming. The cut was scheduled to go into effect July 1, but HHS Secretary Mike Leavitt issued a temporary freeze for Medicare physician payments that will be in effect while the Senate resolves this dispute.

H.R. 6331 also contains an ASCP advocated provision to permanently repeal the Medicare competitive bidding demonstration project for clinical laboratory services. This provision is also linked to a reduction in the Consumer Price Index (CPI) payment update for clinical laboratory services by 0.5 percent for the next five years. While ASCP had hoped for a full update to the Clinical Laboratory Fee Schedule (CLFS), this compromise was necessary in exchange for including the repeal of the competitive bidding project in the Medicare package. The good news is that clinical laboratories will, for the first time in many years, receive a partial CPI update. In essence, if the legislation passes as written, the ASCP goal to "Thaw the Freeze" to the CLFS will be implemented.

ASCP also supports a provision in the legislation that allows for an 18-month extension of the technical component (TC) grandfather clause, which allows Medicare reimbursement for the TC for pathology services provided to certain hospitals that have arrangements with independent hospitals.

ASCP is urging that everyone send a strong message to the Senate through the ASCP eAdvocacy Center.

To see how your Senator voted on the issue of cloture (ASCP position is yea), click here.

Meetings

Joint Commission Provides Update of Work, Goals
ASCP Involvement with Commission Continues to Emphasizes Safety Issues

ASCP recently participated in the 16th Annual Invitational Liaison Forum of the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organization or JCAHO). In this annual forum Liaison Network members, including ASCP, discuss important quality and safety health care issues and share experiences. This year's forum emphasized two distinct projects of the Joint Commission: the release of the 2009 Patient Safety Goals and the 2009 Standards Improvement Initiative (SII) E-dition. According to the Joint Commission, the 2009 National Patient Safety Goals promote specific improvements in patient safety by providing health care organizations with proven solutions to persistent patient safety problems. These goals apply to the more than 15,000 Joint Commission-accredited and -certified health care organizations and programs.

"The 2009 National Patient Safety Goals represent ongoing opportunities for improvement that can immediately benefit patients," said Mark R. Chassin, MD, MPP, MPH, president, The Joint Commission. "By taking action to consistently meet the goals, health care organizations can substantially improve patient safety in America."

The development, annual review, and modification of the National Patient Safety Goals, first introduced in 2003, is overseen by the Sentinel Event Advisory Group, a panel that includes widely recognized patient safety experts, nurses, physicians, pharmacists, risk managers and other professionals who have hands-on experience in addressing patient safety issues in hospitals and other health care settings. Each year, this panel works with the Joint Commission to undertake a systematic review of the literature and available databases to identify potential new goals and requirements. The commission also conducts an extensive field review of potential new goals and seeks input from practitioners, provider organizations, purchasers, and consumer groups, among others. The Joint Commission's Board of Commissioners approves the goals and requirements each year. Compliance with the requirements is a condition of continuing accreditation or certification by the commission.

The web-based version of the Commission's standards is slated to be issued in two phases; phase one will focus on ambulatory, office-based surgery, critical access hospitals; hospitals and home care. Phase two will include standards related to behavioral health care, the laboratory and long term care. Roll-out of phase one is expected in January of 2009 with the additional component to be released the following year. The E-dition is geared toward providing quick access to the standards in eight accreditation programs, with automatic updates and the ability to view history tracking, however, manual versions will still be made available.

ASCP will continue to work with the Joint Commission and chronicle quality and patient safety initiatives.

Quality Care, Health Care Discrepancies Focus of New Initiative
RWJ Hopes Targeted Initiative will Reduce Gaps Based on Race, Location

ASCP attended last month's launch last month of an initiative of the Robert Wood Johnson Foundation (RWJ) to target disparities in quality care in 14 communities nationwide. The initiative, Aligning Forces for Quality: Improving Health & Health Care in Communities across America, takes a community-focused emphasis to lift the overall quality of health care, reduce racial and ethnic disparities, and provide models for national reform. The foundation is making a $300 million commitment to the effort. The goals of the initiative stem from recent research conducted by the Dartmouth Atlas Project at the Dartmouth Institute for Health Policy and Clinical Practice. The research found that Medicare claims reveal staggering variations in health care quality across the country.

"Across America there are serious gaps between the health care that people should receive and the care they actually receive," said RWJ President and CEO Risa Lavizzo-Mourey, MD, MBA. "Despite having the most expensive health care system in the world, patients are subject to too many mistakes, too much miscommunication and too much inequity. As a result, too many Americans aren't receiving the care they need and deserve."

Local efforts uniting vested stakeholders to improve quality and reduce disparities are the cornerstone of this initiative. Efforts will be concentrated in the following areas: Cincinnati; Cleveland; Detroit; Humboldt County, CA; Kansas City, MO; Memphis; Seattle; South Central Pennsylvania; Western Michigan; Western New York; Willamette Valley, OR; and Maine, Minnesota, and Wisconsin.

Emphasis on these 14 geographical areas marks the second phase of the foundation's initiative. When it launched in 2006, the initiative focused on improving quality of care for patients with chronic illness in outpatient settings. In this new phase, the initiative aims to improve care for all patients across all settings.