Federal

ASCP, Pathology Community Continue Press on Anti-Markup Rule

ASCP is teaming up with other members of the pathology community, including the College of American Pathologists and the American Clinical Laboratory Association, to ensure that the Centers for Medicare & Medicaid Services (CMS) does not dilute its recent anti-markup rule on anatomic pathology procedures.

As part of the 2008 Physician Fee Schedule, CMS established an anti-markup rule to cover the technical and professional components of anatomic pathology services purchased from an outside supplier or performed at a site other than the “same building” of the billing practice or supplier. The original anti-markup rule was applicable to all diagnostic testing services, not just anatomic pathology services. However, after the final rule was released, CMS delayed implementation of the anti-markup rule to diagnostic services other than anatomic pathology due to technical concerns about the impact of the rule on other areas of diagnostic testing. The agency is expected to revisit the anti-markup rule this year.

As the agency works to address these issues, ASCP and the pathology community will work to ensure that the agency does not weaken the important protections against self referral and potentially abusive billing arrangements affecting patients, pathology and laboratory medicine.

Laboratory Medicine: A National Status Report
CDC Releases Status Report Examining Past, Present and Future

CDC has released a report on the past, present and future of laboratory medicine. The report provides a detailed overview of the key factors affecting the laboratory medicine sector. It is intended that the report serve as a point of reference for measuring and improving quality in the future as well as for policy guidance to professional organizations, government agencies, and others who provide, use, regulate, and pay for laboratory services.

ASCP President Lee Hilborne, MD, MPH, FASCP, DLM(ASCP)CM has been working closely with CDC on the report. ASCP is studying the report and in particular the sections related to the future of the profession of pathology and laboratory medicine. The study “describes the status and future of quality systems in laboratory medicine, including the shift away from analytic–focused quality control, quality assurance, and proficiency testing to more comprehensive, systematic approaches to quality management. Also included is discussion of the current status of performance measurement in laboratory medicine.” We encourage all members to view the document.

Congress

ASCP Advocates Passage of Global HIV/AIDS Initiative

Reaching beyond geographic boarders, ASCP members are looking to Congress to aid in a global health initiative. Through the Society’s e-Advocacy center, members are urging their respective Senators to support S. 2731, which provides funding for the President's Emergency Plan for AIDS Relief (PEPFAR/Emergency Plan). Legislation has passed the House of Representatives (H.R. 5501) and is pending in the Senate. The Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 provides integrated prevention, diagnostic and treatment programs to address HIV/AIDS, tuberculosis and malaria in Africa and other developing countries. In addition, the legislation will help these countries develop systems to provide accurate, reliable and timely clinical laboratory testing for HIV and related diseases. Unfortunately, a small number of Senators have placed a “hold” on the bill. This “hold” places the legislation in jeopardy.

Since its implementation in 2003, PEPFAR has been responsible for 1.4 million men, women and children receiving life-saving antiretroviral therapy. Of those writing Capitol Hill, many have worked in underdeveloped countries and have witnessed first hand the impact of aid abroad. (To read excerpts from these Congressional letters, click here). If you would like to take action to urge your Senators to reauthorize the President’s PEPFAR initiative, visit ASCP’s eAdvocacy Center. To read the Society’s statement on funding for the PEPFAR initiative, click here.

Coalition Courts Congress
ASCP Seeks Funding for Allied Health Professions

The Health Professions and Nursing Education Coalition (HPNEC), of which ASCP is a member, is seeking congressional support for full funding for health professions education. Specifically, the group is targeting the House of Representatives Committee on Appropriations to provide at least $300 million for Title VII health professions programs in the FY 2009 Appropriations bill being crafted by the House Labor, Health and Human Services and Education Committee. Considering the workforce shortage that laboratory medicine is facing, ASCP is pleased to join with other stakeholders in advancing the need for increased funding. Providing financial resources to allied health programs aids in achieving the mission of improving the supply, distribution and diversity within the profession.

During ASCP’s recent Capitol Hill Day, funding for Title VII was among the issues advocates carried to the Hill. Since drastic cuts were made to these programs in the FY 2006 budget, as much as 51%, even incremental funding increases over the years have failed to bring these programs to adequate funding levels necessary to maintain programs.

At Last...Genetic Information Nondiscrimination Act is Signed into Law

On May 21, President Bush signed the Genetic Information Nondiscrimination Act (GINA) into law to protect Americans from genetic discrimination by employers and insurance companies. Fear of discrimination on the basis of genetic information has led many individuals to shy away from genetic testing that could greatly benefit their health. This apprehension has also caused significant delays in the development of beneficial treatments and medications as researchers faced difficulty recruiting patients for clinical trials. Supporters of GINA hope the new legislation will diminish public apprehension about participating in genetic studies.

Passage of this bill, first introduced by Rep. Louise Slaughter (D-NY) more than 10 years ago, has been a long time in coming. For years, the Senate passed bills in support of genetic nondiscrimination, only to see them become stalled in the House. This spring, GINA finally received support in both chambers. GINA passed the Senate with a unanimous vote of approval, and in the House of Representatives, it was passed by a landslide vote of 414-1. “This is a tremendous victory for every American not born with perfect genes – which means it’s a victory for every single one us,” said Slaughter. “Since all of us are predisposed to at least a few genetic-based disorders, we are all potential victims of genetic discrimination.”

Specifically, GINA prevents group health insurance plans and issuers of Medigap policies from basing eligibility determinations or adjusting premiums on the basis of an individual’s genetic information. Likewise, the bill prohibits employers from refusing to hire, fire, or base compensation, terms, conditions or privileges of employment on an individual’s genetic profile. It also makes it unlawful for insurers and employers to disclose genetic information or request, require or purchase the results of genetic tests. Similar provisions apply to employment agencies and labor organizations. The health insurance protections offered by GINA are expected to roll out 12 months after the bill is signed, whereas the employment protections will be fully realized in 18 months.

“Today marks the beginning of a new era in health care,” continued Slaughter. “Americans can finally take advantage of the tremendous potential of genetic research without the fear that their own genetic information will be used against them.”

This spring, ASCP signed a letter of support for GINA that went to both chambers of Congress and was organized by the Genetic Alliance, a coalition of more than 600 organizations that collectively advocates for 25 million people affected by 1000 conditions. Sharon Terry, president of the Coalition and CEO of Genetic Alliance, said: “Individuals no longer have to worry about being discriminated against on the basis of their genetic information, and with this assurance, the promise of genetic testing and disease management and prevention can be realized more fully. We applaud our champions on the Hill who have worked tirelessly to pass this important legislation. It is now our responsibility to make sure the public knows that these new protections are in place.”

States

Direct Billing Legislation Moves Through State Legislatures: MD, MO Join the Fold

Maryland Gov. Martin O’Malley recently signed into law direct billing legislation. The state now becomes the 14th state to prohibit markups on anatomic pathology services by an ordering physician who does not perform or supervise the service. The law requires that a patient or insurer be billed directly from the laboratory or physician performing or supervising the anatomic pathology service. The Senate version, S.B. 602, and the House version, H.B. 1089, of the legislation both had unanimous support.

Similarly, the Missouri Senate also passed direct billing legislation recently. ASCP issued an Action Alert to its Missouri members asking them to urge their state legislators to support direct billing. S.B. 817 now resides in the Missouri House, where it will be referred to committee.

ASCP has continued not only to support direct billing but also to work with many state pathology societies and the CAP to enact direct billing legislation in other states.

Society News

ASCP 2007 Wage & Vacancy Survey Completed

The 2007 ASCP Wage and Vacancy Survey, which provides current wage data and determines the extent and distribution of personnel shortages within the nation’s clinical laboratory workforce, is now complete. (A full report on the 2007 ASCP Wage and Vacancy Survey will appear in the August 2008 issue of LABMedicine.) Conducted every two years since 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 was collected for staff medical technologists (MT), MT supervisors, MT managers, staff cytotechnologists (CT), CT supervisors, histotechnicians (HT), histotechnologists (HLT), HT supervisors, staff medical laboratory technicians (MLT), MLT supervisors, staff phlebotomists (PBT), PBT supervisors, laboratory assistants (LA), and LA supervisors. New position categories included in the 2007 survey were pathologists’ assistants (PA), PA supervisors, specialists in blood banking (SBB), and SBB supervisors. Information about vacancies, hiring practices and laboratory demographics was also collected. Also new in 2007 was the collection of data for non-waived versus waived testing facilities.

Preliminary data from the 2007 survey suggest a worsening shortage of laboratory personnel across the nation. Nearly one-half of the clinical laboratories across the nation are experiencing difficulties hiring personnel. The national vacancy rates for certified medical technologists and histotechnicians were particularly high, at 9.5% and 13.7%, respectively. Increased competition for qualified staff and lower compensation for laboratory work compared to other fields were the predominant reasons cited for the hiring difficulties.