ePolicy News March 2017
Tuesday, March 7, 2017
BOC, ASCP, and ASCLS Urge CMS to Reverse Nursing Policy
The Centers for Medicare and Medicaid (CMS) should immediately reverse its unsound position that the biological sciences include nursing. In a February 15 letter to CMS, the ASCP Board of Certification (BOC), American Society for Clinical Laboratory Science (ASCLS) and the American Society for Clinical Pathology (ASCP) urged the Agency to reverse its policy allowing individuals with a bachelor’s degree in nursing and no formal laboratory training to perform and supervise high complexity laboratory testing and to direct moderate and waived complexity laboratories.
Under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations, an individual with a baccalaureate degree in the biological sciences may perform and supervise high complexity testing. Despite overwhelming evidence provided by the BOC to the contrary, CMS still appears to maintain that the biological sciences include nursing.
The Feb. 15 letter noted that the Department of Veterans Affairs (VA) recently declared that the scope of practice of Advanced Practice Registered Nurses does not include performing or supervising high complexity laboratory testing. Yet, CMS would let individuals with less training perform or supervise such tests in non-VA facilities.
The BOC, ASCLS, and ASCP also raised legal objections to the CMS policy on the grounds it is in direct conflict with well-established judicial limits on the ability of federal agency’s to interpret their own regulations. The courts have consistently ruled that federal agencies may not interpret their regulations in a manner that is erroneous or inconsistent with them. The BOC, ASCLS, and ASCP noted, however, that CMS’s interpretation is clearly erroneous and inconsistent with the CLIA regulations and, thus, it should be rescinded.
The new letter is a follow-up to the Sept. 27 meeting between the BOC, ASCLS, ASCP and CMS. During that meeting, the organizations presented CMS with a petition signed by more than 30,000 laboratory professionals opposed to the CMS policy. At the time, CMS indicated it would take several months to determine by what method it would cancel its flawed policy.
ASCP will update ePolicy readers on the Agency’s official response once it is received.
ASCP’s Dr. Hilborne Wins AMA Burgess L. Gordon Memorial Award
The American Medical Association (AMA) awarded ASCP Past President Lee H. Hilborne, MD, MPH, FASCP, DLM(ASCP) with its Burgess L. Gordon Memorial Award. The award recognizes individuals for their contributions to the AMA’s Current Procedural Terminology (CPT) program. Dr. Hilborne’s award was part of a sweep for pathology as Ms. Ayanna Wooding, Assistant Director for Economic and Regulatory Affairs for the College of American Pathologists, earned the CPT Staffer of the Year award.
The AMA’s Burgess L. Gordon Memorial Award honors the efforts of the AMA specialty advisors. It is named for Burgess Gordon, who was a member of the AMA staff and was the first editor of the Current Procedural Terminology (CPT) code set. Nominations are made solely by AMA staff for individuals they believe best:
- Serve as an advocate for the CPT process;
- Provide complete and timely responses to applications for CPT codes;
- Demonstrate an understanding of the full range of CPT issues, beyond the specialty area; and
- Provide technical support to the variety of stakeholders in the CPT code set.
Congratulations Dr. Hilborne and Ms. Wooding!
2015 Wage Survey Results Highlight Need for Strategic Recruitment and Retention Programs
ASCP published the results of its ASCP 2015 Wage Survey in AJCP Online on Feb. 26, 2017. The survey results indicate that salaries for most staff-level laboratory professionals have increased since 2013. Not surprisingly, survey results reflect the fact that more academic training and/or work experience can have a positive effect on salaries, as Pathologists’ Assistants and administration personnel were found to have higher salaries than laboratory assistants and phlebotomists. Edna Garcia, MPH, ASCP Senior Manager of Scientific Engagement and Research, also noted, “Overall, the survey results also put an emphasis on strategic recruitment and retention by laboratory training programs and institutions that hire laboratory professionals.”
The ASCP Wage Survey provides current wage data for U.S.-based laboratory scientists. This report is the second half of the ASCP’s Wage and Vacancy Surveys, which are administered as two separate surveys. The wage portion highlights pay levels broken down by title, geography, certification and other variables using results of an online survey that requested data from more than 17,000 laboratory managers, directors, supervisors, and staff across the United States.
To read the ASCP 2015 Wage Survey Results, click here.
ASCP Concurs with NQF’s Diagnostic Quality and Safety Framework
ASCP recently submitted comments on the National Quality Forum draft framework titled: Improving Diagnostic Quality and Safety: Draft Measurement Framework. The NQF framework articulates its vision to address some of the key concerns identified in the 2015 National Academies of Sciences, Engineering, and Medicine (NASEM) (previously known as the Institute of Medicine [IOM]) study Improving Diagnosis in Health Care. The NQF conceptual framework for measuring patient safety and quality in diagnoses was developed by a multi-stakeholder expert panel. ASCP concurred with the NQF framework as an important step to improve the diagnostic process and patient care.
As a sponsoring organization of the original NASEM study, ASCP wholeheartedly agrees with its findings that “…diagnostic errors have been more challenging to measure than other quality or safety concepts.” This observation is precisely why ASCP created the National Pathology Quality Registry (NPQR) to set standards for patient-centric diagnostic care.
Through the development of the NPQR, we have identified similar gaps in measurement.
ASCP submitted comments supporting the overall framework and concepts. As a patient-centric organization, ASCP strongly agrees with the proposed measures that focus on patient safety and outcomes as opposed to “diagnostic accuracy.” ASCP also agrees with the NQF that increased measurement in this area can lead to improvements in quality of care. Further, Ali Brown, MD, FASCP, Medical Director of the NPQR, observed that she “…is especially impressed that [the draft framework] really emphasizes the entire healthcare team's involvement in diagnosis.”
ASCP will continue to collaborate with the NQF Committee to advance a patient-driven measurement construct to improve diagnostic quality and safety.
ASCP Influences MIPS Measure Selection Process
As part of its annual measure development process, the Centers for Medicare & Medicaid Services (CMS) recently announced a Call for Measures for the Merit-based Incentive Payment System (MIPS) 2018 program year. In response, ASCP recommended CMS adopt Accredited Continuing Medical Education (CME) for the MIPS for the Improvement Activity performance category. Recall that MIPS is a newly-implemented Medicare payment program rewarding physicians for their performance in four measurement categories—with Improvement Activities being one of them.
As ASCP has iterated in previous comments,
“Improvement activities and CME activities that improve performance can contribute to patient health by helping clinicians improve their knowledge, competence, and patient outcomes. CME activities are a key component of ensuring adherence to quality metrics and use of health information technology to produce clinical performance improvement. As patients will continue to need healthcare professionals who engage in lifelong learning, assessment, and improvement in practice, it is imperative for these activities to be recognized and rewarded in value-based payment programs promulgated by CMS and/or private payers.”
It is with this rationale that ASCP submitted Accredited CME as an Improvement Activity to improve the ability of pathologists to meet MIPS’s requirements and to receive incentive payments. CMS is currently reviewing and evaluating the activity for applicability and feasibility. ASCP will continue to monitor the progress of our suggested activity as it moves through the development process.
CMS Eases PAMA Reporting for Laboratories
On Feb. 8, the Centers for Medicare & Medicaid Services (CMS) announced that reporting laboratory pricing data as required under the Protecting Access to Medicare Act (PAMA) will be easier. The Agency explained that a reporting entity that has multiple Taxpayer Identification Numbers (TINs) and multiple National Provider Identifiers (NPIs) can now register TINs and NPIs under one user.
Recall that PAMA requires data submission by March 31, 2017 for payment adjustments in beginning in 2018. To learn more about data submission, see the CMS user guide. For more information about PAMA, please visit ASCP’s resource page.
2017 PEPFAR Annual Report to Congress Released
The President’s Emergency Plan for AIDS Relief (PEPFAR) 2017 Annual Report to Congress was released on Feb. 15. The Annual Report details much of the important work that has been accomplished through PEPFAR funding to date, including:
- Support of nearly 11.5 million people with antiretroviral treatments;
- Nearly 2 million babies born HIV-free to pregnant women living with HIV;
- Transformation of the global HIV/AIDS response
Through strong bipartisan support in Congress and across various administrations, PEPFAR has expanded its impact, strengthened partnerships, and come a long way in fighting the HIV/AIDS pandemic. Since 2005, ASCP has worked with PEPFAR funding to improve laboratory infrastructure, technology, and training in Africa and other resource-limited countries. Laboratory programs in developing countries play a pivotal role in effective implementation of prevention, care, and treatment programs.
For more information regarding ASCP's
initiatives and policy positions, please contact ASCP's Center for
Public Policy at (202-347-4450).
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