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ePolicy News January 2013

Wednesday, January 2, 2013



Congress Approves, Obama to Sign Bipartisan Fiscal Cliff Compromise into Law

Compromise measure provides one-year patch to SGR-mandated cuts to Medicare Physician Reimbursement

On Jan. 1 at the eleventh hour, the House of Representatives approved the fiscal cliff compromise negotiated by Vice President Joe Biden and Senate Minority Leader Mitch McConnell. Earlier in the day, several signs suggested that House Republicans might oppose the Senate measure, raising the prospects that most Americans would see their tax rates rise in 2013. Ultimately, the House passed the measure 257–167, clearing the way for the measure to be sent to President Obama for his signature. Besides preventing increases in income taxes for most Americans, the measure provides a two-month delay in the sequester, an across-the-board cut in spending effecting federal defense and domestic programs. The compromise measure is expected to increase federal revenues by approximately $620 billion over 10 years.

The legislation will block until Dec. 31, 2013, cuts in Medicare physician payment rates triggered by the sustainable growth rate. Had Congress failed to pass the measure, Medicare physician payment rates would have been cut 27 percent. ASCP had hoped that Congress would close loopholes in the Physician Self-Referral Law’s In-Office Ancillary Services Exception to pay for part of the $31 billion cost of the fix. The two-month postponement in the sequester holds off for now a 2 percent across-the-board cut in Medicare fee schedule payments. The 2-percent cut will go into effect on March 1, unless Congress acts to prevent or reduce it.

Here are the major elements of the compromise:

Congress agreed to extend the Bush-era income tax rates for most Americans, but increased income tax rates on individuals for incomes above $400,000 and above $450,000 for married couples. Earnings above these amounts would be taxed at a rate of 39.6 percent, up from the current 35 percent. The measure extends Clinton-era caps on itemized deductions and the phase-out of the personal exemption for individuals earning more than $250,000 and couples making more than $300,000.

The new law will tax estates at a top rate of 40 percent. The law exempts the first $5 million of individual estates and $10 million for family estates. In 2012, the top tax rate for estates was 35 percent. Taxes on capital gains and dividends will increase from 15 percent to 20 percent on income exceeding $400,000 for individuals and $450,000 for families.

The legislation permanently addresses the alternative minimum tax and will index it for inflation. This will prevent almost 30 million middle- and upper-middle income taxpayers from paying higher taxes, on average totally about $3,000. The measure also expands a number of tax credits for five years, including the child tax credit, earned income tax credit, and college tuition tax credit. The measure extends unemployment benefits for an additional year.

One tax cut the measure did not extend was the Social Security payroll tax cut. The 2 percentage point payroll tax cut will expire, raising the rate to 6.2 percent.




ASCP Urges CMS to Reconsider Placement of Molecular Pathology Codes and Cuts to 88305

In a letter to the Centers for Medicare and Medicaid Services, ASCP has raised concerns about the Agency’s decision to place the new molecular pathology codes on the Clinical Laboratory Fee Schedule (CLFS) and its rejection of some of the practice expense inputs that resulted in a sharp decrease in reimbursement for the technical component of CPT code 88305, Level IV biopsy. The letter focused on issues pertaining to CMS’s CY 2013 Physician Fee Schedule (PFS) final rule.

ASCP urged CMS to reconsider its recent changes to the 88300-88309 family of CPT codes. These changes are due, in part, to CMS’s rejection of a number of direct practice expense inputs that were approved and recommended by the Resource-based Relative Value Scale Utilization Committee (RUC). CMS’s “refinements” to the RUC recommendations will result in significant cuts for most of these services, including a 52-percent cut in reimbursement for the technical component (TC) of 88305 (Level IV–Surgical pathology and gross and microscopic examination), reducing the TC payment from $69.78 to $33.70.

In its letter, ASCP argued that rejection of these costs was done erroneously and noted that many items recommended by the RUC are outlined as acceptable direct practice expense inputs in CMS’s Direct Input List. For example, CMS rejected courier transportation costs as a direct practice expense input; however, the Agency’s own documentation allows for recognizing transportation costs, such as Federal Express and device shipping costs, as direct inputs.

Even if CMS accepted all of the RUC-recommended direct practice expense inputs, the TC of 88305 would still be significantly reduced because the costs of performing these services is less than when the RUC last performed a thorough review of these services more than 10 years ago. “Given the magnitude of the cut in the TC of these codes, particularly 88305, and the significant impact that this impeding loss of revenue will have, we urge CMS to phase in the changes in the practice expense for these codes over several years, at least three,” ASCP wrote.

The Society expressed disappointment with CMS’s decision to assign the new molecular pathology codes to the CLFS and urged the Agency to reconsider. “CMS’s decision not to place these codes on the PFS denies the Agency the opportunity to periodically examine and update the valuations for these procedures, as there is no review process built into the Clinical Laboratory Fee Schedule,” ASCP’s letter states. The Society also raised concern that the Agency may have mistakenly assumed that automated tests and negative test results require no professional interpretation service.

ASCP thanked CMS for announcing it would establish a new G code for physician interpretation and reporting of a molecular pathology service to replace the deleted CPT code 83912. However, ASCP urged the Agency to instead allow the use of a -26 modifier. Doing so would improve the Agency’s ability to “monitor the utilization of this service and collect data on billing patterns to ensure that G0452 is only being used when interpretation and report by a physician is medically necessary and is not duplicative of laboratory reporting paid under the CLFS,” according to ASCP.

In the final rule, CMS also announced that it intended “to reassess whether this Health care Common Procedural Coding System code is necessary and, if so, [conduct the reassessment] in conjunction with which molecular pathology tests.” ASCP believes that -26 modifier would provide the Agency with better data necessary to support a permanent code for the physician interpretation and report of molecular pathology services.




Clinton Releases Blueprint for an AIDS-Free Generation

As Secretary of State Hilary Rodham Clinton prepares to step down from her post, she leaves her successor, the next Congress, and all other partners in the global fight against AIDS a blueprint for achieving what she calls an “AIDS-free generation.” Secretary Clinton’s plan, PEPFAR Blueprint: Creating an AIDS-Free Generation, released on World AIDS Day 2012, seeks to build on a proven track record of success in reducing global AIDS as a result of the President’s Emergency Plan for AIDS Relief (PEPFAR).

Launched in 2003 by President George W. Bush with strong bipartisan support, PEPFAR was initially an emergency response. As the epidemic has waned, PEPFAR has evolved to be a more sustainable response with partner countries assuming ownership for programming to ensure the response is appropriate, effective, and lasting.

The PEPFAR Blueprint is based on five essential principles:

  • Making strategic, scientifically sound investments to rapidly scale–up core HIV prevention, treatment and care interventions, and maximize impact;
  • Working with partners to mobilize, coordinate, and efficiently use resources to expand high-impact strategies;
  • Focusing on women and girls to increase gender equality in HIV services;
  • Ending stigmatism and discrimination against people living with HIV and key populations; and
  • Setting benchmarks that are regularly assessed to ensure goals are being met.

The ultimate goal is to prevent new infections and to stop HIV-positive individuals from developing AIDS, rather than attempting to end the HIV pandemic altogether. “As we continue to drive down the number of new infections and drive up the number of people on treatment, we will get ahead of the pandemic and an AIDS-free generation will be in sight,” Secretary Clinton says.



Advances in Diagnostics Protecting Women’s Health

“Personalized Medicine: the Role of Diagnostics in Protecting and Promoting Women’s Health” was the theme of a recent Capitol Hill briefing focusing on women’s health, hosted by AdvaMedDx. The briefing was held in conjunction with the U.S. House of Representatives’ Medical Technology Caucus. Panelists included:

  • Lisa Hill, a four-year breast cancer survivor, medical laboratory professional, and mother of three;
  • Jennie McGihon, a survivor of both ovarian and uterine cancer, and spokesperson for the Center for Disease Control and Prevention’s (CDC) “Inside Knowledge” campaign;
  • Carl Hull, Senior Vice President and General Manger of Diagnostics at Hologic Gen-Probe, in San Diego; and
  • Bonnie Rib, Vice President and General Manager of Women’s Health and Cancer at BD Technologies, in Durham, N.C.

The panel emphasized the importance of diagnostics in treating debilitating diseases, particularly in women. Innovation in diagnostic tests targeted at women’s health holds great promise for identifying small genetic differences that can often impact prognosis and outcomes,” according to a statement on AdvaMedDx’s website. “These advancements in diagnostics have led to better screening, treatment, and survival rates for women.”

Pathology and laboratory medicine play a key role in the prevention and treatment of disease in women. As such, ASCP’s policy statement on cervical cancer screening tests maintains that such tests should be available to all patients at a reasonable cost and should occur at regular scientifically and clinically validated intervals. The policy also states that efforts should be made to identify and recruit unscreened or poorly screened women into screening programs.

To access the policy statement, go here.

For women’s health resources, please see AdvaMedDx.


ASCP Focus on Patient-centered Care for Women

The Women’s Health Forum, held during the 2012 ASCP Annual Meeting, focused on the challenges of defining and delivering patient-centered care to women in different settings around the globe. The session examined practitioners’ responsibility to provide patient-centered care that is respectful of and responsive to individual patient preferences, needs, and values, and to ensure that patient values guide all clinical decisions. It also addressed gaps that exist in women’s health care, domestically and globally. Panelists noted that pathology and laboratory medicine play critical roles in the diagnosis, management, and therapy of women’s health challenges and in delivering quality patient-centered care.

The panelists were:

Kimberly Allison, MD, Director of Breast Pathology at the University of Washington Medical Center, in Seattle
 Dr. Allison began the discussion with her personal story. A breast pathologist and breast cancer researcher, she was diagnosed with Stage 3 breast cancer. She recounted her sudden journey from the role of physician to patient and then to patient advocate, and shared how her experience as a patient has transformed the way she practices.

Doyin Oluwole, MD, MRCP, FRCP, Executive Director of the Pink Ribbon Red Ribbon at the George W. Bush Institute
 Dr. Oluwole is a physician-scientist who specializes in maternal health and strengthening health systems. Dr. Oluwole highlighted efforts in the area of gender specific health programs, including the Bush Institute’s Pink Ribbon, Red Ribbon Partnership, to raise awareness and improve the treatment and screening for cervical and breast cancer in several African nations.

John Nkengasong, PhD, Chief of the Division of Global HIV/AIDS International Laboratory Branch at the Centers for Disease Control and Prevention
Dr. Nkengasong outlined the essential role of pathology and laboratory medicine in the delivery of patient-centered care, and discussed the challenges, successes, and opportunities that exist in the delivery of patient-centered care in resource limited areas.

Eric G. Bing, MD, PhD, MBA, Director for Global Health at the George W. Bush Institute, moderated the forum. He also gave an overview of the Bush Institute’s global initiatives to provide integrated health services to women, including Pink Ribbon Red Ribbon, and discussed ways that the United States can assist in bridging the gap in women’s health globally.

In recent decades, tremendous strides have been made in women’s health care throughout much of the world, yet many countries are still lagging or losing ground in this area. Within some resource-limited countries, evidence exists of inequalities in health care. The number of new cases of breast cancer has jumped dramatically worldwide, from approximately 640,000 in 1980 to more than 1.6 million in 2010. More than half of these new cases are in developing countries.

During the same period, the number of cases of cervical cancer has increased more slowly; 200,000 women worldwide died from cervical cancer. While the world health community has acknowledges that no woman should die because of complications related to pregnancy and childbirth, given the current trends, breast and cervical cancer must also become a focus of the discussion when priorities are being set for women’s health programs.

At the 2013 ASCP Annual Meeting, the Society will focus again on a patient-centered approach to global health for women. Look for an announcement on the topic and experts participating in this forum in this spring. ASCP is deeply committed, through education, advocacy, and outreach initiatives, to promoting high quality, patient-centered health care for all women.



ASCP, APC Lead Effort to Inform IOM about Pathologist Workforce

ASCP and the Association of Pathology Chairs (APC) collaborated with the Cooperating Societies of the American Board of Pathology to request that the Institute of Medicine (IOM) consider adding pathology to the list of specialties that are recommended for targeted increases in Medicare funding for graduate medical education. The sign-on letter was crafted by ASCP and APC and sent to all of the Cooperating Societies for consideration. To view the letter, please click here.


IOM Debates Future Direction of GME Funding

The Institute of Medicine (IOM) Committee on the Governance and Financing of Graduate Medical Education met last month to consider the future of funding for physician workforce training. The Committee is tasked with developing policy recommendations to improve graduate medical education (GME), with an emphasis on training physicians. There have long been calls for broad reform of the GME system to better align funding with the public’s health workforce needs. GME governance and financing currently face an array of challenges. These include a rapidly aging and increasingly diverse patient population; underserved rural and urban populations; growing prevalence of disability and chronic disease; an urgent need for a more cost-effective healthcare system; innovations in healthcare delivery; the impact of GME on state level policies and GME in state institutions; advances in diagnostics, therapeutics, and health information technology; and others.

During their discussion, panelists examined how to approach GME in terms of innovation. For instance, should there be involvement of both patients and families in the educational process? Current trends must be examined, along with consideration of the implications in terms of curriculum development and practical application.

The Committee will focus on how best to increase the capacity of the nation’s clinical workforce to deliver efficient and high-quality health care that will meet the needs of a diverse population. Issues to consider include the current financing and governance structures of GME; the residency pipeline; the geographic distribution of generalist and specialist clinicians; types of training sites; relevant federal statutes and regulations; and the respective roles of safety net providers, community health and teaching health centers, and academic health centers.



DOL Funding Tilts Training Program Toward Innovative, Collaborative Model

Pathology and laboratory medicine have been described as being at a crossroads. There are available jobs; however, there are an insufficient number of qualified personnel to fill them. In addition, training programs have evaporated due to budget cuts, yet the need for pathologists and other laboratory personnel is on an incline. This increase is due, in large part, to an aging population. Despite what appears to be a dismal outlook, one training program seems to be thriving because it has embraced innovation, collaboration, and partnership.

The Clinical Laboratory Science program at San Jose State University (SJS) is thriving. One reason may be that the school was able to access Department of Labor (DOL) funding for academic training. In total, the school received $5 million in federal funding. While some institutions pursued grant money to resurrect floundering programs, SJS saw pursuing the available funds as an opportunity to enhance and add to its existing program. SJS Program Director Suzanne Gayrard says her predecessor led the initiative to secure DOL funds, believing it could be used to increase and maintain the program’s enrollment and design a product that offers a “value added features” to attract faculty and students.

Ms. Gayrard discussed the necessity to expand the workforce, noting that California has 17,000 medical laboratory scientists, many of whom are 60 or older. SJS has embraced partnerships, forging alliances with clinical sites, biotech companies, and others to assure that students have a comprehensive educational experience that reflects the multi-faceted nature of a medical laboratory science career. This year, SJS received 122 applications for 17 student openings.

The 34 students in the program engage in hands-on learning at nearby sites, such as Santa Clara Valley Medical Center, which takes six students per semester, Los Angeles Hospital, and Cedar Sinai Hospital. The program has initiated a concentration in molecular biology and contracts with area biotech companies to have students do rotations there. The program is taught online in real-time, with students participating via instant messaging; it is modeled after SJS’s Clinical Laboratory Science (CLS) face-to-face program.

The CLS program enjoys a near perfect graduation rate, and a 99.9 percent pass rate of its graduates on the ASCP certification exam. After graduation, alumni job prospects are ideal. Some students have already secured employment prior to graduation, while others are working within a couple of months, in all sectors of the laboratory.

Ms. Gayrard credits the SJS program’s success to the support of its clinical affiliates, a strong foundation of seed funding before it received government funds, and the long-term partnerships it has formed. For example, the Hospital Council of the Bay Area pledged $10,000 a year for five years to the program and recently renewed that pledge. In addition, SJS envisions opportunities in areas where training programs have closed. It is working to develop a partnership with Dignity Health, which runs 42 hospitals in Arizona and Nevada, to serve as additional training sites for its program.

Having gotten off to a strong start, the SJS program can now serve as a model for other laboratory science programs seeking to gain traction and move their programs forward.



ASCP Forms Task Force to Examine Work Force Issues

ASCP has formed the Task Force on Workforce to examine issues related to the laboratory workforce shortage and recommend a comprehensive strategy to address these concerns. The Task Force will review all of the laboratory professions. laboratory professions and pathologists will be considered separately. The challenges to recruitment and retention, educational requirements, and the body of available workforce data for each group differs significantly. The first phase of the Task Force’s work will focus on the current state of the laboratory professionals’ workforce, while the second phase will consider the nation’s workforce of pathologists.





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