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ePolicy News November 2012

Monday, October 29, 2012



New York ASCP Members Score Victory in State Self Referral Rollback

Pathologists and other laboratory professionals in New York scored a major legislative victory in October when New York Gov. Andrew M. Cuomo vetoed legislation that would eliminate much of New York’s own Physician Self Referral Law. The measure, AB 3551, would have had the state follow the federal Stark Law, which is replete with loopholes that have encouraged self referral arrangements as clinicians increasingly try to profit on the medical services they order. The failures of the Stark Law have been blamed on a significant overutilization of anatomic pathology services, as well as overutilization of advanced imaging, radiation therapy, and physical therapy services.

ASCP worked hard to encourage Gov. Cuomo to veto the measure. In addition to promoting a letter-writing campaign to the Governor and his staff, ASCP sent several e-Advocacy alerts to New York members urging them to contact the Governor and ask that he veto the bill. ASCP’s alert was highly successful in mobilizing members to write letters. ASCP also coordinated a response from the Alliance for Integrity in Medicare, a coalition of organizations representing over 100,000 professionals involved in anatomic pathology, advanced imaging, radiation therapy, and physical therapy services. It also coordinated its advocacy efforts with the New York State Society of Pathologists, New York State Clinical Laboratory Association, American Clinical Laboratory Association, and the College of American Pathologists.

As a result of Gov. Cuomo’s Oct. 3 veto of AB3551, New York will continue to be covered by a physician self referral prohibition that is stronger than the federal Stark Law and will better protect patients. In a statement, Gov. Cuomo expressed concern about the impact that loosening the state’s current prohibition on physician self referral would affect conflicts of interest.

“This bill would amend the Public Health Law which prohibits, subject to certain exceptions, health care practitioners from referring patients to providers of health care services with whom the practitioner or an immediate family member has a financial relationship,” Gov. Cuomo said. “This bill could weaken those Public Health Law prohibitions by, among other things, creating additional exceptions to what constitutes a financial relationship, albeit in conformity with federal law. Given the concern with real and apparent conflicts of interest that this change would engender, I see no reason to upset New York’s rules for determining the propriety of practitioner referrals.”




A Glimpse of Health Care in the Post 2012 Election Era
Will Rhetoric Translate into Effective Change?

With the election just a week away, the economy may not be the only factor voters are considering as they size up the two presidential candidates; voters may regard healthcare delivery and access as another means of evaluating President Barack Obama and former Gov. Mitt Romney. A huge portion of the U.S. budget goes to health care. Given the controversy over the Affordable Care Act (ACA) signed into law by President Obama, it is worth noting what the candidates are promising and how voters are viewing the debate.

Media reports indicate mistrust among voters, particularly in swing states such as Ohio where voters tend to be critical of President Obama’s healthcare law because they say their healthcare costs are rising. Yet, others believe Romney, with all his wealth, doesn’t understand the average voter’s needs. Romney proposes to repeal the 2010 healthcare overhaul law, saying the move would help balance the budget. He says it “doesn’t sound good and it’s not affordable.” Moreover, he has also pushed for Medicaid block grants, saying they would significantly cut program spending and provide states with flexibility to design their own healthcare programs without meddling from Washington.

With the passage of the ACA, set to start in 2014, Obama maintains he accomplished what previous presidents failed to do—overhaul the nation’s healthcare system. The ACA calls for comprehensive reforms to improve access to affordable health coverage for everyone and to protect consumers from abusive insurance company practices. The Obama Administration says the law allows all Americans to make their own health insurance choices, guarantees access to care for the nation’s most vulnerable, and provides new ways to reduce costs and improve quality of care.

ACA aims to decrease the number of uninsured Americans and reduce overall costs of health care. It provides a number of mechanisms—including mandates, subsidies, and tax credits—to employers and individuals to increase the coverage rate of health insurance. Additional reforms are aimed at improving healthcare outcomes and streamlining the delivery of health care. ACA requires insurance companies to cover all applicants and offer the same rates regardless of pre-existing conditions or gender. Many questioned the constitutionality of some provisions of the law, including the individual mandates, and fought the merits of the law at the state level and before the U.S. Supreme Court. On June 28, 2012, the U. S. Supreme Court upheld the constitutionality of most of ACA in the case, National Federation of Independent Business v. Sebelius. It remains to be seen if all that the law promised—more Americans insured, cost-savings, etc.—will materialize, especially if Romney wins the election.


Emerging Healthcare Leaders Focus on What’s Next

As the U.S. Presidential election nears, the future of health care has been a hot topic of conversation among voters. Last month, a bipartisan panel of Congressional staff with healthcare experience lent their voices to the national debate.

Tony Clapsis, a staff member on the Senate Finance Committee, Elizabeth Falcone, legislative assistant for health care and education policy for U.S. Sen. Mark R. Warner (D-Va.), Josh Trent, policy adviser to U.S. Sen. Tom Coburn, MD (R-Okla.), and James Paluskiewicz, deputy chief of staff and legislative director to U.S. Rep. Michael C. Burgess, MD (R-Texas) served on the conference panel.

Medicare Part A and Patient-Centered Medical Homes recurred frequently during the discussion. Panelists had varying opinions on healthcare implementation, yet agreed that strategic planning is essential for implementation of medical homes, accountable care organizations, and dissemination of the healthcare budget.

To improve the quality of patient care and control costs, the ASCP believes that pathologists and advanced certified laboratory professionals should be fully incorporated into the administrative and clinical structures of accountable care organizations and medical homes.




PEPFAR Board Promotes Implementation Science

The Scientific Advisory Board of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) convened its third meeting last month to consider the application of implementation science (IS) to the realities of combination prevention, reaching populations marginalized in their own countries, and effectively organizing HIV testing and treatment services for health, prevention, and care. IS refers to the integration of research findings and evidence into healthcare policy and practice. It seeks to understand the behavior of healthcare professionals and other stakeholders as a key variable in the sustainable uptake, adoption, and implementation of evidence-based interventions.

In his opening remarks, U.S. Global AIDS Coordinator Ambassador Eric Goosby pointed out that lack of communication between those needing services and those planning services continues to hamper efforts to realize the promises of recent biomedical advances in prevention, treatment, and care. He announced that grants will soon be available for IS that address the needs of “key populations,” including intravenous drug users, sex workers, transgender individuals, and gay men.

The latest round of IS funding went to proposals that included rigorous evaluation and impact measures, and addressed the following areas:

  • Building off the HIV platform to address multiple health outcomes;
  • Testing and diagnostic technologies;
  • Care and treatment cascade;
  • Building off the HIV platform to address TB diagnostics and care; and
  • Key populations

For this round and upcoming IS request for application rounds, Coordinator Ambassador Goosby noted that allocation decisions will be based on the proposed program’s evaluation mechanism and the estimated “time to results.” In-country linkages between investigators and PEPFAR implementers will be closely scrutinized in this process. Mr. Goosby reiterated the message that flattened-out funding, due to budget constraints caused by the global recession, is placing much more emphasis on increased efficiency and effectiveness. All parts of the PEPFAR portfolio will be subject to closer scrutiny. Criteria on which programs will be evaluated and funded will be based on the extent to which they decrease sero-conversion and promote country ownership without sacrificing quality of care.



Coalition Urges Congress to Maintain Funding for Allied Health Training

As a follow-up to proposed cuts in Title VII and Title VIII funding, the Health Professions Nursing Education Coalition (HPNEC) is preparing to issue a sign-on letter voicing its disappointment. (Title VII provides funding for allied health professions training. Title VIII funds nursing education.) The Coalition, of which ASCP is a member, is urging Congress to increase funding or, at the very least, maintain funding for allied health training programs.

HPNEC members recently provided examples of sequestration's impact on the Title VII and VIII programs and their beneficiaries. Their letters, delivered to all House and Senate offices, demonstrated the devastation not only of sequestration, but of any cuts to the programs.

In late September, President Barack Obama signed a continuing resolution (P.L. 112-175) which funds most federal programs at essentially FY 2012 levels through March 27, 2013; however, the resolution did not provide an increase in funding for training programs. Observers speculate, however, that the current Congress may complete work on the FY 2013 spending bills before adjourning (and well in advance of the March 27 CR expiration). Yet this scenario seems unlikely, given the long list of tasks Congress must complete during its lame duck session.


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