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Health regulators in New York State have proposed to reverse a ban on pathologists discussing laboratory results with patients following two years of advocacy by the CAP and New York State Society of Pathologists (NYSSPATH).

The New York State Department of Health (NYS DOH) proposed during a Public Health and Health Planning Council, Committee on Codes, Regulation, and Legislation hearing on June 9 to exempt pathologists from regulations that prohibit discussing laboratory test results directly with patients. While the proposal still needs to be codified in state regulation, health officials are clear they are seeking to exempt all physicians from the current restrictions on laboratories responding to patient questions.

The proposed affirmative statement says "Pathologists and other physicians in the laboratory may discuss the meaning and interpretation of the test results with patients on request." Discussion of the proposal occurred at the start of the June 9 meeting and can be viewed from the NYS DOH meeting archive.

During the hearing, Foster Gesten, MD, the chief medical officer in the NYS DOH Office of Quality and Patient Safety, said they discussed the issue with several stakeholders to gather feedback on changing the regulatory language. "There was overwhelming support to amending the language to allow physicians, pathologists in the lab, to communicate the meaning or interpretation of test results to patients on request," Dr. Gesten said.

Since 2014, the CAP and NYSSPATH have sought to repeal the prohibition on conferrals. In 2014, the US Department of Health and Human Services granted greater patient access to laboratory results in a final rulemaking. The CAP then urged the NYS DOH to comply with this federal regulation by removing its ban on pathologists communicating with patients.

"Although this effort took longer than first anticipated, we achieved this result after spending countless hours educating regulators and raising awareness about the critical role pathologists have in patient care," said NYSSPATH President Mary Elizabeth Fowkes, MD, FCAP. "Our success is also attributed to the broad coalition we built of patient advocates, medical societies, and other key stakeholders who supported a change that's clearly in the best interest of patient safety and care."

Dr. Fowkes and other pathologists in New York previously provided testimony on how pathologists interact with patients to improve care. Concerned patients will contact pathologists to better understand diagnostic findings. On some rare occasions, patients will ask to look at microscopic slides used to make a diagnosis of cancer.

Prior to the hearing, the Medical Society of the State of New York (MSSNY) adopted policy that is supportive of the repeal of this language. "There was consensus that when a patient seeks out a pathologist about the test results that the pathologist should be able to answer questions posed by the patient," MSSNY said in a June 3 letter to Dr. Gesten.

In addition to advocacy by the CAP, NYSSPATH, groups that support the removing the ban include:

  • AARP, NY Chapter
  • National Kidney Foundation
  • New York Prostate Cancer Coalition
  • Long Island Breast Cancer Coalition
  • Medical Society of the State of New York
  • New York Bladder Cancer Coalition
  • National Brain Tumor Society
  • New York Center for Medical Consumers
  • New York City Health & Hospitals Corporation
  • New York State Clinical Laboratory Association
  • New York State Society of Pathology
  • American Society of Clinical Pathology
  • Association of Molecular Pathology
  • American Society of Cytopathology
  • American College of Radiology, NY Chapter

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The CAP joined with the American Medical Association (AMA) and a number of other medical associations in urging the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to develop better metrics for promoting and improving interoperability among health information technologies (IT).

In a June 3 letter sent to the CMS and the National Coordinator for Health IT at HHS, the CAP and more than 35 other groups said that while many health IT vendors claim their products are interoperable, the vast majority only exchange static documents in a manner that satisfied minimum Meaningful Use (MU) requirements.

"We are therefore concerned that both [CMS] and the Office of the National Coordinator (ONC) are misinterpreting the current use of health IT as a benchmark for successful interoperability," the letter said. Current measures related to data exchange are too focused on the quantity of information moved and not the relevance to these exchanges or the underlying business case for transmitting data, the groups argue.

"Greater exchange of patient data does not mean that we are achieving interoperability and better coordinated care," the letter said. "For medical professionals and patients alike, interoperability means the usefulness, timeliness, correctness, and completeness of data, as well as the ease and cost of information access. This requires measures that do more than count how many times voluminous documents are sent back and forth."

MACRA's Advancing Care Information Category

While the ONC has acknowledged limitations with existing measures and data derived from the MU program, the CMS has proposed to carry over these deficient measures in the recently proposed Medicare Access and CHIP Reauthorization Act (MACRA) regulation in the Advancing Care Information (ACI) category, the letter said. The ACI category is one of four in the new Merit-based Incentive Payment System.

The proposed MACRA regulation was published on April 27. The CAP is engaged on behalf of pathologists on the proposed regulation and is providing its comments to the CMS by June 27.

"Continuing a policy of 'counting physician clicks' will not adequately measure interoperability or incentivize health IT developers to make significant changes," the physician groups said in the AMA letter. "Rather, it will further propel developers to build EHRs that simply meet federal reporting requirements that focus solely on data exchange."

The CAP and other physician organizations said the CMS now has an opportunity to develop true metrics for promoting and improving operability. Instead of developing a list of proxy measures of metrics, ONC should work with the CMS to identify ACI objectives in which interoperability measurement is inherent, urge the groups.

"Such an approach could be done by focusing on specialty-specific interoperability use cases rather than the quantity of data exchanges," says the letter. "This would also serve to reduce physician burden and relieve ONC from needing to identify additional data sources for interoperability evaluation. If physicians are asked to shoulder additional tasks or evaluation activities, they should receive credit for such activities in the ACI category of MACRA."

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At the Seventh National Accountable Care Organization (ACO) Summit in Washington, DC, Donald Karcher, MD, FCAP, represented the CAP on an expert panel discussing the integration of specialty care into ACOs and other value-based care models on June 10.

Dr. Karcher, who chairs the CAP ACO Network and the Value-Based Care Strategy Steering Group, presented to the audience an overview of pathology practice and outlined some roles pathologists will play in future care models.

"In many ways, our value comes from how we can support other providers," said Dr. Karcher, who is also chair of pathology and director of laboratories at the George Washington University Medical Center in Washington, DC, and is president of the Association of Pathology Chairs. "Pathologists are the ultimate team-based physicians."

There are opportunities and challenges to pathologists' participation in ACOs and other payment models, Dr. Karcher said. Lab utilization management, lab test-related consultation, and support of population health management are only a few value-added roles pathologists can offer value-based models. Like any industry transition, there are challenges that arise when considering pathology's role in value-based initiatives, such as gaining recognition and compensation for pathologists' roles or the limitations in quality and performance measures currently available to pathologists. However, pathologists have unique skills sets that provide the opportunity to add great value, and can bring the traditionally "behind the scenes" work of pathologists into the light as a more recognized contributor.

Dr. Karcher highlighted the CAP's advocacy and strides toward value-based models. When posed with the question of how pathologists will handle the transition, Dr. Karcher concluded, "If we focus first and foremost on the patient and the equation, value = quality + outcome/cost, we are going to be okay in value-based care."

On alternative payment models (APMs), the CAP is engaged on behalf of pathologists on the proposed MACRA regulation and is providing comments to the CMS by a June 27 deadline. The CAP is hosting the webinar "How Medicare's New Physician Payment Systems Under MACRA Will Affect Pathologists" to review MIPS and APM payment pathways in MACRA on July 7. Complementary registration is open to CAP members.

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The CMS published its proposed regulation to implement Medicare payment reform under the MACRA. CAP leaders will review the proposed MACRA rule and discuss how it affects pathologists during a 60-minute webinar presentation on July 7 at 2 PM ET.

The MACRA regulation would set two payment pathways for physicians beginning in 2019: the MIPS and APMs. MIPS is expected to have an estimated $1.5 billion impact on payments to pathologists. Physicians participating in eligible APMs would not be subject to MIPS and would receive 5% Medicare payment bonuses.

The CMS is proposing to use 2017 as its first year to start measuring physician performance under the new payment system. Learn more about MACRA, MIPS, and APMs during this complementary presentation for CAP members. At the end of the presentation, our expert panel will answer your questions.

Register Today

Registration for this complementary presentation is available for CAP members and their staff. If you are unable to attend the live event, those who register will automatically receive an email link to an archive recording of the presentation by July 11.

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Throughout this hour-long panel discussion on July 14, CAP experts will explain the changes proposed by the CMS in the draft 2017 Medicare Physician Fee Schedule. The presentation begins at 2 PM ET.

Expected to be published by the CMS in early July, the proposed fee schedule contains reimbursement changes affecting pathologists. Under a new requirement, the CMS will provide additional detail on its intention to revalue certain pathology services targeted as potentially misvalued. During the webinar presentation, the CAP will review proposed changes, discuss how the rule affects Medicare reimbursement for pathology services, and the CAP's advocacy efforts to impact the CMS’ proposal prior to its finalization.

The second part of the webinar will be a question-and-answer session.

Register Today

CAP members are encouraged to register for this complementary presentation. If you are unable to attend the live event, those who register will automatically receive an email link to an archive recording of the presentation by July 18.

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