9/19/2014. Challenges Facing Pathology Today A CAP Pathologist s View Presenter: Sang Wu, MD, FCAP MGMA Annual Conference, Las Vegas, NV.

Transcription

1 sub-brand here Challenges Facing Pathology Today A CAP Pathologist s View Presenter: Sang Wu, MD, FCAP MGMA Annual Conference, Las Vegas, NV October 2014 cap.org v. # Introduction 2 Introduction 3 1

2 Course Objectives Examine the impacts of various governmental and societal changes underway on the practice of pathology in various settings Analyze organized efforts to advocate for favorable changes and contest detrimental policies on local and national levels. 4 Course Outline Historic perspective Evolution of pathology practices Current trends Future prospects, challenges, and opportunities 5 6 2

3 Evolution of Pathology Structural Functional H & E EM IHC xish Qualitative Quantitative Stains IHC Semi Quant IHC Quan t xish ELISA Assay Discrete Multiplex K, Na, Glu SMA C ACA ELISA, ECL Modular Platforms Analog Digital Glass Slides Photo of Slide Digitized Photo Digitized Slide No Slide? Evolution of Health Care Pure Senses Extended Senses Hands, Eyes, Ears ON Tools, scopes Hands, Eyes, Ears IN Hands OFF, Brain ON Manual Automated Touching, Moving Observing Intervening Thinking Discrete Multiplex Fever Cause Treatment Prognosis Predisposition Analog Digital Paper Records Fax EHR Prognostic EHR Predictive EHR Population Health Patterns of History Are Clear Qualitative evolves to quantitative Analog evolves to digital Distinct evolves to integrated Data becomes aggregated into information Qualitative Analog Distinct Data Quantitative Digital Integrated Information Information with context becomes knowledge Information Knowledge 3

4 Pathology is Evolving Diagnostics clearly evolving with data integration o Increasing dependence upon integrated structural, functional, molecular, genetic, proteomic, and genomic information 10 Pathologists are Evolving Getting Out From Behind the Paraffin Curtain E. Uthman, Arch Path Lab Med, Jan Pathologists 2.0 Master of one s trade; deliver timely and accurate diagnoses Success rests on personality traits/practice habits Overcome traditional stereotypes of pathologists You may not be interested in politics, but politics is very interested in you. Become engaged leaders 12 4

5 The Future of Pathology is Now J. Saad, Arch Path Lab Med, Jan 2014 Pathology is a dying specialty and has no future Pathologists must be engaged with the process of change We must be the physicians who direct testing, diagnosis, prognosis, and treatment 70% of clinical decision-making involve laboratory testing We must be front and center in our hospitals and laboratories to actively engage our clinical colleagues and administrators 13 Health Policy Landscape for Pathology Affordable Care Act (ACA) Obamacare Changes the way hospitals and physicians are reimbursed Fee for service value based Payments based on episodes of care, bundled payments, accountable care models Physicians will be paid based on quality measures and efficiency Congress delayed the SGR cut until April 1, Future Pathology Practices Less distinction between community practice and academia Trend towards sub-specialization Need for generalists exist Growth of employment models within the ACO structure 15 5

6 Pathology Anatomic Immunology Hematology Clinical Genetics Cytology Microbiology Molecular Imaging Radiology Nuclear Medicine Integrated Diagnostics Anatomic Immunology Hematology Clinical Radiology Genetics Cytology Molecular Microbiology Nuclear Medicine 6

7 CAP Policy and Advocacy Position Ensure that reimbursement revaluations of pathology services accurately account for the cost of delivering the services provided Ensure pathologists can comply with the new CMS value-based payment models Ensure a level playing field against unfair competition Protect pathologists scope of practice Protect funding for graduate medical education Sustain a favorable lab regulatory environment Priorities and Challenges SGR Reform: CAP is still pushing to enact the permanent SGR reform bill. It has pathology specific language to help us going forward. Self-Referral: CAP is pushing to close the self-referral loophole to pay for SGR reform. Immunohistochemistry: (PC & TC): CAP is working to reverse CMS decision to require the use of two new G codes for this service, but the solution may not be finalized until In situ hybridization services: 88365, 88367, and (PC & TC): CMS deferred final action on the revaluation of these services for 2014, but changes are anticipated beginning in Priorities and Challenges Linking Pathology TC Payments to the Hospital Outpatient APC Rates: While we succeeded in 2013, CMS remains committed to the policy which we will continue to oppose in Bundling of Pathology Services: The CAP will be opposing efforts to bundle pathologist professional services into bundled payments for hospitals. PQRS: CAP is working to ensure that pathologists can comply with CMS s PQRS program and will develop additional measures going forward. 21 7

8 2014 Priorities and Challenges Molecular Payment and Coverage: The CAP is advocating for payment and coverage in face of restrictive CMS and private payer policies. Next Generation Sequencing: The CAP continues to work with AMP to advance CPT code proposal for NGS technical component. NGS coding and Medicare pricing for the technical service is expected in 2015 and pathologists can use existing codes (80502) to bill for NGS consultation services. 22 Summary Healthcare delivery in the US is changing Pathology is evolving Challenges will bring opportunities 23 8