Newsletter April 2009 - Newsletter by liuqingyan


                                     Massachusetts Society of Pathologists Newsletter
                                     Our thanks to Genzyme, Inc., for their generous sponsorship of our spring meeting.

                        April 2009   Comments from the                           Our advocacy activity requires the
                                                                                 assitance of professional lobbyists and
                                     President                                   attorneys. All of this does not come
                                                                                 cheap; in fact, we have been fortunate to
                                     Donald G. Ross, MD, PhD                     date that we do not have a major battle
                                                                                 to fight every year, so we have time to
                                     With mixed feelings of satisfaction,        replenish the “war chest.” Our principal
                                     relief, and regret at what has not yet
Inside this Issue                    been finished, I write my last newsletter
                                                                                 source of revenue is your membership
                                                                                 dues. I appeal to all of you, once again,
                                     as President of the MSP. Dean Pappas,       if there are pathologists in your practice
        Comments from the            MD, will be taking over later this
1       President                    month. I thank you all for the
                                     confidence you showed in me, and the
                                                                                 or of your aquaintance who live and/or
                                                                                 work in Massachusetts, who are not
                                                                                 MSP members, approach them and see
                                     many expressions of support I’ve            if you can bring them in. Remember, it
        Cytology Proficiency
1       Testing
                                     received from you over the last two
                                     years. I hope that you will give Dean
                                     the same kind of backing and assistance
                                                                                 is now possible to join and register for
                                                                                 events online at
        “The Blues” Discourage       I have received.
2       Use of Hospital Labs

                                                                                 Don Ross
        The “Medical Home”           The speaker for our April meeting is our
3                                    own Rebecca Johnson, MD, of
                                     Berkshire Medical Center. Becky’s
                                     presentation is on the topic of
                                     Maintenance of Certification. Many          Cytology Proficiency
                                     specialty boards already require
                                     periodic recertification. The American      Testing
                                     Board of Pathology has had this
                                     requirement for a few years for new         Donald G. Ross, MD, PhD
                                     diplomates, but people who passed their
                                     boards in earlier years do not (yet) have   And the beat goes on…
                                     to do this. This issue may be forced
                                     upon us, however, by insurors and/or        The CAP-endorsed Cytology
                                     state medical boards, which are             Proficiency Improvement Act of 2007
                                     increasingly reluctant to recognize         (HR1237) was passed by the House last
                                     lifetime board certification.               summer. The Senate version of the bill
                                                                                 (S2510) was moving long nicely until
                                                                                 the present financial crisis hit us.
                                     Your Massachusetts Society of               Understandably, Congress is
                                     Pathologists is the only organization       preoccupied at the moment with the
                                     which advocates for the practice of         very pressing economic issues, and
                                     pathology at the state level. NESP,         fixing cytology proficiency testing has
                                     ASCP and CAP do not do this. CAP            moved to the back burner.
                                     advocates for pathologists on the
                                     national level, but many issues must be     So, we are still using the existing,
Mass. Society of Pathologists        tackled at the state level, and even the    flawed proficiency testing system. Into
22 Hutchins Road                     national issues require local advocacy;     the “vacuum” came CMS, with a
Medford, MA 02155                    our state representatives in Congress                 want to hear from their own                 Continued on page 2.
                                     constituents, not from strangers.

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April 2009

Continued from page 1.                         director must use to assess the

proposed improvement to the system, a
                                               performance of laboratory personnel.
                                               For example, laboratory directors            “The Blues”
                                               (pathologists) conduct monthly
20-slide test every two years instead of
a 10-slide test every year – not much of
                                               assessments of cytotechnologists             Discourage Use of
                                               screening Pap tests, on a daily basis
a change!
                                               assess cytotechnologist’s screening          Hospital Labs
                                               totals and monitor daily workload,
The following is the text of a letter
                                               rescreen at least 10% of negative cases,     Donald G. Ross, MD, PhD
authored by CAP and signed by me as
                                               as well as any negative cases from the
your President, sent to CMS regarding
                                               previous five years on any current           Early this year, Blue Cross/Blue Shield
this issue:
                                               HGSIL case. However, the proposed            of Massachusetts (BCBSMA) sent a
                                               regulation fails to consider a               communication to their primary care
To Whom It May Concern:
                                               proficiency testing approach that would      docs offering an unspecified incentive
                                               take into account these existing             for using office labs or commercial labs
I am writing to express my concern with
                                               performance requirements.                    in preference to hospital labs. As many
the content of the Centers for Medicare
                                                                                            of us are hospital-based, we were
and Medicaid Services’ (CMS)
                                               Both the current and proposed                puzzled and alarmed by this policy. I
proposed regulation concerning
                                               proficiency tests suffer from the same       wrote to John Fallon, MD, the Chief
cytology proficiency testing, CMS-2252-
                                               scientific and statistical deficiencies.     Medical Officer of BCBSMA, about
P. I urge you to withdraw the
                                               Yet, a test of 100 slides is neither cost    this issue:
regulation and develop an alternative
                                               effective nor practical. CMS should
proficiency testing model that will be
                                               consider the alternative approach
more meaningful and effective in                                                            March 2, 2009
                                               provided in the Cytology Proficiency
improving quality and women’s health.
                                               Improvement Act of 2007. The
The Cytology Proficiency Improvement
                                               alternative provides for proficiency
Act, passed by the House of                                                                 John Fallon, MD
                                               testing and documented assessment of
Representatives last year, provides such                                                    Blue Cross/Blue Shield of
                                               skills in the context of an educational
an alternative.                                                                                 Massachusetts, Inc.
                                               framework. It also has significant
                                               advantages over the test proposed in the     The Landmark Center
I have repeatedly taken the proficiency                                                     401 Park Drive
                                               regulation in that it would incorporate
test in its current form and find that it                                                   Boston, MA 02215-3326
                                               complex, difficult Pap tests, keep
neither represents normal practice nor
                                               contemporary with best practices and
is an effective measure of competency.
                                               new technologies and ensure on the
Experts in the field have concluded that                                                    Dear Dr. Fallon:
                                               ground oversight through lab directors,
CMS would have to administer a
                                               accrediting agencies as well as CMS.
program consisting of at least 100 Pap                                                      I am the current President of the
test slides to ensure that this testing                                                     Massachusetts Society of Pathologists.
                                               The proposed regulation mandates a
model is statistically valid. Simply                                                        Many of our members are dismayed
                                               proficiency test that is of no value to my
increasing the number of slides from 10                                                     with the recent policy change at
                                               profession or the fight against cervical
to 20, as the new regulation proposes,                                                      BCBSMA which would attempt to direct
                                               cancer. Again, I urge you to withdraw
still results in a test that lacks validity.                                                laboratory testing away from hospital-
                                               this proposed regulation and allow
In addition, the proposed regulation                                                        based labs and pathologists to commer-
                                               alternatives to be considered.
maintains a very limited set of                                                             cial labs or physician office labs. I
diagnostic categories. These                                                                refer to a recently-communicated
categories, similar to those in the                                                         (November 2008):
current program, are not representative
                                               Donald G. Ross, MD, PhD, FCAP
of the slides we see in real practice and                                                   Lab Efficiency Measure. This measure
                                               President, Massachusetts Society of
don’t reflect complex, ambiguous cases,                                                     will reward physicians at three levels of
such as ASCUS, that we seen the                                                             performance for the percentage of
                                               Chief Pathologist, Holy Family Hospital
laboratory every day. The proposed                                                          outpatient lab tests performed for their
                                               70 East Street
regulation also provides no evidence                                                        members at freestanding labs or in
                                               Methuen, MA 01844
that either the current or revised testing                                                  physician offices.
model can enhance skills and produce
                                               Please visit to see what
better patient outcomes.                                                                    This measure would adversely affect
                                               the status is and what you can do to help
                                               promote reform of this proficiency           hospitals and hospital-based patholo-
CLIA mandates extensive Pap test
                                               testing requirement.
quality standards which the laboratory                                                      Continued on page 3.

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                                                                                                             Massachusetts S

                                             CAP has provided the following          all health care services, including
Continued from page 2.                       summary of the concept:                 specialist care, community services,
                                                                                     hospitalizations, and post-acute
gists at a time when many hospitals          The Medical Home: At a Glance           care. In a medical home, a physician
are already under severe financial
stress. We are upset that BCBSMA                                                     acts as the facilitator and manager of
                                             Introduction                            all the care a patient receives.
would institute such a policy, and at a
loss to understand why this measure
would be adopted. There is no evidence       Seeking ways to slow the growth of      According to principles endorsed by
that physician office labs or commercial     Medicare spending and to better         the American Medical Association,
labs provide higher quality than             coordinate the health care it
                                                                                     care is coordinated across all
hospital labs. Patient care is adversely     finances, the federal government is
affected when outpatient laboratory                                                  elements of the complex health care
                                             preparing to test the concept of the
results are not available in the                                                     system, facilitated by registries
                                             "medical home" in the Medicare
hospital setting, and costs are increased                                            and information technology, to
when tests are unnecessarily repeated        program. Congress has directed the
                                             agency to use the program to            ensure that patients get the
due to this problem.
                                             "redesign the health care delivery      indicated care when and where
Thank you for your attention. Could we       system to provide targeted,             they need and want it in a
make an appointment to discuss this          accessible, continuous and              culturally appropriate manner.
policy and the possibility of altering it?   coordinated, family-centered care to
                                             high-need populations." The federal     A medical home incentivizes
                                             demonstration program will operate      physicians to have regular contact
                                             for three years in rural, urban, and    with patients, as well as to be
Donald G. Ross, MD, PhD                      underserved areas in up to eight        meaningful users of information
President, MSP                               states. The demonstration is            technology to ensure patients receive
                                             intended to inform future reforms       appropriate, evidence-based care. In
Dr. Fallon has yet to respond to my
                                             related to physician payment and        the current demonstrations,
letter.                                                                              providers receive payments and
                                             health care delivery.
                                                                                     incentives for serving as care
                                             Lapses in patient safety and quality,   coordinators.
                                             attributed to a fragmented health
                                             care delivery system and misaligned
The “Medical Home”                           incentives in how care is paid for
                                                                                     In the current research and pilot
                                                                                     demonstrations of the medical home,
Donald G. Ross, MD, PhD                      has lead payers in the public and       in addition to traditional fee-for-
                                             private sectors to propose the          service arrangements for physician
CMS, AMA, Mass. Medical Society              medical home as a mechanism to          services, providers are eligible to
and a host of insurors are interested in     better organize how care delivered      receive per patient care management
the concept of the “medical home” as a       and paid for.
means to make patient care more                                                      fees and share in savings that can be
efficient and cost-effective. Briefly, the   Within a medical home, physicians       attributed to the care coordination
concept is to place the patient’s primary    provide closer management of            services provided.
care physician in charge of organizing
                                             patient care, averting unnecessary
all of his/her specialty care and testing.
                                             treatments and hospitalizations.        Early research on the medial home
The PCP would be compensated for this
                                                                                     model has shown that this care
management role, and would be
financially incentivized to provide cost     What is a medical home?                 delivery model and alignment of
efficiency.                                                                          incentives lead to improved patient
                                             A medical home is not a place but a
                                                                                     outcomes with fewer readmissions,
                                             process of care in which a physician-
How does this affect us as pathologists?                                             more patient-centered care and
                                             led team provides comprehensive
Sounds a lot like capitation, where                                                  better coordination of specialty care.
primary cares are incentivized to avoid      primary care. A medical home
use of specialists, or seek the cheapest     allows a physician to provide, and to
                                                                                     Stay tuned.
provider.                                    be remunerated for, serving as a
                                             single point of care coordination for

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April 2009

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Massachusetts Society of Pathologists
22 Hutchins Road                                                BULK RATE
Medford, MA 02155                                              US POSTAGE
                                                               CITY, STATE
                                                              PERMIT NO. 000


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