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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 exp ressions of support I’ve if you can bring them in. Remember, it
Cytology Proficiency
1 Testing
received fro m 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 reg ister for
events online at http://masspath.org.
“The Blues” Discourage I have received.
2 Use of Hospital Labs
Thanks.
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 Certificat ion. Many Cytology Proficiency
specialty boards already require
periodic recertificat ion. The A merican Testing
Board of Pathology has had this
requirement for a few years for new Donald G. Ross, MD, PhD
diplo mates, 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 fo rced
upon us, however, by insurors and/or The CAP-endorsed Cytology
state medical boards, wh ich are Proficiency Improvement Act of 2007
increasingly reluctant to recognize (HR1237) was passed by the House last
lifetime board certificat ion. 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 mo ment 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 CM S, with a
Medford, MA 02155 our state representatives in Congress
masspath@comcast.net want to hear fro m their o wn Continued on page 2.
constituents, not fro m 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 o f 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 communicat ion 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 co mmercial labs
I am w riting 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 Ch ief
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 o f 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
Sincerely,
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
Pathologists
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 www.cap.org to see what
better patient outcomes. This measure would adversely affect
the status is and what you can do to help
promote reform o f this proficiency hospitals and hospital-based patholo-
CLIA mandates extensive Pap test
testing requirement.
quality standards which the laboratory Continued on page 3.
2 . . . . . . . . . . . . . . . . . . . . . . . .
Mass achusetts S
CAP has provided the follo wing 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
program. Congress has directed the and information technology, to
when tests are unnecessarily repeated ensure that patients get the
due to this problem. agency to use the program to
"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
Sincerely,
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 ho me” 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 co mpensated 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
incentives lead to improved patient
efficiency. 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
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