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					TO:        Intersociety Pathology Council

FROM:      Stephen N. Bauer, MD, FCAP
           President, College of American Pathologists

DATE:      February 5, 2010

RE:        College of American Pathologists – Report




TRANSFORMATION OF THE SPECIALTY OF PATHOLOGY
Over the past year, the CAP’s campaign to transform the pathology specialty has gained
momentum with the launch of the Institute, the Center, and our ―Now and Future‖
advocacy agenda. The ultimate goal of the CAP’s effort is to create an enhanced and
evolved role for the pathologist over the next generation as well as greater recognition as
a physician actively involved on the patient care team.
College leaders continue to take our message and a call to action around the country,
encouraging pathologists to understand our changing roles and to see a bright future
ahead as researchers/innovators, test providers, interpreters, clinical data integrators,
clinical consultants, business developers, and practice leaders.
The College will support pathologists in their changing roles through a variety of
initiatives, several of which are referenced in this report.

FEDERAL AND STATE ADVOCACY
The College’s advocacy efforts are focused on a ―Now and Future‖ agenda—one that
strives to mitigate against pending policy actions that negatively impact CAP members,
while at the same time begins to establish a future role for pathologists in the coordinated
care model. The College will also advance other important issues as long they don’t
impede progress on the pathology ―Now and Future‖ agenda.

Health Care Reform
In the wake of the special election in Massachusetts, negotiations to reconcile differences
between the health system reform bills passed by the US House of Representatives and
US Senate have been put on hold. The loss of the Senate's 60-seat Democratic majority
and the firm Republican opposition to both bills means that Congressional leaders must
reassess both their goals and strategy to successfully enact health system reforms.
The CAP continues to closely follow the health care reform debate to ensure that the
voice of pathology is heard and that our concerns are addressed.

Physician Payment
The 2010 Physician Fee Schedule (PFS), published in November from the Centers for
Medicare & Medicaid Services (CMS), addressed a number of physician payment issues
affecting pathologists. Notably, CMS removed physician-administered drugs from the
Sustainable Growth Rate (SGR) formula. CMS also finalized its proposal to use the
physician practice information survey data to update the practice expense relative value
units (RVUs), reduce the practice expense RVUs used to calculate the direct practice
costs associated with technical component services, and finalized a provision stipulating
that the consultation codes are no longer recognized for Medicare part B payment,
effective January 1, 2010. Additionally, the PFS removed a requirement that would have
established a minimum patient sample size for reporting quality measures as part of the
PQRI.

SGR/ Technical Component (TC) Grandfather
Pathologists, although hoping for a permanent solution to the SGR, may have to settle for
a temporary fix that would freeze pay for five years at 2009 levels and then cut it by 25%
to 30% in 2015. The College will continue to urge Congress to act to avoid these cuts in
Medicare payments to physicians.

The TC ―Grandfather‖ also expired at the end of 2009. The College will be advocating
that the TC Grandfather needs to be extended so that independent laboratories can
continue to be paid directly by Medicare to cover the technical component’s cost. The
biggest impediment to reforms is the cost associated with them: Getting rid of the current
formula and replacing it would cost more than $240 billion over 10 years, and the TC fix
amounts to $100 million per year.

Direct Billing. Direct billing laws remain a state legislative priority for the College.
Sixteen state laws now require direct billing for certain pathology services, six state laws
prohibit markups, and 16 require disclosure.


SCIENTIFIC AFFAIRS
The Center
At CAP ’09, the College launched the CAP Pathology & Laboratory Quality Center,
known as ―the Center.‖ The Center is a forum for development of guidelines and position
papers in areas related to the practice of pathology.

The Center will:
    Clearly define and develop practice guidelines and white papers that ensure
      quality in diagnostic medicine, its linkage with patient outcomes, and the role of
      the pathologist in improving quality and contributing to patient care




College of American Pathologists – February 2009                                               2
       Focus on development of evidence-based and/or consensus practice guidelines in
        areas that are directly involved in the practice of pathology, pathologists, and their
        role in lab medicine
       Conduct the medical literature research necessary to support development of
        practice guidelines and protocols. The Center may also identify and collaborate on
        protocol development needs for supporting research (eg, HER2 tissue fixation)
       Facilitate coordination of consensus activities in the absence of evidence-based
        practice guidelines

The CAP has created the Center to achieve the following:
    Help pathologists improve patient care and safety through more accurate and
      timely diagnosis and involvement in therapeutic decision making
    Position the pathologist as core members of the patient care team
    Demonstrate CAP’s continuing leadership in developing guidelines and best
      practices as already seen in such standard-setting activities as the SNOMED
      Clinical Terms, the Cancer Protocols, and the ASCO/CAP HER2 Guidelines
    Allow the CAP to be more proactive on issues related to pathology practice and
      more responsive to other organizations
    Strengthen alliances with other medical specialties and patient advocacy
      organizations
    Create rigorous quality standards for anatomic pathology.
    Develop pathology-specific performance measures

The Center invites all stakeholders to submit topics for guidelines and white papers via a
Center Idea Submission form, found on www.cap.org/center. The Center will prioritize
topics for development by patient risk and impact on patient care and quality outcomes.
In addition, you may volunteer to participate in a work group that will develop the
guideline or white paper. Visit cap.org/center to submit your name and area of expertise.

CAP Cancer Protocols
For more than 20 years the College of American Pathologists Cancer Protocols and
Checklists have served as a resource and reference for accurate and complete pathologic
staging of malignant tumors. They have grown in number and scope over the past several
years, and have taken on additional significance with their adoption in 2004 by the
American College of Surgeons Commission on Cancer (ACS-CoC) as the standard for
required data elements in pathology reporting. Fifty-five checklists were revised and
released in October 2009 in conjunction with the release of the 7th edition of the
American Joint Committee on Cancer (AJCC). The revised checklists also contain
additional images and diagrams to assist pathologists with some of the staging concepts.
Additionally, seven new cancer protocols have been developed and will be published in
the Archives in Pathology and Laboratory Medicine in 2010.

SNOMED® International began releasing SNOMED encoded checklists in July 2003 to
licensees of SNOMED. The checklists allowed institutions and software vendors to code
their malignant tumor reports on the ―front end‖ before distribution to clinicians and



College of American Pathologists – February 2009                                             3
registrars, which added greater quality control and efficiency to the transfer of data and
concepts.

New Products
Among the new offerings from the CAP are the Fine-Needle Aspiration Glass Slides and
PIP online. The CAP Board of Governors and the American Society of Clinical Oncology
(ASCO) have approved the estrogen receptor/progesterone receptor (ER/PgR) testing
guidelines. Publication is currently pending.


EDUCATION
The CAP Institute
The CAP Institute was launched in 2008 at CAP ’08. During the past year, a portfolio of
products has been developed within the CAP Institute including new certificate programs
and self-assessment modules (SAMs). In June 2009, the first CAP Certificate program
was launched as part of the CAP Institute portfolio of products. The CAP Certificate
Programs are intended to offer pathologists the opportunity to learn new skills and be
recognized in new and emerging areas of practice. CAP Certificate Programs are focused
in areas for which there is no board certification.

The first CAP Certificate Program, Ultrasound-Guided Fine Needle Aspiration (USFNA)
was piloted in June 2009 and offered again at CAP ’09 in October. The Breast Predictive
Factors Testing Certificate Program is nearing completion. Courses in support of the
Breast Predictive Factor Testing Certificate Program were offered at CAP ’09 and the
entire CME program and cognitive assessment will be delivered at an intensive workshop
April 30-May 2, 2010. Additionally, programs in support of a Breast Pathology and a
Laboratory Medical Director Certificate Program were offered at CAP ’09.

The CAP offered nine SAMs during CAP ’09 as well as two online SAMs in 2009.
Approximately 30 SAMs are planned for 2010, with 10 of those offered during CAP ’10.

The first in a series of Digital Pathology Demonstration Learning Activities was released
in December. The New Pathology Paradigm – Digital Pathology is an online activity that
describes how the emerging technologies of digital imaging can improve pathology
practice.

The College’s Personalized Health Care Committee launched a series of one-hour
teleconferences to raise the visibility of personalized health care. The first in the series,
Personalized Pathology: PHC in the General Pathology Practice, began in December
and provided an overview on how personalized health care intersects with the everyday
practice of pathology. The series continues this month with Introduction to the Medical
Home, which covers the evolving coordinated care model and how it could impact the
role of pathologists in their practice. Following this, the Committee is planning a
teleconference on how to set up a biorepository.

For more information about the Institute, you can go to www.cap.org/transformation.



College of American Pathologists – February 2009                                                4
USCAP Companion Society Symposium
The College once again presented a Companion Society Meeting symposium at the 2010
USCAP meeting. The CAP symposium—Quality and Patient Safety in Anatomic
Pathology: Practical Solutions—is an extension of the symposium presented in March
2009. Jennifer L. Hunt, MD, FCAP, and Paul E. Swanson, MD, FCAP, moderated the
program.

Virtual Management College
The College is planning its twelfth series of Virtual Management College (VMC)
audioconferences designed to improve leadership and management skills for residents
and new pathologists. The new sessions will begin in August 2010.

Highlights of the remaining sessions of the 2010 Virtual Management College (VMC)
audioconference series:
    Employment Issues: Awareness, Your Best Friend—March 9, 2010, Benjamin
       Ziemer, MSEd, SPHR
    Bringing a New Molecular Test into the Laboratory—April, 13, 2010, Gregory J.
       Tsongalis, PhD, HCLD, FACB
    Lifelong Learning—May 11, 2010, William F. Hickey, MD, FCAP
    Politics in Health Care—June 8, 2010, John Scott

For information on all Education activities, visit www.cap.org under the Education
Programs tab.

CAP ’10 – THE PATHOLOGISTS’ MEETING™
We invite you to join us for CAP ’10 – THE Pathologists’ Meeting, scheduled September
26–29 at the Hyatt Regency Chicago.


PUBLICATIONS
CAP TODAY published its first digital edition in October 2009, and the response has been
very favorable. We have scheduled digital editions through the end of 2010. There are no
plans to discontinue the hard-copy version at this time. To view the January digital
edition of CAP TODAY, please use the following link:
http://digital.olivesoftware.com/Olive/ODE/CAPTODAY/


CAP Press released two publications in 2009:
   Histologic Preparations: Common Problems and Their Solutions, Richard W.
      Brown, MD, FCAP, editor. Developed in conjunction with the National Society
      for Histotechnology, the text includes chapters on fixation and processing,
      microtomy, frozen sections, H&E and Gram stains, microorganisms, trichrome,
      reticulin, elastin, and immunohistochemical stains. Dr. Brown is the medical
      director, System Laboratory Services, for the Memorial Hermann Hospital
      System in Houston and president of Memorial Pathology Consultants. He has




College of American Pathologists – February 2009                                       5
        served as chair and a member of both the CAP Surgical Pathology Resource
        Committee the CAP/NSH Histotechnology Committee.

       Reporting on Cancer Specimens: Case Summaries and Background
        Documentation, 2009 edition, Mahul B. Amin, MD, FCAP, and Mary Kay
        Washington, MD, PhD, FCAP, editors. Developed by the CAP Cancer
        Committee, the new edition contains 55 revised cancer protocols, updated to
        reflect the 7th edition TNM staging system. Drs. Amin and Washington have both
        served as chair of the Cancer Committee.

PUBLIC AFFAIRS
On January 19, 2010, the College of American Pathologists announced the new
MyBiopsy.org offering more content, resources, and features. The site is a resource for
cancer patients and their loved ones to help them better understand their diagnosis.
MyBiopsy.org now offers information on more than 40 cancers and cancer-related topics,
as well as survivor stories, a comprehensive glossary of key terms, tips on how to read a
pathology report, a newsroom for journalists, and more. Visitors to the site can now share
the information they find on MyBiopsy.org through email and Facebook. The site
continues to offer questions for patients to ask their doctors and images of normal and
diseased cells and tissues. Written by a pathologist, each patient information sheet
provides accurate and credible information on a specific cancer diagnosis and explains
the role of the pathologist in diagnosing cancer.

The College continues to raise the image of pathologists through its ongoing campaign,
―If it were not for my pathologist…‖ In 2010, the CAP developed an ad, featuring a
breast cancer survivor for American Airlines’ in-flight magazine American Way. The ad,
which promoted pathologists and their life-saving contributions to patient care, was
featured on the inside front cover of the magazine on October 1-14, 2001, and was seen
by 1.6 million people. In addition, the ad featured the College’s two patient information
websites—MyBiopsy.org and MyHealthTestReminder.org.

Awareness for and usage of the College’s NewsPath® articles and podcasts continues to
grow with the number of visits, views, and downloads to the articles and podcasts nearly
doubling from 2008 to 2009. Recent NewsPath articles and podcasts have covered such
topics as the updated CAP Cancer Protocols, IVDMIAs, and KRAS testing. In addition,
the CAP NewsPath Editorial Board formed strategic partnerships in 2009 with the CAP
Technology Assessment Committee to develop NewsPath articles and podcasts on the
College’s POET reports.


SNOMED
The CAP’s SNOMED Terminology Solutions™ (CAP STS™) division, which includes
the Diagnostic Intelligence and Health Information Technology (DIHIT), Clinical
Informatics, Operations, and Professional Services departments, is furthering its
leadership role in the areas of health information management and diagnostic
intelligence. Leading the pursuit of semantic interoperability for electronic health records


College of American Pathologists – February 2009                                            6
(EHRs), CAP STS Professional Services specializes in customized best-practice health
information solutions from strategy and planning to implementation and maintenance.
These services include quality and performance improvement, clinical terminology,
clinical informatics, research data management, synoptic reporting, and education.

The DIHIT team is committed to improving and/or developing health IT standards,
practices, tools, and standardized electronic reporting. The CAP Diagnostic Work Station
and the CAP electronic Cancer Checklists (CAP eCC) are two examples of such
initiatives. In January, the DIHIT team released the updated CAP eCC. Read the CAP
eCC press release. The current CAP eCC release contains elements from the AJCC
Cancer Staging Manual 7th edition and all of the new and updated cancer checklist
content posted in October 2009 on the CAP website at www.cap.org/cancerprotocols.
Content is also partially encoded with SNOMED Clinical Terms® (SNOMED CT®)—a
globally recognized controlled medical vocabulary.

CAP STS continues to serve as the support organization to update and maintain
SNOMED CT for the International Health Terminology Standards Development
Organisation®, which now consists of 15 member nations.

In November 2009, the CAP Board of Governors approved the creation of a
commercially focused professional consulting capability for the CAP built on the STS
division. This professional consulting capability will focus initially on the health
information management market, but it will evolve to support all areas of the CAP. For
more information about CAP STS initiatives, call 847-832-7700, email
snomedsolutions@cap.org, or visit www.capsts.org.


CAP FOUNDATION
The CAP Foundation established the Haiti Relief Fund to provide aid to pathologists
impacted by the earthquake. We encourage contributions to the fund by visiting the
Foundation’s website at http://foundation.cap.org.

In 2009, the CAP Foundation held its third Futurescape Conference. The next
Futurescape of Pathology Conference will be held April 15-17, 2011, at the
Intercontinental Hotel in Rosemont, Illinois. The conference will explore the latest
innovation theory, strategies, and case studies, and pathologists will learn how to
successfully implement and refine innovation to leverage and grow their practice.

In addition, the Foundation continues to offer funding for educational, research, and
humanitarian grants.


FUTURE MEETING DATES
CAP ’10 September 26-29, 2010 – Hyatt Regency Chicago, Chicago
CAP ’11 September 11-14 – Gaylord Texan Resort & Convention Center, Grapevine
        (Dallas), Texas
CAP ’12 September 9-12 –Manchester Grand Hyatt, San Diego, California


College of American Pathologists – February 2009                                         7

				
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