ASCLS_Membership_Matters

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					    Membership
     Matters
ASCLS Recruitment Series
         Part I
History of ASCLS and
 the CLS Profession
                      CLS - The Beginning
• Can be traced back to the early 1900s
      – Development of public
        health labs to help combat
        the outbreak of infectious
        diseases
      – Employed women
            • Had been discouraged from entering scientific careers
                  – Women’s conceptual abilities were considered to be
                    inferior to men’s
            • Were willing to work for low wages




August 22, 2011                                                          3
                  CLS – The Beginning

• 1919 – American College of Surgeons
      – Wanted to assure minimum standards for
        hospital care
            • Must establish a clinical laboratory
            • Must have a physician in charge, preferably a
              pathologist




August 22, 2011                                               4
                       CLS – The Beginning
• Early 1930’s
      – American Society of Clinical Laboratory
        Technicians (ASCLT) formed
            •     Membership limited to BOR certified professionals
            •     Inception of a Journal
            •     Establishment of a Constitution and Bylaws
            •     Began educating the public about the profession
            •     Placed emphasis on importance of medical technology
                  becoming a profession




August 22, 2011                                                         5
                        ASCLT to ASMT
• 1936
      – Changed name from ASCLT to American Society
        of Medical Technologists (ASMT)
            • 500 members in 1937
            • Held an annual convention
            • Appointed Advisory Board to meet with BOR
• 1939
      – First State Charter
            • Texas Society of Medical Technologists




August 22, 2011                                           6
                     ASMT and the BOR
• Before 1940
      – Membership in BOR restricted to pathologists who were
        members of ASCP
• 1940
      – BOR amended constitution to allow MTs on the BOR with
        advisory duties only, no voting rights
            • Allowed 2 MTs from ASMT
            • Appointed 3 MTs at large
• 1946
      – BOR permitted the addition of 1 ASMT member for a total
        of 3 ASMT members




August 22, 2011                                                   7
                       ASMT and the BOR
• 1948
      – Board of Schools (BOS) took over the BOR’s
        accreditation function
            • Elected Board
                  – 6 members of ASCP and 3 members of ASMT
• 1949
      – Allowed full voting rights to MTs
            • Total of 5 MTs
            • Total of 6 Pathologists




August 22, 2011                                               8
                         ASMT Moves Toward
                           Independence
• 1947
      – ASMT held its first annual meeting
        independent of physicians’ organizations
• 1948
      – Established Committees

            •     Education and Research      •   Standards and Studies
            •     Publications and Awards     •   Research
            •     Membership                  •   Legislation
            •     Constitution and Bylaws     •   Finance
            •     Nominations and Elections   •   Education




August 22, 2011                                                           9
                  Developing Professional
                         Identity
• 1945-1962
      – Membership grew in ASMT
            • Diminished its reliance on ASCP for annual meetings and
              continuing education
            • Provided more services for its members
            • Expanded its range of activities
• Late 1950’s
      – Took first steps toward seeking governmental recognition
        through personnel licensure laws
            • Educational qualifications
            • Scope of practice




August 22, 2011                                                         10
                    ASMT the Professional
                       Organization
• 1958
      – Well-defined organizational structure
      – Purpose:
            • to promote higher standards in clinical laboratory methods
              and research;
            • to elevate the status of those specializing in medical
              laboratory technology;
            • to create mutual understanding between the medical
              technologist and the physicians and all others who are
              employed in the interest of individual or public health;
            • to issue charters to constituent societies;
            • to promote the mutual aid and benefits of its members.




August 22, 2011    By-laws of the American Society of Medical Technologists. Am J Med Tech   11
                                                1958;14:1-15.
                     1960s – 1970s: Greater
                           Autonomy
• Legal actions
      – 1968 – Supreme Court of New Jersey
            • Set limits on the BOR’s control over MTs
                  – BOR could not revoke certification of a MT if they decided
                    to work in a laboratory operated by non-physician
                    bioanalysts
      – 1969 – U.S. Department of Justice
            • Forbade the practice of decertifying personnel working
              for non-physicians
            • Annual registration became voluntary




August 22, 2011                                                             12
                     1960s – 1970s: Greater
                           Autonomy
• Legal actions (continued)
      – Justice Department criticized ASMT by saying the
        organization was “too supine and docile”
                  – ASMT demanded equal representation on the BOR for MTs for
                    the establishment of policies and procedures affecting
                    accreditation and certification
                  – ASMT advocated that the BOR be independent from both ASMT
                    and ASCP
• 1969
      – Dr. William Selden, former Executive Director of the
        National Commission on Accrediting state that
            • A professional association must have full responsibility for
              admission of its members
            • This supported ASMT’s advocacy for independent
              certification processes




August 22, 2011                                                              13
                   1960s – 1970s: Greater
                         Autonomy
• 1973
      – Commissioner of the U.S. Office of Education and the
        National Commission of Accreditating
            • Said BOS should have an autonomous relationship with
              ASCP
            • ASCP disbanded BOS
• 1974
      – National Accrediting Agency for Clinical Laboratory
        Sciences was formed
• 1977
      – National Credentialing Agency for Laboratory Personnel
        was created




August 22, 2011                                                      14
                     ASMT in the 1970s
•   Grew in numbers
      – Over 30,000 in 1976
•   P.A.C.E was introduced
      – Documentation of continuing education
•   Provided graduate programs
      – In conjunction with Central Michigan University
•   Future Direction Plan
•   Statements of competence
•   Arranged for the introduction of the annual National Medical
    Laboratory Week
      – Increased public awareness of profession
•   Members testified before congressional committees
•   Changed name from America Society of Medical Technologists to
    American Society for Medical Technology




August 22, 2011                                                     15
                   ASMT in the 1980s
• More involvement in national politics
• Started
      – Clinical Laboratory Educators Conference
      – Legislative Symposium
      – Moved office from Houston, Texas to
        Washington, D.C.
            • Became more involved in legislation that
              would advance the profession



August 22, 2011                                          16
                  ASMT/ASCLS in the
                       1990s
• ASMT became the American Society for
  Clinical Laboratory Science (ASCLS).
• Joined forces with the American Association
  for Clinical Chemistry (AACC).
      – Holds one of the largest annual meetings and
        vendor expo’s in the country
• Provided input to the National Labor
  Relations board.
      – Medical Technologists were finally recognized as
        PROFESSIONALS



August 22, 2011                                        17
                    What Has ASCLS
                     Done for Us ?
• Over the Past Seven Decades, ASCLS has:
      – Advocated for the profession
      – Set standards
      – Provided education (professional and continuing)
      – Influenced legislation that impacted the field of
        clinical laboratory science
      – Fought for the rights of laboratorians
      – Has represented the best interests of
        laboratorians as individuals and collectively




August 22, 2011                                        18
                                               References
 •   Kotlarz, V. R. Clinical Laboratory Science, 1998
       –   Vol    11,   No   1,   pp 5-7
       –   Vol    11,   No   2,   pp97-100
       –   Vol    11,   No   3,   pp 161-166
       –   Vol    11,   No   4,   pp 209-213
       –   Vol    11,   No   5,   pp 275-279
       –   Vol    11,   No   6,   pp 339-345
 •   Kotlarz, V. R. Clinical Laboratory Science, 1999
       –   Vol 12, No 2, pp 91-97
       –   Vol 12, No 6, pp 336-341
 •   Kotlarz, V. R. Clinical Laboratory Science, 2000
       –   Vol 13, No 3, pp 166-171
 •   Kotlarz, V. R. Clinical Laboratory Science, 2001
       –   Vol 14, No 1, pp 13-17
 •   Karni, K. History of ASCLS.
       –   Retrieved from http://www.ascls.org/docs/HistoryofASCLS.pdf




August 22, 2011                                                          19
Benefits of Being an
  ASCLS Member
                  Continuing Education
                        Matters
•   Audio conferences
•   Workshops
•   Online Courses
•   Journal Quizzes
•   CD-Rom
•   Online CE Organizer




August 22, 2011                          21
                  Scholarships / Awards

• Education scholarships
  (including graduate)
• Research grants
• Leadership, authorship,
  and membership awards




August 22, 2011                           22
                  Networking Matters
•   National Meeting and Exposition
•   State Society Meetings
•   Local Branch Meetings
•   Social Events
•   Networking Opportunities




August 22, 2011                        23
                  Membership Perks

• Discounts on credit cards,
  hotels, and car rentals
• Insurance Programs
  (health, liability, auto)
• Real Estate commission rebate




August 22, 2011                      24
                  Publications

• Clinical Laboratory Science
    (quarterly journal)

• ASCLS Today (monthly newsletter)
• State Society Newsletters




August 22, 2011                      25
                  Legislation Matters

• Legislative Symposium
• Liaisons to Congress,
  Federal, and State Agencies
• Monitor and influence laws affecting
  profession




August 22, 2011                          26
                  Invaluable Resources
•   Scientific Assembly
•   Forums
•   Library
•   Online bookstore
•   Clinical Laboratory Marketplace
•   Website links


August 22, 2011                          27
                  Advocacy Matters
ASCLS is our voice for the following issues:
•   CCCLW – workforce shortage
•   Doctoral Level CLS professional
•   Personnel Licensure
•   NCA and ASCP BOR Credentialing Initiative
•   Medical Laboratory Errors and Safety
•   Scope of Practice
•   Career Ladder Task Force



August 22, 2011                                 28
                  Leadership Matters
• Leadership Academy
• Networking
• Opportunities to serve
  the society in many capacities
      – Committees
      – Task forces
      – Executive officers



August 22, 2011                        29
  Legislative Issues
facing ASCLS and the
      Profession
                  Current Issues

• Competitive Bidding
• Laboratory Fee Schedule
• Workforce Shortage and the
  Allied Health Reinvestment Act
• State Licensure
• What Can You Do?



August 22, 2011                    31
                  Competitive Bidding
                      Defined
• A method for setting the price of health care
  services through a bidding process in order
  to establish payment rates based on the
  lowest price submitted by providers.
  Medicare would require that its
  beneficiaries’ lab work be outsourced to the
  “winning bid” sites.




August 22, 2011                               32
                  Competitive Bidding
   Congress and the Centers for
   Medicare and Medicaid Services
   (CMS) have considered
   competitive bidding for
   procurement of Medicare
   laboratory testing services as one
   possible measure to reduce cuts to the
   Medicare program.




August 22, 2011                             33
                  Competitive Bidding
• In 1985, the Secretary of Health and
  Human Services issued a request for
  proposals to establish demonstration
  projects for the provision of clinical
  laboratory services for Medicare
  beneficiaries on a competitive bidding basis.
• The Budget Reconciliation Act of 1985
  prohibited any such projects.



August 22, 2011                               34
                  Competitive Bidding
• The Balanced Budget Act of 1997 lifted the
  prohibition and permitted CMS/HCFA to develop
  demo projects on competitive bidding.

• Up to 5 demos were mandated, one being
  laboratory services for Medicare Part B.

• This marks the first time a lab demo made it into
  law.




August 22, 2011                                       35
                  Competitive Bidding
• October 2007--San Diego-Carlsbad-San
  Marcos MSA selected as first demo site
• February 2008--Bids were submitted
• April 11, 2008--Winning labs would be
  notified
• July 1, 2008--Demonstration would be initiated
• Fall 2008--Second demo site to be selected




August 22, 2011                                    36
                  Competitive Bidding
• FY 2009 budget calls for a
  competitive bidding PROGRAM
  prior to the completion of the
  demo, and a 5% decrease in
  reimbursement for these
  services.




August 22, 2011                         37
                  Competitive Bidding
• Covers 330 most commonly ordered tests.
• All beneficiaries permanently living in
  designated ZIP code.
• Excludes ESRD bundled tests.
• Beneficiaries who travel outside the area
  will be able to obtain testing, but the lab
  will be reimbursed at the demonstration fee
  schedule rate.



August 22, 2011                             38
                  Competitive Bidding

• Criteria for Demo sites
      – Single state with 1-4
        million total population
      – Medicare population
        100,000-400,000
      – Medicare managed care
        population 5-50%



August 22, 2011                         39
                  Competitive Bidding
• Definition of non-patient varies depending on
  issue.
• Bid package says non-patient has specimen drawn
  by hospital personnel but not registered as an in-
  or outpatient.
• Medicare manuals have multiple definitions:
      – Patient whose specimen is drawn and sent to hospital for
        analysis
      – Patient who is neither in- or outpatient; has specimen
        submitted for analysis but is not present




August 22, 2011                                                40
                  Competitive Bidding

• Patient having blood drawn in
  hospital collection site is
  considered outpatient for
  Medicare Secondary Payer
  (MSP), but is considered non-
  patient for competitive
  bidding.


August 22, 2011                         41
                  Competitive Bidding
• Participation determined by whether participants
  live in ZIP codes included in MSA.
• If a lab’s volume increases, and the $100,000
  ceiling is exceeded by $25,000 or more, that lab
  cannot continue to do testing covered in the
  demonstration.
• If subcontractor loses as a prime bidder, lab can
  provide testing as a subcontractor but cannot bill
  Medicare directly.




August 22, 2011                                        42
                  Competitive Bidding
• Winning bidders must agree to
  demonstration terms and conditions
      – Includes a requirement to serve all beneficiaries
        in an included ZIP code.
      – Labs will not be able to pick only those patients
        they want to serve.
      – Significant for nursing homes in that large
        national labs characteristically do not serve
        nursing home patients; large labs will have to
        develop new relationships to serve nursing
        homes.



August 22, 2011                                         43
                  Competitive Bidding
• Will CMS terminate demonstration
  if patient care suffers?
• What provisions have been made
  for national disasters?
• Restrict Physician choice
      – No connection to electronic medical
        record
      – Physicians required to use even more
        laboratories for their patients




August 22, 2011                                44
                     Lawsuit Against
                     Demonstration
• 3 San Diego area laboratories, Sharp HealthCare;
  Scripps Health; and Internist Laboratory of
  Oceanside, filed suit against U.S. Department of
  Health and Human Services (HHS) on January 29,
  2008.
• Plaintiffs assert:
      – HHS failed to follow required rulemaking process,
        adequate input not obtained from all stakeholders
      – Inadequate protection for small business
      – Demo will cause irreparable harm to Medicare
        beneficiaries and labs
      – Requested temporary injunction to stop project




August 22, 2011                                             45
                  Lawsuit Against
                  Demonstration
• Court denied injunction
  February 14, 2008.
• Labs sought another injunction
  to block project and asked
  CMS to return bids submitted
  in February unopened.
• At hearing on April 8, 2008,
  the court granted a preliminary
  injunction (PI).



August 22, 2011                     46
                    Lawsuit Against
                    Demonstration
• According to PI, CMS was not to:
      – Proceed with implementation of the
        demonstration project in San Diego
      – Announce the winning bidders on April 11, 2008
      – Disclose information on any bids submitted
      – The injunction will stay in place until there is a
        full trial on the merits of the case.




August 22, 2011                                         47
                     Competitive Bidding
                         Repeal ?
• Congressional Repeal
      – Attempted to add legislation to Medicare bill at
        end of 2007, but Congress extended provisions
        until their next session.
      – On June 24, 2008, the House passed the
        Medicare bill H.R. 6331 approving a repeal of
        the demonstration project.
      – On July 9, 2008, the Senate passed Medicare
        legislation by virtue of a cloture vote 69 to 30.
      – If this bill becomes law, it would repeal the
        demonstration project for clinical laboratory
        services.




August 22, 2011                                             48
                  Fee Schedule
• Fear is that bids submitted in the San Diego
  competitive bidding process could be used to reset
  the fee schedule.
• Currently using the same fee schedule established
  in 1984.
• Original agreement was that co-payment would be
  dropped if fee schedule was instituted.
• In 1984 the fee schedule was set at 115% of the
  median fee, now at 74%.




August 22, 2011                                    49
                  Fee Schedule
• Balanced Budget Act of 1997 eliminated the CPI
  increase for lab tests from 1998 through 2002.
• Subsequent freezes to the fee schedule have been
  applied since that date.
• The current freeze will expire December 31,
  2008.
• Legislation is ready to be introduced in July
  proposing a restructuring of the fee schedule.




August 22, 2011                                 50
                  Workforce Shortage
• In the period from 2000-2010, a total of
  120,000 positions in CLS will be needed.
• This includes 80,000 new jobs and filling
  40,000 vacancies.
• Of the 12,000 openings per year, academic
  institutions are producing only 4,200
  graduates per year.
• Much of the workforce is near retirement.



August 22, 2011                               51
                    Allied Health
                  Reinvestment Act
• Many schools are unable to reach capacity.
• Programs across the country are closing.
• Work schedules in health care are less
  attractive than in other fields.
• Job Stress!!!
• Increased demand for testing--aging
  population, new testing methods,
  bioterrorism threat.




August 22, 2011                            52
                  State Licensure
• Currently 12 states plus Puerto Rico require
  licensure to perform complex clinical
  laboratory testing.
• Another 8 states are currently or previously
  considering licensure of laboratory
  personnel.
• ASCLS supports individual state licensure
  efforts.



August 22, 2011                             53
                  What Can You Do?
• Join ASCLS
      – Even if you can’t be an “active” member, your
        dues money will help to fund legislative and
        other efforts on the national level.
      – You can request to be notified of legislative
        updates and often get the opportunity to
        participate in “grassroots” movements such as
        contacting your Senators and Representatives.




August 22, 2011                                         54
                    What Can You Do?
• Keep Informed
      – http://www.ascls.org/currentevents/index.asp
      – Read online articles and updates
• Contact your Senator’s and Representatives:
      – House of Representatives:
          http://www.house.gov/house/MemberWWW_by_State.shtml#ms
      – Senate:
          http://www.senate.gov/general/contact_information/senators_c
          fm.cfm
• Educate fellow laboratorians -- Spread the word!




August 22, 2011                                                     55
                  Membership Matters


August 22, 2011                        56

				
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