Post on 03-Jan-2016
cap.org v. #
Economic Impacts on Academic Surgical Pathology
Stanley Robboy, MD, CAP PresidentRichard Friedberg, MD, PhD, Chair, Council on Gov’t & Professional Affairs
Notice of Faculty Disclosure
The individual below has disclosed the following financial relationship with a commercial interest:
Richard Friedberg, Consultant, EmpiraMed Inc.
The individual below has no relevant financial relationship to disclose:
Stanley Robboy, MD
© 2013 College of American Pathologists. All rights reserved.
Key Pathology Issues in 2013 PFS
• SGR & Physician Payment• 100+ New Molecular Codes • LDT Oversight• Physician Quality Reporting
System • HIT/Meaningful Use• GME funding• Future payments: ACO, New
paths 4
© 2013 College of American Pathologists. All rights reserved.
Payment Changes
5
88305 PC$43 in 1992$36 in 2012$30 by 2014 if MedPac 17.7% cuts enacted
88309 PC23% RVU increase with 2009 revaluation
© 2013 College of American Pathologists. All rights reserved.
Payment Changes in 2013 PFS
Code PC TC• 88300 0 -
57%• 88302 +5% -
51%• 88304 +3% -
35%• 88305 +2% -
52%• 88307 +4%
+39%• 88309 +4%
+41%
6
© 2013 College of American Pathologists. All rights reserved.
PFS Payment Changes for 2013
• 7% Family Doc Increase
• Overall Pathology Cut -6%
7
© 2013 College of American Pathologists. All rights reserved.
Congress and SGR fix
• Decision pushed to 12/31; ~ 30% cut
• 10-year freeze now $138 billion, due to reduced spending
• Previous proposals: MedPAC to cut specialists’ pay by 5.9% for 3 yrs (~18% total), then freeze for 7 years
8
© 2013 College of American Pathologists. All rights reserved.
AMA’s SGR Stance
• Eliminate SGR
• For next 5 years, provide PFS updates to pace practice costs, while developing new approaches
• Let physicians choose from various payment options best fitting their practice
• Reward reducing duplicated services, adverse events, ER visits/hospitalizations 9
© 2013 College of American Pathologists. All rights reserved.
100+ New Molecular CPT Codes
• New CPT molecular codes placed on 2013 CLFS
• CAP helped create codes and urged placement on PFS
• New CMS HCPCS II G-code for physician interpretation and reporting.
10
© 2013 College of American Pathologists. All rights reserved.
Lab Developed Tests
• Thousands in use…Increased government oversight likely
• Jurisdiction: CMS or FDA?
• Companion diagnostics
• CAP proposed oversight needing minimum administration and time.
11
© 2013 College of American Pathologists. All rights reserved.
Future Genomic Leadership
• Leadership: Positioning
• Payment: Leading on NGS
• Regulatory Framework: LDTs
• Gene Patents: Myriad Case
• Infrastructure Needs: Clinical Variant Database
12
© 2013 College of American Pathologists. All rights reserved.
Pathology PQRS – Part I
• 62% of eligible pathologists participated. Better than 26% of total eligible MDs
• Average pathologist bonus: $1564 in 2010
• 5 measures in place now; 3 new for 2014
13
© 2013 College of American Pathologists. All rights reserved. 14
Included in CMS 2012 and 2013 PQRS:
• Breast Cancer Resection -- #99• Colorectal Cancer Resection -- #100 • Barrett’s Esophagus -- #249• Radical Prostatectomy -- #250• IHC Evaluation of HER2 for Breast Ca --
#251 Proposed for 2014:• Lung cancer (biopsy/cytology
specimens)• Lung cancer (resection specimens)• Melanoma
Pathology PQRS – Part II
© 2013 College of American Pathologists. All rights reserved.
Value-Based Payment Modifier
• In 2013, applies only to groups of >100+ members
• Must cover all physicians by 2018
• Relies on PQRS reporting
• 1% penalty for failure to participate
15
© 2013 College of American Pathologists. All rights reserved.
Health Information Technology
• 2009 Recovery Act catalyzed HIT and Meaningful Use • Program targets PCPs; • Nearly all pathologists eligible
& some academic centers successful
• Most groups unable to participate, and vulnerable to penalties
• CAP advocated relief from penalties. Success! ….temporarily.
• CAP seeks permanent fix in H.R. 4066
16
© 2013 College of American Pathologists. All rights reserved.
HIT issues for AP• Integrated reports
• EMR
• ONC changes• Laboratory Orders/Results
Interfaces• Electronic Delivery of Services• Laboratory Results Reporting
• Key influencers of federal HIT standards
17
© 2013 College of American Pathologists. All rights reserved.
• Policy Developmento Align Specialty for Joint
Advocacyo PRT White Papero GME Panel at Policy Meeting
• Legislative activityo HR 6562, HR 6352, S. 1627 o +15,000 Medicare Supported
Residency Slots over 5 years18
Graduate Medical Education
© 2013 College of American Pathologists. All rights reserved.
Demographics, big changes…
• Pathologist shortages:oRetirement cliffoChanging skills in demand
• Aging Population:o% >65 to double in next 15 yrs
20
© 2013 College of American Pathologists. All rights reserved. 21
Net Changes to Pathology Workforce
2010 2014E 2019E 2024E 2030E
-500
-400
-300
-200
-100
0
100
200
300
400
500
88151
30 23
-139
-284-206-204
-329-346-329-296-222
-144-140-146-180-93 -123-114
-75
Pathologist Demographics:Retirement Cliff Approaching
Path
olo
gis
ts
© 2013 College of American Pathologists. All rights reserved.
Pathology= a Report
22
for 85%
How Other MDs See Us
© 2013 College of American Pathologists. All rights reserved.
Transformation of Pathology
23
What is it? Why is it important?• Emerge from shadow• Affirm value• Show new value• Secure future
© 2013 College of American Pathologists. All rights reserved. 24
• Focus on value, not volume• Reassert our role as
physician• Diversify and expand
services• Prepare for new payment and
delivery models
We must change
© 2013 College of American Pathologists. All rights reserved.
Beyond Fee for Service
• Medicare Shared Savings
• Private Sector Coordinated Care /Clinical Integration Programs
• CAP ACO White Paper, Resource Center, & ACO Network
• CAP’s Promising Practice Pathways
25
© 2013 College of American Pathologists. All rights reserved. 26
• Value = clinical quality/ cost• System transitioning to …
o Value vs Fee For Serviceo Delivery models – coordinated care,
population management
• Consumer health careo Employees now pay > employerso Consumer-directed high deductibles
58% of employers in 201170% of large companies by 2013
Value Transformation
© 2013 College of American Pathologists. All rights reserved. 27
Public Policy Development
Policy RoundtableoPathologists Value in ACOs oGraduate Medical Education oValue Based Pricing of Diagnostics
CAP Policy MeetingoNew Payment Models, Bundled
PaymentsoP4P, Value-based Pathology oPRT: Graduate Medical Educationo Lab Regulation: LDTs, Digital
Pathology
© 2013 College of American Pathologists. All rights reserved.
Promising Practice Pathways™Describes new pathologist-driven services and programs
Adds clinical value outside of the lab by improving downstream clinical quality and outcomes
Generate downstream clinical cost savings
28
TM
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30
Threats Opportunities
Population informatics
Molecular and genomics Dx
Value-based market
Others snatch our
‘golden era’
Dx as vendor to be cut
Why Promising Practice Pathways?
© 2013 College of American Pathologists. All rights reserved. 31
High-Performance Diagnostic Services
Coordinated Population Care
Services
Patient Diagnostic
Services Center
High-Performance Pathology for
High Value Oncology
The Practice Pathways
© 2013 College of American Pathologists. All rights reserved. 32Source: Community Oncology Practice Impact Report, April 2012
1,254 practice
s impacted over past 4 yrs.
Community Oncology Practices Under Financial Pressure
© 2013 College of American Pathologists. All rights reserved. 33
High Accuracy Diagnosis
Value Impact: Better outcomes, less
unnecessary Rx
How:Digital path reviewsCollaborate with radiology
imaging
Oncology Pathway Model
© 2013 College of American Pathologists. All rights reserved. 34
Pathology-Driven Care Decisions
Value Impact: Rx better matched for tumor & patientLower hospital & ER costs Better outcomes How: Personalized medicine + informaticsKnowledge services and tools
Oncology Pathway, Part II
© 2013 College of American Pathologists. All rights reserved. 35
Later Stage: Clinical Trials & PalliationValue Impact: Improved outcomes if trial effectiveBetter patient options and
preferencesAvoiding unnecessary end-of-life
chemo
How: Molecular tumor profiling(Next gen sequencing & informatics)
Oncology Pathway, Part III