New Jersey Society of Pathologists            






 
 

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House of Delegates
 

CAP House of Delegates – Health Care Reform and the Transformed Pathologists

The CAP House of Delegates held its Fall meeting on Saturday, October 10, 2009, in Washington, DC. The meeting focused on health care reform and the transformed pathologist.

The House began its meeting with presentations by College leaders focusing on the transformation of pathology. Outgoing CAP President Jared N. Schwartz, MD, PhD, FCAP told the House that the Transformation is in motion and some of the initiatives the College has undertaken are becoming a reality, particularly the Institute and the Center. He told House members that pathologists must find a way to insert themselves into the lives of their patients and work with the patients and their families to demonstrate value and he encouraged delegates to keep their office doors open, not to make sure people can come in, but to ensure that they (the pathologists ) can go out. Dr. Schwartz thanked the House for their participation during his presidency and encouraged them to keep up with their revitalization.

Charles Roussel, Executive Vice President of the College, told the House that the College is staying ahead of the crowd in order to secure the future of the specialty and that the CAP is investing in the Transformation and working to increase revenue growth in order to fund it. Mr. Roussel informed delegates that the College is looking into ways to improve the image of the pathologist and expanding into international markets. Finally, Mr. Roussel encouraged the delegates to start thinking, and start saying, that “If the diagnosis is wrong, nothing else matters.”

Thomas Malone, the College’s new Vice President of Transformation, updated the House on the progress of the CAP Pathology and Laboratory Quality Center (The Center). The Center will be responsible to develop evidence- and consensus-based guidelines focused on patient care. It officially launched at CAP’09. Through its work, the Center will demonstrate the central role of pathologists in the patient care team, serve as a “brand” to promote guidelines from across the College, and drive additional value for the College by helping to mitigate the risk of government involvement, enabling the creation of pathology-specific performance measures, creating rigorous quality standards for AP, and facilitating alliances with other medical specialties and patient advocacy organizations. Mr. Malone told the House that the College needs their help with the Center. Members can submit topics for Center guideline development at www.cap.org/Center or volunteer to “champion” a proposed Center topic and lead a Center Workgroup, or participate in workgroups.

In order to showcase a transformative technology, the House heard a presentation on Endoscopic Microscopy: Bridging the Radiology/Pathology Divide by Guillermo J. Tearney, MD, PhD. Dr. Tearney demonstrated a current technology that provides a microscopic view of issue inside the patient and told the House that the technology is on the way that will replace the need for glass slides.

After a lunchtime presentation on health care reform by Former Senator Tom Daschle (D-South Dakota), the House heard a presentation from John Scott, Vice President of Advocacy, on the Now and Future Advocacy Agenda of the College.

The College’s Pathology Now Agenda includes physician payment and the sustainable growth rate; Medicare physicians advisory committee and independent Medicare advisory council; linking patient outcomes to payment; health information technology; self-referral and transparency; and comparative effectiveness research. The College’s Pathology Future Agenda is centered on the pathologists’ potential future role in a coordinated care model.

Through its advocacy efforts, the College has made some progress on the Now Agenda. It appears SGR will be corrected, at least in short term. Mr. Scott stated that it is important to note that the Senate bill, which is the only on the Congressional Budget Office says balances, does not permanently fix the SGR. Primary care bonuses will likely be granted and this potentially could impact pathology payments. Penalties for non-participation in pay for performance are still possible in 2012, creating risk for our members and action on self-referral will be limited. The College does expect the Technical Component Grandfather to be extended and that some revaluation of our anatomic pathology codes will have to be undertaken.

The College’s plan for the future role and agenda for pathologists is that pathologists provide direct patient care through diagnostic test selection, performance, interpretation, and direction on optimal therapy options to patients and to clinicians. In order to make this a reality, policy changes will need to obtained to provide new payment for consults initiated by pathologists for appropriate test selection and therapy management and full access to the patient’s Electronic Health Record. The College’s Transformation Ask is for Medicare payment policy to be modified to pay for diagnostic consultations initiated by pathologists with clinicians and patients on test selection and therapy management and that a demonstration project should be conducted to evaluate the role of the pathologist as test selector and therapy manager in terms of reduced costs and improved care. Mr. Scott told that House that we are in the beginning phases of this campaign and the initiative and our work is just starting. Policy makers and other stakeholders are just learning of our proposal for the future and they are receptive to the role we envision, but we will need to better define the services, cost savings and benefits to patients as well as how to measure it.

House members then had the opportunity to discuss health care reform as it pertains to pathology. Overall, House members were concerned with:

  • self-referral issues;
  • unintended consequences of the bills;
  • competition from other specialties for the consultant role;
  • being on the sideline as part of the health care team rather than centrally located to patient care;
  • lack of attention to Tort reform, and;
  • no permanent fix for the SGR.

In addition, house members felt that the highest priority for the College should be a permanent SGR fix, AP CPT revaluation by RUC, documenting the role and value of the pathologist, and coordination with other clinical societies. Finally, House members saw access to patient information and integration of health information across the country and payment issues as challenges and opportunities to the new, enhanced role of the pathologist.

In addition to health care reform and the transformed pathologist, the House held discussion on four topics of importance to the College and the specialty.

Amendments to the CAP Bylaws
The House discussed and endorsed two proposed amendments to the CAP Bylaws. These amendments are to ARTICLE VIII. Miscellaneous Provisions; Section 2. Professional Relations and ARTICLE VI. Discipline; Section 2. Disciplinary Procedure. The amendments adjust the language to state that members are governed by the CAP Principles of Ethical and Professional Conduct and change the procedures for disciplinary action against a member from a bylaw to a policy, thus allowing the College to respond more quickly to allegations of unprofessional behavior of a member. These amendments will be presented to the College membership for approval and will carry the endorsement of the House.

Custodianship of Human Biospecimens and Their Derived Products
The House discussed the CAP Policy on Custodianship of Human Biospecimens and Their Derived Products and its consequences to pathologists. The House agreed that there was a need for setting standards on this topic, not limited to standards on storage, fixatives, and technology. Information from the House regarding this discussion will be sent to the CAP Center as a suggested topic for a standard.

Lymph nodes to be identified in any colon resection for carcinoma
Dr. John Harbour, Virginia Delegate, presented a discussion item to the House on the concept of the minimum number of lymph nodes. The House agreed that the current “minimum” number of 12 has no reference to validity and that the goal should be to “maximize the number of nodes you harvest”. Information from the House regarding this discussion will be sent to the CAP Center as a suggested topic for a standard.

The Transformation of the Practice of Forensic Pathology
Dr. Kim Collins, South Carolina Delegate, presented to the House on the need for Transformation of the Practice of Forensic Pathology and the death investigation system. She told the House that a recent NAS (National Academies of Sciences) Report recommends: 1) Forensic autopsies should be performed or supervised by forensic pathologists; 2) Pathologists testifying in court on the findings of a forensic case should be certified; 3) Steps should be taken to replace coroner systems with medical examiner systems. The House agreed that the coroner system is outdated and a change is necessary and generally supported the 3 NAS recommendations. Delegates agreed to ask the College of American Pathologists to support the recommendations of the National Academies of Sciences and the National Research Council and be a participant in the transformation of the current practice of forensic pathology in medicolegal death investigations, to collaborate with other pathology associations such as the National Association of Medical Examiners to protect the practice of its members while also serving the public by optimizing the practice of forensic pathology, and to take a lead position in transforming the current antiquated death investigation system and practice of forensic pathology and work with other professional organizations to update the 1954 Model Post Mortem Examinations.

Submitted by,
Louis Zinterhofer MD
Chair, NJ CAP House of Delegates


CAP House of Delegates Agrees to PathPAC Contribution Initiative

The CAP House of Delegates held its spring meeting on March 7, 2009 in Boston, Massachusetts. With 78 delegates representing 33 delegations in attendance, the Spring 2009 meeting was the largest Spring Meeting in recent House of Delegates history. The delegates held interactive discussions with the CAP leadership team about the Strategic Directions of the College, new practice model concepts, representation of the International Fellow Class in the House of Delegates, and support for PathPAC. In addition, the delegates heard presentations by the candidates who have declared for the office of President-Elect in the 2009 election, the College’s Strategic Plan, and the College’s Leadership Platform from the new Executive Vice President.

Stephen N. Bauer, MD, FCAP, CAP President-Elect, outlined the CAP Strategic Plan and the Transformation Platform, and updated the House on some recent College activities. Dr. Bauer told the House that that the pathologist needs to have a direct, active, and more visible role in patient care. He told the House that the College must now translate the Vision into action and be the driver of the transformation. He then outlined the high level strategic directions of the College:

  1. Promote quality in the practice of Pathology.
     
  2. Lead the provision of life-long learning opportunities that will prepare pathologists for the future and to assume new roles in the evolving healthcare landscape.
     
  3. Improve laboratory quality and patient safety through expansion of CAP quality improvement programs.
     
  4. Expand the membership and strengthen support of their professional needs.
     
  5. Advocate for public and private policies in the best interest of Pathology, patients and healthcare.
     
  6. Exercise leadership in Health Information Technology advancement that enables Pathology to make the maximum contribution to high quality, cost effective healthcare.
     
  7. Maintain fiscal integrity, effectiveness and agility in proactively pursuing its role as driver of the transformation of Pathology.

Dr. Bauer told the House that, with the work of EVP Charles Roussel, these directions are being repackaged into tangible, measurable strategies that will complement the work of the Strategic Planning Committee. He also told the House that the teams working on the development of the Center and Institute are working to address the concerns and incorporate the ideas expressed by the House at the Fall 2008 meeting.

Speaker of the House Thomas Joseph Cooper, Jr, MD, FCAP, introduced the House to the new CAP Executive Vice President, Charles Roussel. Mr. Roussel was most recently a director of the Atlantic Philanthropies, where he worked to bring healthcare back into schools and advocated for greater funding for preventive medical and mental health services. He previously served as a Managing Partner at Accenture, where he helped clients around the world envision and effect transformational change. Mr. Roussel told the House that the College will not be able to secure a better future without active grassroots support. He explained that time is of the essence; other specialties are staking a claim to the traditional pathologist role, creating a risk that pathologists will be marginalized as technicians. Mr. Roussel told the House that he has been hired to lead the College in its efforts to transform the practice of pathology and the role of the pathologist, and to unify staff and the Board in the pursuit of a common change agenda. The internal transformation of the College will be known as the PATH Forward. The platform consists of three leadership themes - market focus, operational discipline, and catalyzing the transformation. Mr. Roussel reiterated that the transformation of the specialty and the College is a generational undertaking and that the College is fully committed to this endeavor.

In the spring of 2008, the House of Delegates endorsed the establishment of an International Fellow membership class for the College. This class was approved by the Fellows of the College in the summer of 2008 and is available to pathologists practicing outside of the US and Canada. At the Spring 2009 meeting, the House discussed the possibility of extending membership in the House to members of the International Fellow Class (IFCAP). It was decided that IFCAP members may attend the House meetings and participate in the discussions, but will not be allowed to vote at the House meeting. In addition, the Speaker of the House will make the decision to seat IFCAP members on an individual basis versus a delegation being established.

During the summer of 2009, the College will be holding elections for a new President-Elect. In order to inform the House of each candidate’s platform, the three declared candidates for the office gave brief presentations on their history and vision for the future. Following the presentations, House members asked questions of the three candidates. In addition, Dr. Cooper told the House that they may be asked to play a pivotal role in this year’s election. He explained that, according to the CAP Bylaws, in the event no candidate achieves a majority the House of Delegates will elect the next President-Elect by secret ballot at the Fall Meeting.

During a reference committee of the whole, the House discussed some possible new practice models and the issues surrounding them. The House agreed that members need help to better understand the issues surrounding new practice models and mergers, and how to join together in mutually beneficial ways. It was noted that discussion surrounding new practice models is a cornerstone of the Leadership Platform. It was agreed that a report outlining the House discussion will be provided to the necessary parties for input.

Finally, the House discussed how it could help increase pathologist support to PathPAC. PathPAC Chair, Richard A. Bernert, MD, FCAP told the House that while contributions to PathPAC have been increasing, there is still more that needs to be done. In order to have a seat at the Healthcare Reform Table, more members need to contribute. The House of Delegates affirmed its commitment to PathPAC, pledging to increase participation among Delegates from 50% to 100% by the next meeting in October. House members agreed to renew their PathPAC contribution in 2009, make their contribution habitual, and consider contributing the value of a single 88305 each month to the PAC (PC: $38 x 12 = $456 or Global: $104 x = $1,248). They also agreed to spread the word to other members and recruit 5 colleagues to contribute. PathPAC now has the capability to automatically deduct a monthly contribution on your credit card.  If you would like to sign up for this program, or have any other questions about PathPAC, please contact Susan Askew in CAP Washington, DC office at 202-354-7105.

The House now looks forward to CAP’09 at which they will continue to discuss issues of importance to the College, its members, and the practice of pathology. The Fall 2009 meeting is scheduled for Saturday, October 10 in Washington DC. There will be a House of Delegates dinner on Friday evening and the inaugural gala for Stephen N. Bauer, MD, FCAP on Saturday evening. Delegates will receive information on the upcoming meeting and events in the coming months.

For more information on the CAP House of Delegates, contact Shannon Peterson at ext. 7393 or speters@cap.org.

 

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