Pathologists Making A Difference With Patient Care

Background

Do Pathologists make a difference with patient care? Unquestionably YES! Nearly every diagnosis your physician makes is a direct result of the pathologist's oversight and expertise. The pathologist will review a biopsy specimen and render a diagnosis. The laboratory test your physician orders can only be ordered if the pathologist oversees the laboratory and the personnel performing the test. In many cases, the pathologist will consult with your physician on an abnormal laboratory test value, suggest alternative tests, or recommend a different test that may enable a more accurate diagnosis for you. In all cases, the pathologist is rendering a professional opinion but you, the patient, are unaware of these interactions. Pathologists perform these vital tasks with little fanfare or recognition, and oftentimes, without payment. Yet, their actions are no less important to your overall care as a surgical procedure or a physical examination.

We will be collecting examples of pathologists who, by their actions, took the extra step to investigate a laboratory problem, resulting in a significant difference for the care of the patient. There are proactive measures pathologists have taken to reduce ordering of unnecessary tests or streamlining laboratory panels.

A Patient with Unexplained Anemia

Sadly, there are organizations that are actively campaigning to reduce or eliminate any compensation to pathologists for their oversight of the clinical laboratory. The article below highlights recent struggles pathologists have faced in this arena.

AMA House Adopts CAP-Sponsored
Part A Payment Recommendations

The American Medical Association's House of Delegates (HOD) last week approved and, at the College's urging, strengthened language opposing arrangements that force pathologists to accept no or token payment for their oversight of hospital laboratories.

At the AMA's Dec. 7 to 11 Interim Meeting, in New Orleans, the HOD approved a report from AMA Council on Medical Services on the issue. The report recommended that the AMA oppose arrangements that force pathologists to accept no or token payment for the medical direction and supervision of hospital-based clinical laboratories and also called on the federal government, state medical societies, the American Hospital Association and other hospital organizations to eliminate such arrangements.

The College succeeded in adding a third recommendation to the report: that the AMA urge the Department of Health and Human Services' Office of Inspector General (OIG) to revise its hospital compliance document to state that "token or no payment for pathologist Part A medical direction and supervision services in exchange for Part B referrals violates the anti-kickback statute." The recommendation is timely, as the OIG has announced that it will review the hospital fraud and abuse compliance guidance for possible revision to reflect changes that have occurred since the guidance was issued in 1998.
The report reflects close collaboration over the past year between the College and the AMA Council on Medical Services and grew from a 2001 resolution sponsored by the California Medical Association on behalf of the California Society of Pathologists and supported by the CAP. The document prominently notes the College's position on payment to hospital-based pathologists and details years of College advocacy on the issue.

The report focuses, in large part, on the problem of no or token Part A Medicare payment to pathologists who oversee hospital laboratories. Pathologists often are forced to forgo payment for these services, which is included in Medicare diagnosis related group payments to hospitals, in exchange for the opportunity to provide Medicare Part B services for hospital patients.
The College has long opposed such arrangements and, through persistent advocacy, received federal support for its position. The OIG, in a 1991 report and in its subsequent hospital compliance guidance, said the arrangements may run afoul of Medicare anti-kickback statutes and should be avoided. But the OIG has stopped short of calling such arrangements outright violations by hospitals and, as such, the College has sought stronger language.

Several state medical societies and specialty organizations supported AMA approval of the report last week, which reflected an organized campaign that involved the leadership of the CAP Delegation to the House and AMA Pathology Caucus members.
Source CAP STATLINE--Dec. 18, 2002 (Volume 18, Number 24)

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Last Updated 12/18/2002