cap.org v. # economic impacts on academic surgical pathology stanley robboy, md, cap president...

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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.

Payment

& Advocacy

3


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


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


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


PFS Payment Changes for 2013

• 7% Family Doc Increase

• Overall Pathology Cut -6%

7


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


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


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


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


Future Genomic Leadership

• Leadership: Positioning

• Payment: Leading on NGS

• Regulatory Framework: LDTs

• Gene Patents: Myriad Case

• Infrastructure Needs: Clinical Variant Database

12


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


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


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


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


• 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


Workforce &

Models of Care

19


Demographics, big changes…

• Pathologist shortages:oRetirement cliffoChanging skills in demand

• Aging Population:o% >65 to double in next 15 yrs

20


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


Pathology= a Report

22

for 85%

How Other MDs See Us


Transformation of Pathology

23

What is it? Why is it important?• Emerge from shadow• Affirm value• Show new value• Secure future


• Focus on value, not volume• Reassert our role as

physician• Diversify and expand

services• Prepare for new payment and

delivery models

We must change


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


• 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


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


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


www.YourPathYourChoice.org


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?


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


High Accuracy Diagnosis

Value Impact: Better outcomes, less

unnecessary Rx

How:Digital path reviewsCollaborate with radiology

imaging

Oncology Pathway Model


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


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

cap.org v. # economic impacts on academic surgical pathology stanley robboy, md, cap president...

Documents

eligible pathologists

pfs payment changes

new paths4

breast cancer resection

colorectal cancer resection

pfs updates

pfs codepctc88300

pathology pqrs