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Economic Impacts on Academic Surgical Pathology

Economic Impacts on Academic Surgical Pathology. Stanley Robboy, MD, CAP President Richard 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:

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Economic Impacts on Academic Surgical Pathology

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  1. Economic Impacts on Academic Surgical Pathology Stanley Robboy, MD, CAP President Richard Friedberg, MD, PhD, Chair, Council on Gov’t & Professional Affairs

  2. 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

  3. Payment & Advocacy

  4. KeyPathology 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

  5. Payment Changes 88305 PC $43 in 1992 $36 in 2012 $30 by 2014 if MedPac 17.7% cuts enacted 88309 PC 23% RVU increase with 2009 revaluation

  6. 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%

  7. PFS Payment Changes for 2013 7% Family Doc Increase Overall Pathology Cut -6%

  8. 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

  9. 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

  10. 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.

  11. Lab Developed Tests Thousands in use…Increased government oversight likely Jurisdiction: CMS or FDA? Companion diagnostics CAP proposed oversight needing minimum administration and time.

  12. Future Genomic Leadership Leadership: Positioning Payment: Leading on NGS Regulatory Framework: LDTs Gene Patents: Myriad Case Infrastructure Needs: Clinical Variant Database

  13. 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

  14. Pathology PQRS – Part II 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

  15. 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

  16. 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

  17. 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

  18. Graduate Medical Education Policy Development • Align Specialty for Joint Advocacy • PRT White Paper • GME Panel at Policy Meeting Legislative activity • HR 6562, HR 6352, S. 1627 • +15,000 Medicare Supported Residency Slots over 5 years

  19. Workforce & Models of Care

  20. Demographics, big changes… Pathologist shortages: • Retirement cliff • Changing skills in demand Aging Population: • % >65 to double in next 15 yrs

  21. Pathologist Demographics: • Retirement Cliff Approaching Net Changes to Pathology Workforce Pathologists 2014E 2010 2019E 2024E 2030E

  22. How Other MDs See Us Pathology= a Report for 85%

  23. Transformation of Pathology What is it? Why is it important? • Emerge from shadow • Affirm value • Show new value • Secure future

  24. We must change • Focus on value, not volume • Reassert our role as physician • Diversify and expand services • Prepare for new payment and delivery models

  25. 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

  26. Value Transformation Value = clinical quality/ cost System transitioning to … • Value vs Fee For Service • Delivery models – coordinated care, population management Consumer health care • Employees now pay > employers • Consumer-directed high deductibles 58% of employers in 2011 70% of large companies by 2013

  27. Public Policy Development Policy Roundtable • Pathologists Value in ACOs • Graduate Medical Education • Value Based Pricing of Diagnostics CAP Policy Meeting • New Payment Models, Bundled Payments • P4P, Value-based Pathology • PRT: Graduate Medical Education • Lab Regulation: LDTs, Digital Pathology

  28. 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 TM

  29. www.YourPathYourChoice.org

  30. Threats Opportunities Why Promising Practice Pathways? Value-based market Molecular and genomics Dx Dx as vendor to be cut Population informatics Others snatch our ‘golden era’

  31. The Practice Pathways • High-Performance Diagnostic Services High-Performance Pathology for High Value Oncology • Coordinated Population Care Services Patient Diagnostic Services Center

  32. Community Oncology Practices Under Financial Pressure 1,254 practices impacted over past 4 yrs. Source: Community Oncology Practice Impact Report, April 2012

  33. Oncology Pathway Model • High Accuracy Diagnosis • Value Impact: • Better outcomes, less unnecessary Rx • How: • Digital path reviews • Collaborate with radiology imaging

  34. Oncology Pathway, Part II • Pathology-Driven Care Decisions • Value Impact: • Rx better matched for tumor & patient • Lower hospital & ER costs • Better outcomes • How: • Personalized medicine + informatics • Knowledge services and tools

  35. Oncology Pathway, Part III • Later Stage: Clinical Trials & Palliation • Value Impact: • Improved outcomes if trial effective • Better patient options and preferences • Avoiding unnecessary end-of-life chemo • How: • Molecular tumor profiling • (Next gen sequencing & informatics)

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