April 2011

Stephen N. Bauer, MD

Your responses tell the story

Facts can obscure the truth.
—Maya Angelou

Market forces affect pathology in subtle and not-so-subtle ways. The payer mix evolves and practice models become increasingly diverse. We hear about mergers, acquisitions, and accountable care organizations. Our demographics shift and residents clamor for subspecialty fellowships. We need to stay on top of market changes.

The CAP Professional Affairs Committee monitors trends in practice and contractual arrangements between pathologists and other providers, as well as payer, compliance, and scope-of-practice issues. It also conducts the triennial CAP practice characteristics survey.

Sometime in April, every CAP fellow in active practice should receive an e-mail invitation to complete the practice characteristics survey. This instrument will give our members timely, focused, reliable information on salary, benefits, and other practice management matters. It will also provide a clear picture of pathologists’ activities, challenges, and concerns—information that will inform and enhance CAP advocacy and policy development.

Members need data on salaries, benefits, and practice models and settings. We need to know where pathologists work, how subspecialties are represented, and what practices look like. Practice characteristics data are particularly useful to those on both sides of the job market—those seeking a position and those with a position available.

Gerald R. Hanson, MD, chairs the Professional Affairs Committee, which managed a major overhaul of the survey in the past year. Dr. Hanson did not coin the term “field intelligence,” but he may be the first to apply it to pathology. I can appreciate his word choice. There is something almost militaristic about the discipline and intensity with which the committee approached this project, recruited the talent required, identified the necessary tools, and parsed the questions for clarity and pertinence.

To round out the expertise in its working group, the Professional Affairs Committee ­recruited experts from across the College, including the Diagnostic Intelligence and Health Information Technology Committee, the Transformation Program Office, and divisions responsible for advocacy and practice management. The group studied what had been done in the past and determined what changes were needed, taking care not to reproduce other CAP member research.

The first six practice characteristics surveys were conducted under contract to an outside firm. The committee brought the 2007 survey in-house because it realized we needed not more data but a database that we could mine repeatedly. We needed to structure the survey for utility, relevance, and accessibility while protecting member confidentiality.

The working group brought in a powerful new tool, a statistical software package that enables us to own what is learned and to house what we own in a robust, accessible, methodologically sound database that enables customized reporting. When responses are tabulated, we will be able to “slice and dice” the data to meet any of our needs. A granular, in-depth knowledge of the landscape of pathology will provide a real-time snapshot of pathology and inform our advocacy and transformation activities.

The new survey will accommodate trend analysis, reaching to the prior survey results to identify longitudinal data on salaries and benefits, group size, and other demographics. There are questions on payer mix, subspecialists in the practice, self-referral arrangements, and test utilization supervision. It asks about accountable care organizations and other timely topics, including the extent and nature of direct patient contact. Has your group been in conversations about ACO participation? Are mergers and acquisitions as prevalent as we believe? Soon, we’ll know.

A firm grasp of regional market pressures and environmental changes will help align our advocacy with practice needs. There is anecdotal evidence that some payers limit patients to only certain laboratories, that a few would like to have more control of molecular services by managing and approving their utilization, that some members have been pressured to “donate” expensive equipment to support client use of the electronic health record. With data, we will be able to separate fact from fiction and identify how, where, and in what ways these practices are occurring. The responses you provide will tell the story.

I hope that members will take time to complete the survey section for optional comments. What issues affecting pathology are most on your mind? What should our advocacy priorities be? Your feedback will clarify and enhance the effectiveness of our story in Washington. When we testify before committees or write letters to Congress, we will have a narrative that captures your experiences, challenges, and concerns.

The working group has scoured the language in the questions to ensure that the survey will provide the data we need. Still, the accuracy of any survey is directly proportional to its response rate. Each reply to this survey will make it more useful. The content is more focused than in previous surveys and the survey will not take long to complete. The more pathologists who complete it, the better the data and the more accurate the findings.

I often meet members who tell me that they support everything the College is doing and wish they could contribute in a more meaningful way. This survey is your opportunity. Please do your part by completing it.