October 2012

EMR donations

The article in the August issue titled “On EMR donations, steer clear of troubled waters” contains valuable advice on laboratory compliance with federal law when making these donations. However, the article exclusively focuses on the federal aspect of this issue and does not mention important state law applicability. The federal safe harbor for electronic health record donations does not preempt or displace state anti-kickback law and regulations. The CAP, working with state pathology societies, has obtained attorney general or agency clarifications on the application of state anti-kickback law to these donations.

In response to our efforts, five states (New York, New Jersey, Pennsylvania, Missouri, and West Virginia) have issued formal guidance to the clinical laboratory community on the application of their respective state anti-kickback law to these donations. Notwithstanding the federal safe harbor, these state opinions can limit or prohibit the donation of the EHR as delineated. The text of the state opinions elicited to date can be found on the CAP advocacy Web site in the State Advocacy section. As of this writing, other CAP-state pathology society requests for state clarification are pending and may be issued.

The CAP has long advocated with the Office of Inspector General for Health and Human Services and others at the federal level for the removal of pathologists and laboratories as protected EMR donors under the federal EHR safe harbor currently scheduled to sunset on Dec. 31, 2013. The CAP continues to advocate along these lines regardless of the scheduled sunset.

Kathryn Knight, MD
Chair, CAP Federal and State
Affairs Committee
PathGroup
Medical Laboratory Director,
Hamilton Medical Center and
Murray Medical Center, Dalton, Ga.

See, Test and Treat program

On Aug. 18, I and colleagues provided services through the CAP Foundation’s See, Test and Treat program at a health fair at the Nhân Ḥa Comprehensive Health Care Clinic in Garden Grove, Calif., which more than 700 people attended. We could not have done our work alone. A grant from the CAP Foundation and donations from Pathology Inc. laboratory in Torrance, Calif., Hologic, Qiagen USA, CooperSurgical, and others made it possible for us to provide in one day cervical cancer screening to 168 women. Fifty-three women were screened for breast cancer; the See, Test and Treat grant helped fund the purchase of mammogram supplies. This took place in Orange County, one of the richest counties in the U.S., yet as the turnout shows, many are without insurance and access to basic care. Many women at Nhân Ḥa clinic had never before had a Pap test; others hadn’t had one in five years or more. Of the 141 Vietnamese women tested for cervical cancer, abnormal results were found in 14. That’s a 10 percent abnormal rate in our Vietnamese community, where cancer is considered a death sentence and a punishment and is a taboo subject. See, Test and Treat is helping to clear up some of the misinformation and begin in this community a much-needed dialogue about cancer.

See, Test and Treat at this time is in only a handful of cities, but the hope is that it will spread. At the CAP ’12 annual meeting last month, the program in Minneapolis was recognized for its accomplishments. Several pathologists at the meeting were inspired by the success of the Minneapolis See, Test and Treat, and the ones at Nhân Ḥa and in Boston and Houston, and are planning to do volunteer work with an existing program or to start one of their own. We can help prevent cancer and perhaps change cultural attitudes one Pap test at a time.

Si Van Nguyen, MD
Affiliated Pathologists Medical Group
Torrance, Calif.

Medical Director, Laboratory
Garden Grove Hospital