President’s Desk Column

A new ‘Focus’ on what we do

March 2002
Paul A. Raslavicus, MD

Ours is a broad specialty of medicine. Pathologists are involved in so many aspects of patient care, research, teaching, and medical direction of laboratories that it led one former CAP president to define a pathologist this way: "A pathologist is what a pathologist does." We indeed have believed that we could not be classified, that our work was too diverse to be reduced to a simple formula, and that no pigeonhole of any shape would accommodate us.

Were it not for the white water in medicine that managed care and DRG-based reimbursement have brought, we could have continued to exist in this fashion. But it was not to be. In the name of cost-efficient medical care, corporate and laboratory consultants of various stripes descended upon our laboratories and tried to define by simplistic approaches the staffing requirements for pathologists. These misguided attempts resulted in disastrous decisions in many of our institutions.

College leaders realized that others’ poor or imagined staffing standards made our specialty vulnerable to unwarranted requests for staff reductions, and that lack of appropriate information made the heads of groups vulnerable in their Part A negotiations. And so we have undergone a reluctant but reasoned cultural shift on the professional staffing question. We have come to see a need for a College-developed instrument that we can use to ensure that the activities needed to provide proper care in each institution are described appropriately.

The first to look into these issues was the College’s Professional and Economic Affairs Committee, or PEAC. Its 1997 report described the complexities and variability of our practices and concluded that the then available indicators could not be used to define staffing needs. Based on this report, the Board created the Ad Hoc Committee on Pathologist Staffing and asked it to convert the PEAC paper into a usable template with explicit data elements that could be applied to pathology practices nationwide. It also asked the ad hoc committee to explore a mechanism to develop a descriptive database containing elements of pathologist activities based on that template. The result—five years, several pilots, and multiple refinements later—is the College’s pathologists’ activities program called PathFocus.

Before speaking more about what PathFocus is, first let me be clear about what PathFocus is not. The program is not related in any way to regulatory or accreditation activity. It collects no financial information of any kind. It is explicitly not designed to measure the productivity of individual pathologists, and there are no traceable individual identifiers in the forms submitted or results received. Information is communicated back only to the participant—the department or the group leader—of record.

The modern group practice of pathology is a multidimensional chess game, and PathFocus is our sharpest tool and best bet for confidential group strategy, management, and self-assessment. Designed by and for CAP fellows, the instrument provides for the reporting of a broad scope of activities, including many that others miss. The output of PathFocus is the best information for you to fully understand what you do and why. It provides invaluable information on how you need to respond to the pressures applied to your practice by those you serve.

PathFocus is a tool to improve your practice patterns. It factors in service loads, education and research efforts, the complexity of the practice, and scholarly pursuits. A core component is the "fingerprint cluster" (patent pending), designed on the premise that when unmanageable factors are controlled, manageable aspects will readily emerge. The statistical model creates a "fingerprint" for each practice based on certain weighted characteristics. These characteristics include volume levels of CPT codes and individual complexity criteria, such as types of services performed, for whom, and in what context. A fingerprint cluster report for each pathology practice provides data on 10 statistically matched practices and, separately, the "two closest matches" within that group of 10. Another report presents detailed information on "key characteristics" that have a significant effect on staffing levels within your peer group. Eventually, PathFocus will be able to offer each participating practice the opportunity to create a "practice defined group" that will reflect data on up to five characteristics that the practice would like to use as the basis for comparison. (For example, the practice’s members might ask to be compared to practices of similar size that serve pediatric institutions with neonatal ICUs, have a low gynecologic cytology volume, and have extensive blood bank responsibilities.)

PathFocus is your first real opportunity to look at your practice activities through the eyes of a pathologist. It is an opportunity to be seized by all who want to know how they are doing in providing the care that their local health care environments demand. The value received will be truly worth the effort of participation. Several hundred are already onboard, and the good news is that the program is free to all CAP fellows for the 2002 calendar year.

For those of you who may be reluctant to disclose your hidden talents, remember the words of a long ago and now nearly forgotten TV commercial, "The closer they get, the better you look."

For more information on PathFocus, contact Sharon Burr at the CAP (800-323-4040 ext. 7417, sburr@cap.org).