Patrick Godbey, MD
March 2020—It is important to understand that we—those of us who work in the U.S.—are all essentially independent contractors for the federal government. Pathologists who work directly for a federal agency or the Department of Defense are the only exception.
The federal government has enormous influence on funding and reimbursement in health care. Including direct and indirect spending, about 50 cents of each health care dollar comes from Washington. So if you are a pathologist practicing in the U.S., the federal government has a significant role in whether and how much you get paid. (Through its regulations, it also has tremendous influence on where and how you practice, but I’ll get to that in another column.)
The involvement of the federal government in dictating pathologists’ income begins early—much earlier than most are aware. Almost every resident’s salary in this country is paid with funding from Medicare. If you ask residents about this, as I often do, they usually believe their salary originates with their health care institution. But the vast majority of that money actually comes from the federal government. According to government estimates, for each full-time resident, Medicare contributes an average of $40,000 in direct graduate medical education and about $100,000 in indirect medical education funding. The numbers from 2015 put Medicare’s total annual contribution for graduate medical education at $10.3 billion. Medicaid paid $2.4 billion and Veterans Affairs paid $1.5 billion. The protection of this funding is just one reason why pathologists in academic practice should be active in the CAP. There are people in Washington who have challenged this funding.
Even in the earliest stages of a pathology career, it is worth paying attention to the federal government. The best way to do that is by participating in the CAP Residents Forum. The chair of that group is a voting member of the CAP Board of Governors, ensuring that the perspective of residents is considered as we set our priorities and plan our strategies.
Of course, the influence of the federal government on how much pathologists earn for their important services becomes more noticeable after residency. Medicare and Medicaid payments are significant sources of income for most pathology practices, so the reimbursement rates set by the government have an enormous impact on our financial situation. Private payers use those reimbursement rates as part of the calculations they make to determine their coverage levels. Very little of your compensation is not affected by the people in DC.
Because the federal government’s valuation of our services is so important, the CAP takes an active role in engaging with appropriate stakeholders and negotiating on behalf of all anatomic and clinical pathologists. The CAP holds a permanent seat on the committee that evaluates services—a committee organized by the American Medical Association, referred to as the RUC—and we are the main representative of pathologists. The CAP is also the permanent chair of the pathology coding caucus, which is responsible for assessing and making recommendations on codes for new services that will be considered for valuation. Our organization has held this role for more than 25 years.
This is a key reason to be an active member of the CAP. Everything we do in these valuation exercises is based on input from our members. We routinely survey members to make sure we have the most up-to-date information to take into those discussions with the federal government. I urge you to make the time to respond to these surveys when they are sent out. The CAP also frequently seeks out subject matter experts for specific valuation discussions. If you have an interest in this type of work, please make sure we are aware of that so we can be in touch when the need arises.
The federal government has enormous influence on the compensation you receive for your vital role in patient care, and the CAP is the organization that has the greatest understanding of and influence on the federal government’s valuation of those services. Whether you practice in an academic or a nonacademic environment, being active in the CAP is the single best way to ensure you will be fairly compensated for the important work you do for your patients.
I would like to thank John Scott and Charles Fiegl from the CAP’s Washington, DC, office for their assistance with this column.
Dr. Godbey welcomes communication from CAP members. Write to him at president@cap.org.