CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Pete Dysert, what is top of mind for you at Baylor Scott & White?
Peter Dysert, MD, chief, Department of Pathology, Baylor Scott & White Health, Dallas: We’ve validated our digital imaging platform at Baylor University Medical Center. So we’re looking forward to seeing, largely in the beginning, efficiencies around our conference obligations. My department does more than 400 multidisciplinary conferences a year, at which pathology either presents slides or reviews reports and comments on findings. Currently we’re taking pictures and using PowerPoint to present those things, and we’re hopeful, with a digital imaging platform, we’ll have a workflow that’ll be more efficient for residents and staff. We’re also looking at moving to Epic Beaker and hopeful that integration will not further erode surgical pathologists’ productivity and efficiency and will improve our current-state workflows.
Are you planning to use the new CPT category three digital pathology codes?
Dr. Dysert (Baylor Scott & White): My administrative colleagues are looking at the ability to apply those billing codes to our practice.
Dr. Sossaman
Greg Sossaman, where does the ability to do remote pathology sign-outs stand?
Gregory Sossaman, MD, system chairman and service line leader, pathology and laboratory medicine, Ochsner Health, New Orleans: It is still permissible according to the Centers for Medicare and Medicaid Services. I was involved in the Clinical Laboratory Improvement Advisory Committee and it has been in favor of extending that and making it permanent through CLIA. CLIAC is able to make recommendations to the federal agencies, and it came up at the last CLIAC meeting. So the recommendation will be for it to become a changed part of CLIA going forward. Those things can take a while to wind through the system.
James Crawford, MD, PhD, professor and chair, Department of Pathology and Laboratory Medicine, and senior VP, laboratory services, Northwell Health, New York: This was a formal CLIAC recommendation at the most recent meeting [November 2022], which, in essence, sketched out recommendations for the framework of the parent laboratory being the regulatory and compliance host for remote sign-out. My hope is that, with the relaxation in effect, perhaps we’ll have a bit of a honeymoon as this navigates along, as opposed to trying to change something that hasn’t yet occurred.
Lee Bridges, what’s top of mind for you at Bon Secours?
C. Lee Bridges, MD, regional medical director, Bon Secours Mercy Health, Richmond, Va.: I’ve heard from several pathology groups around the country that the No Surprises Act has had devastating effects on their practices. I wanted to find out if others are experiencing something similar.
Greg, do you have experience with the No Surprises Act?
Dr. Sossaman (Ochsner): No, there is not an out-of-network issue for us at Ochsner. I would suspect this would be problematic for some of our pathology colleagues who are in smaller group practices and who still may have some of those contracts with insurers, not through the larger health system or institution. I haven’t talked to anybody who’s had this issue.
Dr. Bridges (Bon Secours): I know of one group out of state that happened to go out of network prior to the No Surprises Act being enacted, and they ended up in an untenable situation. I anticipate payers will start to renegotiate or cancel contracts because it’s to their advantage to have practices not be in network with them now. That’s a concern I have. It has not directly affected our pathology group—we have 11 pathologists in our practice—but I can see some of the payers potentially initiating this, which could pose significant problems.
Farmer
I think it’s largely true that most insurers are seeking to make their networks ever more narrow and then have greater control over how they deal with the few that are left in the narrow networks. Is that a reasonable statement of fact?
Dr. Bridges (Bon Secours): It seems that way to me.
Autumn Farmer, MHA, chief laboratory officer, Bon Secours Mercy Health, Cincinnati: It gives them a huge leverage chip because the pathology group never has the opportunity to present to the patient, and say, This is what your out of pocket will be. And the health system doesn’t know. We don’t necessarily have that information to share with the patient. So you’re essentially in violation if you go out of network.
Dr. Bridges
It’s also my understanding that it’s difficult for a pathology group to make a good-faith estimate of what the cost would be to the patient of the work they’re being asked to do.
Dr. Bridges (Bon Secours): Yes, and the challenge is with arbitration. For my colleague who is going through this now, the arbitrators are so overwhelmed there’s no good, efficient way to go through that process.
Stan, do you have contracted pathologists within MaineHealth?
Stan Schofield (NorDx): Yes, but we’re not having a problem with the No Surprises Act. We have a lot of pathologists but it’s a contained network within the state. They do work for other organizations but it doesn’t impact us. They’re a separate corporation and it’s a supergroup—anesthesia, radiology, and pathology together—and they provide additional services in surrounding hospitals and states. We don’t have a problem because we don’t do the professional billing, and the technical billing is well spelled out. We haven’t had blowback or pushback on billing transparency.
Dwayne, what is the position on masking in your laboratory now?
Dr. Breining (Northwell): At Northwell it’s no longer required as long as you’re in a nonpatient-care area. However, walking through the lab today, I see around 75 percent of our people are still wearing masks.
Pete, what is the current policy at Baylor?
Dr. Dysert (Baylor Scott & White): It’s in line with regulatory—relaxing and encouraging it to be worn.
John Waugh, I’ll ask you for the last word. What is your holiday forecast for what’s ahead?
John Waugh, MS, MLS(ASCP), system VP, pathology and laboratory medicine, Henry Ford Health System, Detroit: Health care systems, as we all know, are still facing strong financial headwinds, and there’s a lot of budget remediation going on. That has occupied a lot of my and others’ time during this month.
I like that our staff get an opportunity to get away and spend time with their families. Some are visiting families far away, on the other side of the world. It’s gratifying to see those things, and a lot of moms are going to smile.
I’m telling our staff: We recruit the best people every day, and we titrate the limited amount of capital we have because it will have to last us until we get to the other shore. There will be another side to the valley and things will be better there, but it’s going be a long walk up and down. There are no small jobs left in health care, only big ones, so focus on the mission-critical things—length of stay and the legal and regulatory issues that help our organizations and add value.