From the President’s Desk: Together, we gain more than we give, 4/15

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Gene N. Herbek, MD

April 2015—Before I could become your president, my partners had to agree to cover for me. I would be away a lot and it would be more work for everyone. We talked about it, weighed the impact on our practice, considered what it would mean for them, and came to a consensus. I would be the person whose picture appeared on this page. They would have a decisive role in making it possible.

Dr. Herbek

In our practice communities and in the greater context where health care policy is kneaded and shaped, collective commitment and good faith keep us on course. This month, I’d like to talk about that, about the integral work of our state pathology societies and how they enable, enhance, and even define much of what we do.

A. Joe Saad, MD, who chairs the CAP Federal and State Affairs Committee, likes to say that federal and state advocacy is a two-way street. We hear a lot about the federal issues such as the SGR and the Medicare fee schedule, he says; the College does a great job of keeping us informed and motivated. But much of what we talk about in Washington has its roots in the states. Medicaid, for example, is a state/federal program administered by the states. The states control medical licensure and scope of practice within their borders. Insurance companies are state regulated, as are hospitals and accountable care organizations.

Advocacy never ceases. The CAP Legislation and Political Action Unit monitors legislative proposals as they surface and reaches out to state pathology society leadership when a bill of interest is brewing. Still, as Dr. Saad points out, much of what happens in the states evolves under the radar, and legislation can move fast. We must all be vigilant. A bad idea—or a good one—can jump from Nebraska to Iowa and from there to the governor’s desk in a blink.

All of us should be active members of our state pathology societies, routinely in contact with one another and the CAP, sharing information and discussing strategies. We build grassroots strength by cultivating individual relationships with state legislators through laboratory tours, campaign donations, contributions to our state advocacy funds, and regular friendly constituent contact. Then, if a bill concerning scope of practice, for example, is suddenly released from committee and sent to the state senate floor, members of the state pathology society, with the ready support of our Washington team, are prepared first-line responders. Even with active grassroots, our state pathology societies may need contract lobbyists, so pathologist financial support for state pathology societies is critical.

One relatively new state issue of concern to the CAP and state pathology societies is insurance network adequacy: the need to ensure that our patients have appropriate access to hospital-based specialists. Members searching for the best ways to articulate the importance of stringent oversight of insurance networks can turn to the CAP advocacy team for updates and advice. To learn more, see the Dec. 18, 2014 Statline at www.cap.org under “Advocacy.”

Between 2001 and 2014, state pathology societies, working with the College, helped pass 58 bills covering everything from direct billing and anti-markup provisions to pharmacists’ scope of practice, genetic testing, ACOs, and use of autopsy materials. Last year, collaboration between the CAP and Illinois Society of Pathologists (including 360 emails from 150 individuals to legislators) resulted in a rare veto override that enabled enactment of legislation to ban markups on pathology services.

Relationships with federal policymakers often take root in our home communities. The proportion of federal legislators who are former state lawmakers has held steady for 30 years. At any given time since the 1980s, roughly 52 percent of representatives and 24 percent of senators have served in their state capitols. Their priorities don’t change when they move to Washington. Individuals who make a sustained effort to establish credibility over time can have a lot of impact.

State pathology societies are about more than advocacy. They are ideal places to learn networking, job-search, and leadership skills. The Texas Society of Pathologists sponsors a Young Pathologists’ Section with poster presentations and agenda topics of interest to newer pathologists. The TSP has also established resident liaisons with each of the training programs in Texas to facilitate communication and encourage membership.

State pathology societies create fine venues for education. In fact, the most important educational program of my career took place at a meeting of the Nebraska Association of Pathologists in 1986. Patrick E. Besant-Matthews, MD, presented a talk on what he had learned as the pathologist on duty when a Lockheed L-1011 crashed at the Dallas-Fort Worth Airport. Three years after that talk, United Airlines Flight 232 crashed near a runway at Sioux Gateway Airport in Sioux City, Iowa, with 296 people onboard. Ten years out of training, as medical examiner for Woodbury County, Iowa, I was responsible for a huge rescue operation. We would recover and perform autopsies on 111 bodies over the next four days. Nearly everything I knew about what to expect and where to turn came from that talk at my state pathology society meeting.

We are a community of learners, which is why the College promotes grassroots education by supporting state pathology society programs through the CAP Joint Providership Program, managed through CAP Learning. Joint Providership enables us to help state pathology society education teams structure programs that meet requirements for CME credit at a reasonable cost. Last year, the CAP provided CME and/or CE credit for 40 pathology-related meetings. A total of 1,532 physicians and 38 nonphysicians earned 118 CME credits and 21 CE credits through the Joint Providership Program in 2014.

The value of community became a durable lesson of that 1989 disaster recovery in Sioux City 25 years ago. When the sirens went off, people showed up and did what needed to be done. That’s what communities do. Wherever we come together, we gain more than we give. To protect our patients and the quality of our practices, we need you in your state pathology societies. Please do your part to bolster their fine work.
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Dr. Herbek welcomes communication from CAP members. Write to him at president@cap.org.