Ethics of laboratory billing at stake in AMA’s code

Proposed revisions to the American Medical Association’s Code of Medical Ethics would remove language that supports direct billing and condemns clinicians who charge markups for laboratory or pathology services. The changes could weaken efforts to rein in billing practices that CAP leaders argue are not in the best interest of the patient and that the AMA currently defines as unethical.

“The importance of this is that many states utilize the AMA’s code of ethics as their code of ethics for things related to medicine. . . . So, if you change the AMA code of ethics that these laws are based on, then people can make the argument that since these ethics principles have changed, perhaps these laws need to be changed,” Daniel C. Zedek, MD, tells CAP TODAY. He is an alternate delegate to the AMA House of Delegates for the CAP and is director of dermatopathology at the University of North Carolina School of Medicine.

My latest in CAP TODAY’s Put it On the Board section. Read the whole shebang.

Lab gets a jump on pay-for-value world

Before the Affordable Care Act was passed, and before the notion of an ACO became a Medicare reality, Richard J. Cote, MD, was among those in medicine who saw the writing on the wall regarding health care payment.

Dr. Cote recalls his thinking as he joined the University of Miami Miller School of Medicine in 2009 to become chair of its Department of Pathology.

“President Obama had just been elected. There was a great push for creating a comprehensive health care system across the country to insure uninsured people,” Dr. Cote tells CAP TODAY. “What was very clear to me, even before the ACA came into being, was that this push was going to accelerate the at-risk model of reimbursement and that there was also going to be very much a downward pressure on reimbursement for all medical services, including pathology, which we’ve clearly seen take place. And there was going to be a move to better coordinated management of care.”

Dr. Cote and his laboratory colleagues at UM are preparing for this transition away from the traditional, and still predominant, fee-for-service payment model. They say the health-system–owned laboratory must move beyond its established role to show how it will help cut costs while improving care and outcomes.

My latest feature article in CAP TODAY. Read the whole shebang.

For trainees, information ‘gaps are closing’

With the dismissal of residents from training programs having led to well-known tragedies, the most recent in pathology just a year ago, attention is being paid to the importance of ensuring residents’ well-being and properly handling remediation, probation, and dismissal.

The Accreditation Council for Graduate Medical Education has strengthened its requirements for what kind of information residency programs must share about residents’ performance. The ACGME’s common program requirements, last revised in June 2013, say “a program director must provide timely verification of residency education and summative performance evaluations for residents who may leave the program prior to completion.”

My latest in CAP TODAY’s Put it On the Board section. Read the whole shebang.

Making the most of big data no easy task

A trillion base pairs of sequence here, a trillion there. Pretty soon, you’re talking about a lot of information—and it all needs to be managed. That’s the dilemma facing Mayo Clinic and other health care organizations leading the personalized medicine revolution that relies on compiling and analyzing patients’ genetic code to better diagnose, predict, and treat disease.

“We generated 90 trillion base pairs of sequence last year,” says Eric Wieben, PhD, director of Mayo’s Medical Genome Facility in Rochester, Minn. “Gathering big piles of data is the easy part. It’s trying to transform the data into knowledge that’s the hard part.”

My latest in CAP TODAY’s Newsbytes section. Read the whole shebang.

Cancer biomarker use varies widely, needs a ‘broader view’

Despite an explosion of research into cancer biomarkers and professional guidelines that urge testing for certain genetic mutations that help detect disease, anticipate its course, or predict response to treatment, many cancer centers are out of sync with oncology testing recommendations.

Payment policies, regulatory oversight, clinician preferences, and varying access to testing technology are among the factors that contribute to discrepancies in cancer care.

So says Jan A. Nowak, MD, PhD. And he is worth hearing out on the subject, as did an audience of hundreds of pathologists, oncologists, and others at this year’s Cancer Biomarkers Conference in Houston.

“Adoption of biomarker cancer testing is not high among cancer centers,” Dr. Nowak told the crowd. “It seems high to us because . . . we go to the meetings and we talk to each other, and we’re doing this stuff. But then there are the people who are not going to the meetings, not talking about it, and not doing it.”

My latest feature article in CAP TODAY. Read the whole shebang.

Here’s the problem …

… If your drug cops conduct a raid that ends up putting a child in the hospital with critical burns, and they did nothing that violates your department’s policy, then there’s something wrong with your policy.

A flashbang is an explosive device that emits a deafening boom and a blinding flash of light. It’s designed to temporarily stun the occupants of a building so that the armed men who deployed it can “clear” the building. It is an instrument of war. And cops are tossing these things through doors and windows with no idea what’s on the other side. Indeed, that’s the whole point.

— Radley Balko, “Georgia toddler critically injured by police’s flash grenade

It’s worth remembering …

… that the inconvenience and injustice of the TSA’s activities exists for literally no reason. If the agency’s privacy violations and annoying carry-on regulations were merely the price we paid for reducing the incidence of terrorist attacks, that’d be one thing. But, as security expert Bruce Schneier likes to note, there’s no evidence that the TSA has ever prevented a terrorist attack, and there’s some research suggesting it could serve to increase non-airborne terrorist attacks. Airline security is, so far as we can tell, totally useless.

— Dylan Matthews, “The case for abolishing the TSA

Health care industry reacting to overtesting, overtreatment

Carla Johnson’s lede:

The American health care system wastes an estimated $750 billion a year, according to the Institute of Medicine. At a recent AHCJ chapter event in Chicago, four panelists discussed one source of that waste: unnecessary tests and procedures.

Moderated and organized by AHCJ member Kevin B. O’Reilly, senior editor of CAP Today, the panel looked at the issue through the lenses of doctors, journalists, health system executives and academics.

Read the whole shebang at the Association of Health Care Journalists’ Covering Health blog.