If you are a physician capturing these points of data, CMS gives you a bump in pay for the eligible cases, with the idea being that physicians are rewarded for taking time to help track treatment, practices, and other pieces of data that helps inform the medical community of either the effectiveness of a current treatment or provides greater insight into the current state of how a disease is affecting the populace.
For pathologists, there are 5 specific quality measures that they can capture which will lead to greater reimbursement. As College of American Pathologists (CAP) Economic Affairs Committee member, Emily E. Volk, MD, FCAP, explained to CAP's website:
If pathologists participate successfully in 2013, they will receive a 0.5% bonus of total Part B allowed charges and they will also avoid a 1.5% deduction in overall Part B Medicare payments in 2015.
Remember - this is individual pathologists, not labs or facilities as a whole. You, as a pathologists, will see a 0.5% bump in your individual pay (on those Medicare cases). And if they don't capture this data? Well not capturing has its consequences as well - for one thing, you'll avoid that 1.5% deduction in payments. "But next year is also the first year that all providers can be penalized for not participating," says Volk, who also reminds pathologists that they only have to "report on at least one measure" to "not be penalized."
So what are these measures? And how can pathologists ensure that they are correctly capturing the information? How does synoptic reporting figure into this?
The 5 Quality Measures to Capture to Ensure Increase Reimbursement
Breast Cancer Resection Pathology Reporting pT category (primary tumor) and pN category (regional lymph nodes) with histologic grade
Colorectal Cancer Resection Pathology Reporting pT category (primary tumor) and pN category (regional lymph nodes) with histologic grade
Barrett’s Esophagus Esophageal biopsies with a diagnosis of Barrett’s esophagus that also include a statement on dysplasia
Radical Prostatectomy Pathology Reporting Reports include the pT category, the pN category, the Gleason score and a statement about margin status
Immunohistochemical (IHC) Evaluation of HER2 for Breast Cancer Patients Quantitative HER2 evaluation by IHC uses the system recommended by the ASCO/CAP guidelines The good news: if you are already using CAP cancer checklists in your pathology reporting, then you're already capturing this information. Which means that, right now, you're already reporting on this and qualifying on that additional reimbursement. The information is being captured and sent into cancer registries to create that more complete portrait of the state of cancer in the nation.
But if you haven't adopted these checklists, now would be a good time to do so. And the best way would be to utilize the checklists in an electronic synoptic reporting format. CAP has developed electronic Cancer Checklists (eCCs), which is an electronic version of their cancer checklists - allowing pathologists to report on cancer cases using over 80 templates. The templates ensure that all requirements are meant, that best practices are followed, and that a comprehensive pathology report is generated that provides a complete understanding of the case.
By using eCCs, not only are you guaranteed to capture the previously mentioned quality measures on all cases, but you are helping to keep your cancer program accredited by the American College of Surgeons' Commission on Cancer, and it's one of the requirements if you want your lab/facility to be accredited by CAP as well. This means that, by using these eCCs, pathologists are meeting their individual quality measure reporting requirements, helping their lab reach CAP accreditation and helping to sustain their cancer program's ACS CoC accreditation. Additionally, pathologists are avoiding penalties, increasing their reimbursement, and helping to provide a better understanding of the status of cancer on a national level and the effectiveness of various treatments.
mTuitive is one of the vendors that offers CAP's eCCs; in fact, mTuitive was the first company to license SNOMED CT encoded CAP cancer checklists. As you can see in the snippet of a sample report above, by guiding pathologists through relevant, required fields using intuitive internal logic, a comprehensive synoptic report is generated. These responses aren't just capturing the quality measures but are also pieces of structured data that, when sent into cancer registries, national organizations can now search without the time- and money-consuming process of data abstraction. Like is compared to like; standardized, uniform language is used to eliminate any chance for subjective misinterpretation. By adopting synoptic reporting solutions that already incorporate CAP eCCs, pathologists are ensuring that they will receive increased reimbursement, they will help secure accreditation for their labs and their cancer programs, and they will produce a more comprehensive report that helps improve cancer treatment for many years to come.