PROFESSIONAL ADVOCATES AND VOLUNTEERS – ARE YOU ONE?

ASC President’s Blog
Ritu Nayar, MD, MIAC

August 2014

Advocacy is “the act or process of advocating or supporting a cause or proposal” (Merriam Webster) or the “active support of an idea or cause etc.; especially the act of pleading or arguing for something.” (Thesaurus)

All of us advocate frequently, for something or someone, at a personal or professional level.  So why and how is advocacy important to you, as an individual and as a member of the American Society of Cytopathology?

Advocacy raises awareness of the contributions pathology and cytopathology make in supporting local, state and national health care needs and advances the role of pathologists and laboratory professionals as team players in the healthcare system. While the ASC does not directly engage in lobbying, we do strongly support advocacy efforts for pathology and specifically cytopathology through our volunteer members who are extremely active throughout the year in various efforts led by the College of American Pathologists (CAP) and the American Society for Clinical Pathology (ASCP) and their lobbying efforts on behalf of pathology. The CAP works in close collaboration with our ASC leaders and representatives on several legislative/regulatory issues.

Some of our members have asked “what does the ASC do for us in the area of reimbursement and lobbying for our cause and why don’t we know what is happening?”  Most of us know there is a “RUC” and “CPT” committee and a “PCC.” However it was not until the past year, when I participated in and/or observed a lot of these discussions and meetings, that I better understood how much detailed work these groups do and the added value that our ASC volunteers bring to these advocacy efforts. So I wanted to take this opportunity to share some of what I have learned from our volunteers and the outstanding CAP staff:

  1. The AMA/Specialty Society RVS Update Committee (RUC)

This is a volunteer committee comprised of physicians and other health care professionals. The RUC’s mission is to make recommendations to the Centers for Medicare and Medicaid Services (CMS) regarding the Medicare Resource-Based Relative Value Scale.  In addition, societies seated in the AMA House of Delegates can also serve on the Advisory Committee to the RUC.  The Advisors attend the RUC meeting and present their societies’ recommendations, which the RUC evaluates.  ASC, CAP, as well as ASCP have appointed members of the RUC Advisory Committee who participate in the deliberations with the RUC and advocate for the specialty.

  1. The AMA Current Procedural Terminology (CPT) and Pathology Coding Caucus (PCC)

CPT is maintained by the CPT Editorial Panel, which meets three times a year to discuss issues associated with new and emerging technologies as well as difficulties encountered with procedures and services and their relation to CPT codes. Supporting the CPT Editorial Panel in its work is a larger body of CPT advisors, the CPT Advisory Committee. The members of this committee are primarily physicians nominated by the national medical specialty societies represented in the AMA House of Delegates.  One of the Advisory Committees’ primary objectives is to serve as a resource to the CPT Editorial Panel by giving advice on procedure coding and appropriate nomenclature as relevant to the member’s specialty.  Similar to the RUC Advisory Committee, ASC has an appointed member to the CPT Advisory Committee.  The Pathology Coding Caucus (PCC) is a partnership of the AMA and other pathology and laboratory groups, which develops consensus recommendations on proposed new and revised CPT codes prior to consideration by the AMA CPT Editorial Panel.  ASC in collaboration with other pathology and laboratory groups contribute regularly to PCC deliberations as part of the work of the AMA CPT Advisory Committee.

It is important to realize that the CPT and the RUC are staffed by physicians and professionals representing the entire house of Medicine.  The CPT and RUC processes are complex, complicated and can be rather laborious.  An incredible number of staff and volunteer hours are spent every day, to thoroughly evaluate each current issue and present the best recommendations on behalf of pathology and cytopathology.

The RUC is a unique multi-specialty committee dedicated to making relative value recommendations for new and revised codes as well as updating RVUs to reflect changes in medical practice. Because of this unique structure, the RUC has created the best possible advocate for physician payment – the physician. It is through the work of these dedicated physicians who contribute their time, energy and knowledge that make the RUC process a success that benefits all practicing physicians.

Although historically, RUC recommendations have had acceptance rates of 90% or more, CMS with its new authorities and directives from the Affordable Care Act has put the RUC activities and recommendations into heightened and intense scrutiny.  More recently, RUC recommendations have had acceptance rates below 80%, which represents a flag for RUC participants to step up to the plate and work harder to infuse more specialty society expertise through the RUC physician work survey process.

I would like to thank our outstanding ASC representatives: Dr. Margaret Havens Neal, ASC-AMA House of Delegate Member and Member RUC – Practice Expense Review Committee; Dr. Swati  Mehrotra, ASC/RUC Advisory Committee representative and Dr. Carol Filomena, ASC/CPT Advisory Committee representative as well as our wonderful colleagues;  Dr. Jonathan Myles, Chair, CAP Economic Affairs Committee and CAP/RUC Advisory Committee representative; Todd Klemp and Ayanna Wooding, Assistant Directors, CAP Economic and Regulatory Affairs, and Pam Johnson Director, CAP Economic and Regulatory Affairs.

As you know, the ASC now has memorandums of understanding (MOU) with the ASCP and the CAP.  At the ASC 2014 Annual Scientific Meeting in Dallas, we will have a CAP-ASC session, Advocating for Our Specialty and Our Patients. How and Why You Should Get Involved,” presented by Dr. Emily Volk, Vice Chair of CAP Council on Government and Professional Affairs (CGPA) and Nora Bowers, CAP staff and patient advocate. The ASCP-ASC session will focus on Emerging Roles for Cytotechnologists: Real-life Examples.  Be sure not to miss these exciting events at the Meeting.

Why should you be an advocate for Cytopathology?

Advocacy does not happen by itself.  The current landscape demands new ways of thinking and doing, be it in medicine/healthcare or any other arena.  We cannot assume that policy makers know what we do and how pathology and laboratory medicine contribute to the health care system. It is extremely important to have a presence and build sustainable relationships at all levels.  We can and should provide ongoing information and updates about our work, and the professional and public value of pathologists and laboratory professionals; specifically the various ways in which our specialty and practitioners contribute to patient care.  The number of people involved in a cause matters and the success of advocacy efforts is usually proportional to the strength of the advocating group.  If you and I don’t speak up for our cause, then others will speak up for their causes which will then be more likely get attention and resources.

THE VALUE OF VOLUNTEERING

A volunteer is “a person who voluntarily undertakes or expresses a willingness to undertake a service” (Merriam Webster) or “a person who performs or offers to perform voluntary service” (Thesaurus)

Central to these definitions is the fact that volunteering should be a choice that is freely made by an individual.  While it involves the desire to help others, volunteering does not exclude other concurrent motivations that encourage an individual to participating in such efforts.  While there are a variety of motivations, consistently ranked high are:  (1) Ability to make a difference, (2) Opportunity to “give back,” (3) Opportunity to learn and gain professional experience, (4) Boosts personal esteem and self-confidence, (5) Builds camaraderie and teamwork, and (6) Saves resources and strengthens communities or groups one works with.

While some may be uncomfortable with the notion that a person can “benefit” from doing volunteer work, there is really nothing wrong with a little “give and take” – both sides win.

I have talked to so many of you who have had wonderful experiences when volunteering in various roles, within and outside the United States. I asked three of our members to share their recent experiences with us:  Janie Roberson, SCT(ASCP) describes her trip to a Mission Hospital in South India- a project supported by an ASC Foundation Advocacy grant; Barbara MeGahey Frian, CT(ASCP), recently went to Botswana as part of ASCP’s Center for Global Health Programs, and Vijayalakshmi Padmanabhan, MBBS, MD shares the highlights of her trip to Peru as part of the CerviCusco program.

As I reflect back on my own training and career over the past 23 years, I can say without doubt, that volunteering and advocating for pathology, cytopathology and the ASC as well as other pathology organizations have been very fulfilling for me at so many levels. I have been mentored by so many wonderful and inspiring people, many of whom have become close personal friends, learned so much, and been able to give back a little to the profession I love.

How can you get Involved?

Among the ASC’s 3000+ membership of pathologists, cytotechnologists and scientists, we are fortunate to have many highly motivated individuals who dedicate their time and effort towards supporting the ASC and Cytopathology. This year, among a total of 294 ASC committee and liaison positions, I was able to assign 145 to new volunteers, and 85% of all those who expressed an interest in being involved were assigned to a committee.  If you would like to offer your time and expertise towards the ASC’s missions of education, advocacy, innovation and teamwork, please take a few minutes to fill out the volunteer form, which can be found on the member section of the ASC Website – no effort is too small!   You can refer to the ASC Website for a complete listing of ASC committees and initiatives.

This year we have advertised a number of volunteer opportunities on the ASC Website. Also, if you have had fruitful volunteer experiences you would like to share with your ASC colleagues, please submit them to ASC (email: lweber@cytopathology.org). Besides volunteering your time and expertise, there are other ways you can support the ASC. Our Foundation has many exciting endeavors that can be further supported by our contributions; and for your younger colleagues and those who are “tech” savvy, the power of social media’s reach to support our profession and professionals cannot be underestimated.

So next time you wonder what your professional organizations and the ASC are doing for you, ask what can I do to help?  Remember “ASC IS MY SOCIETY” – you and I are the ASC!

Acknowledgement:  My thanks to Meg Neal and Todd Klemp for helping me with the details of the RUC/CPT process.

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