2. Adapting to Change in Health Care and the Role of Policy in Enabling Our Future

3. Paul Valenstein, MD, FCAP CAP Secretary-Treasurer Adapting to Change in Health Care and the Role of Policy in Enabling Our Future May 7, 2012

4. Pathology market drivers Pathologists adapting to change Role of policy in enabling change

5. Pathology Market Drivers Funding Care Models Technology Demographics

6. Health care costs are soaring Currently 17% of GDP Source: US HHS 2012

7. 2007 Per Capita Health Care Spending vs. GDP Source: OECD 2010

8. 2007 Per Capita Health Care Spending vs. GDP Source: OECD 2010

11. CPT 88305 Professional Reimbursement 1992: $63  2012: $34 Source: CAP 2011

12. Average Pathologist Income Inflation-adjusted to 2004 dollars Source: CAP 2011

13. Test Volume Total 88305s Add-on Tests Source: CAP 2011

14. “If something is unsustainable, it will stop.”

15. Changing Care Models National Pathology Laboratories Capitated Inpatient Reimbursement HMO Lab Carve-Outs In-Office Histology & Pathology Accountable Care Organizations

16. Market Concentration

17. Laboratory Consolidations

18. Emerging Technology Genomics and Personalized Medicine Informatics Digital Imaging In vivo microscopy

19. Demographics

20. Pathology Workforce Projection

21. Pathologist Age Workforce Additions/Separations

22. US Population Projection

23. Affordable Care Act: Supply and Demand

24. Pathology Specialization

25. Pathology market drivers Pathologists adapting to change Role of policy in enabling change

26. Transforming your practice Transforming yourself Adapting to Change Means…

27. 1.Assess services you offer and the setting in which you practice 2.Develop near-term plan focused on efficiency and long-term plan to extract value in coordinated care settings

28. 3.Expand scope of practice to provide new value in evolving ecosystem 4.Delegate services when technology or extenders can meet standard of care

29. 5.Fundamentally change pathology graduate medical education 6.Engage at local, state, and national level to increase visibility and credibility

30. Pathology market drivers Pathologists adapting to change Role of policy in enabling change

31. Transforming the Healthcare Environment Transforming Pathology Practices Transforming Individual Pathologists

32. Policy / ˈ päl ə sē/

33. If I am not for myself, who will be for me? If I am only for myself, what am I? – Hillel the Elder, ~30 BCE

34. Public Values Private Values

35. Public Values Private Values Fact Fantasy

36. Requirements for Public Policy EvidenceRelevanceConsensusCredibility

37. CAP ‘NOW’ Agenda… SGR: potential -28% cut $16B clinical laboratory fee cuts TC Grandfather eliminated Self-referral of pathology services AMA RUC: 88305 TC revaluation CMS: Selective code revaluation

38. Value over volume Accountable, integrated providers Informed patients Genomic Personalized Medicine Electronic records & connectivity Evidence based medicine CAP ‘FUTURE’ Agenda…

39. Get the facts and talk with the experts Cost containment and competitive pressure on specialty Accountable Care Genomics & Personalized Medicine Electronic Health Record

40. 40

42. Stanley J. Robboy, MD, FCAP, President Charles Roussel, CEO Andrew E. Horvath, MD, FCAP, Transformation Program Office Steering Committee Paul N. Valenstein, MD, FCAP, Secretary-Treasurer Panel Discussion