ePolicy News October 2018

Oct 03, 2018
Read the latest ASCP policy news from Washington, DC.








Fifth List of Choosing Wisely Recommendations Released

ASCP has released its fifth list of recommendations for laboratory tests that are commonly ordered but not always appropriate in pathology and laboratory medicine as part of the Choosing Wisely campaign, an initiative of the ABIM Foundation. The new list of five targeted, evidence-based recommendations expands ASCP’s existing list of 20 recommendations and is designed to support conversations between patients and physicians about what care is really necessary.

This year, the Effective Test Utilization Steering Committee sought potential recommendations from ASCP’s newly-formed Choosing Wisely Advisory Board members to increase awareness and participation of the field in the Choosing Wisely campaign. Submitters were asked to provide a proposed recommendation with background rationale and sources.

ASCP’s new Choosing Wisely recommendations include:

  • Don’t request a serum creatinine only to test adult patients with diabetes and/or hypertension for CKD; instead use the Kidney Profile (serum Creatinine with eGFR and urinary albumin-creatinine ratio).
  • Don’t transfuse plasma to correct a laboratory value; treat the clinical status of the patient.
  • Don’t order IgM antibody serologic studies to assess for acute infection with infectious agents no longer endemic in the US, and in general avoid using IgM antibody serologies to test for acute infection in the absence of sufficient pre-test probability.
  • Do not perform peripheral blood flow cytometry to screen for hematological malignancy in the settings of mature neutrophilia, basophilia, erythrocytosis, thrombocytosis, isolated anemia, or isolated thrombocytopenia. Don’t perform Procalcitonin Testing without an established, evidence-based protocol.

ASCP continues to seek potential recommendations for its sixth list. Please contact Edna Garcia, MPH, Director, Scientific Engagement and Research, at edna.garcia@ascp.org, 202-735-2283 if you would like to submit a recommendation for consideration.


2017 Wage Survey Published by ASCP’s AJCP

Analysis suggests awareness of career opportunities and profession’s value needed to strengthen the future of the field.

ASCP recently published its 2017 ASCP Wage Survey Report online. New questions were added in this survey which asked the respondents about the geographic areas where their facilities are located, whether it is from an urban area (defined as 50,000 or more people); urban cluster (defined as areas with at least 2,500 and less than 50,000 people); and rural (defined as areas with 2,500 or less people). The average wage of laboratory professionals, based on age, is gradually increasing in every age range, even for Clinical Laboratory Assistants/Medical Laboratory Assistants and phlebotomists, whose wages didn’t have an increase in the 2015 Wage Survey. Geographically, laboratory professionals from urban areas earn more than their rural counterparts. Survey results also encourage laboratory professionals to be actively engaged in advocating for the profession, both in the workforce and educational training programs. Awareness of the career opportunities and value of the profession is needed to strengthen the future of the field.

To read the ASCP 2017 Wage Survey Results, click here


ASCP Launches Online Interactive Maps to Better Visualize Workforce Data

ASCP is excited to launch a set of online interactive maps that incorporate findings from its wage and vacancy surveys. The online geospatial visualization of this data will advance the laboratory field’s understanding of current workforce dynamics and hopes to appeal to a larger audience. In addition to the 2016-17 vacancy survey, the first set of maps include findings from the 2017 wage survey, the results of which were recently published in the American Journal of Clinical Pathology. Findings from these workforce reports can be explored using ASCP’s online maps showing state and regional variation of vacancy, retirement, certification, age, location, and hourly wage data for laboratory professionals across the United States. Users will also have the ability to navigate the interactive maps to search for workforce data based on occupational title, occupational level and department of their choice. These publicly shared, online maps will be available on ASCP’s website at no cost.

In addition, a map showing locations of current laboratory training programs across the United States has also been developed. This map includes training programs accredited by National Accrediting Agency for Clinical Laboratory Sciences, Commission on Accreditation of Allied Health Education Programs, and Accrediting Bureau of Health Education Schools. As highlighted in the 2017 wage report, laboratory professionals need to be actively engaged in advocating for the profession both in the workforce and in educational training programs. ASCP hopes that these interactive maps can provide useful tools to support such advocacy efforts.



BLS Target of ASCP Advocacy Campaign

On Sept. 19, ASCP wrote the U.S. Department of Labor’s Bureau of Labor Statistics (BLS) urging it to change its wage and employment data for the laboratory profession. In July, BLS began aggregating wage and employment data for medical laboratory scientists (technologists)(MLSs) and medical laboratory technicians (MLTs). The resulting pooled wage now neither reflects the wages paid to MLSs or MLTs. ASCP warned in its letter that “the absence of more granular wage data should be expected to result in career dissatisfaction, lower wages, and more skilled laboratory professionals exiting the field.” ASCP also released an action alert to encourage laboratory professionals to add their voices to the effort to fix BLS’s wage and employment data. So far, almost 2,000 ASCP members have participated in the eAdvocacy campaign. If you haven’t done so, add your voice to the effort today!



2018 Choosing Wisely Champions Named

Pathologists and laboratory professionals play a critical leadership role in promoting and managing the delivery and use of healthcare resources and initiating these conversations about appropriate care with clinicians and patients. Choosing Wisely, an initiative of the American Board of Internal Medicine (ABIM) Foundation, is about doing the right thing for patients and avoiding unnecessary, inappropriate, and potentially harmful care. The ABIM Foundation launched the Choosing Wisely Champions program to seek and highlight individual clinicians who are making significant contributions toward advancing the ideals of Choosing Wisely. Its goals are to help expand the Choosing Wisely campaign through the dissemination of positive stories of individual clinicians or teams of clinicians. This is intended to serve as an inspiration to others within their specialty so that they may apply learning in their own practice and reaffirm society partner commitments to the campaign and demonstrate tangible action toward advancing the goals of Choosing Wisely. ASCP is a major proponent of patient-centered care and evidence-based medicine. This year, ASCP named its Choosing Wisely Champions individuals who have made significant contributions toward advancing the ideals of Choosing Wisely. They are:

Ila Singh, MD, PhD*
Baylor College of Medicine & Texas Children’s Hospital
Professor; Chief, Laboratory Medicine

Curtis A. Hanson, MD*
Mayo Clinic
Professor of Laboratory Medicine and Pathology Division of Hematopathology
Chief Medical Officer, Mayo Medical Laboratories

Diane George, DO*
Henry Ford Medical Group
Chief Medical Officer, Primary Care-Henry Ford Medical Group

Heather Signorelli, DO
HCA-HealthOne
Chief Laboratory Officer

James Littlejohn, MD, PhD
University of California Davis School of Medicine
Assistant Professor, Department of Anesthesiology and Pain Medicine

Jennifer Stumph, MD
Michigan Pathology Specialists
Pathologist

Pallavi Patil, MD
Brown University
PGY4 Pathology Resident Physician, Brown University Pathology Residency Program

*These Champions have been selected to present at the ASCP 2018 Annual Meeting in Baltimore. They were the top three chosen by the ASCP Effective Test Utilization Steering Committee based on their Choosing Wisely activities.

This session will include a discussion of ASCP’s Choosing Wisely fifth list of recommendations, major initiatives on effective test utilization in pathology and laboratory medicine, and the Choosing Wisely Champion Presentations and Awards Ceremony.



ASCP, CAP and ASH Invite Public Comment on Lymphoma Guideline

Medical practitioners are challenged to diagnose lymphoma on samples of decreasing tissue volume, including fine needle aspirations and needle biopsies. With a focus on the pathology aspects of diagnosing lymphoma, ASCP, the College of American Pathologists (CAP), and the American Society of Hematology (ASH) are collaborating to develop an evidence-based clinical practice guideline for the workup of lymphoma. An interdisciplinary panel of experts representing these organizations is developing the guideline. The expert panel includes clinical oncologists, pathologists, and patient representatives.

According to Steven H. Kroft, MD, MASCP, ASCP Co-Chair of the guidelines workgroup, “Diagnosis and classification of lymphoma has become a highly complex, multi-modality process that requires rigorous attention to and quality assurance of pre-analytical, analytical, and post-analytical details. At the same time, clinical practice has evolved to favor the least invasive possible procedures to secure diagnoses. Thus, pathologists are being asked to do more and more with less and less. However, little guidance exists regarding the appropriate handling, testing, and reporting of lymphoma specimens. This guideline will assist pathologists and clinicians in making good decisions about the workup of lymphoma, so as to best serve our patients and enable optimal outcomes.”

The draft recommendations summary for the “ASCP/CAP/ASH Requirements for Laboratory Workup of Lymphoma Guideline” is available for public comment now through October 24, 2018.

All stakeholders, including pathologists, pathologists’ assistants, hematologists/oncologists, clinicians, laboratory personnel, quality managers in laboratories, hospitals or health systems, vendors, patient advocacy group representatives, and patients are encouraged to provide feedback on these draft recommendations. Following the open comment period, the guideline authors will consider all feedback to finalize the recommendations. The final recommendations will be available in the guideline manuscript and will be available at no cost. To read and comment on the draft guidelines, please click here.



Cytopathology Workgroup on Emerging Roles Continues

In 2014, the ASC-ASCP WORKGROUP FOR EMERGING ROLES IN CYTOPATHOLOGY (WERC) developed as a collaboration between ASCP and the American Society of Cytopathology (ASC) to develop concrete goals towards addressing evolving practice changes while ensuring that education, practice and trending data support the cytotechnology profession’s longevity and livelihood. The collaborative work of this group has focused on collecting and interpreting data for publication, and developing educational programs to support practicing cytotechnologists and students. In August 2018, both ASCP’s Lab Medicine and the Journal of the American Society of Cytopathology simultaneously published three articles related to how cytopathology practice is changing, what practicing cytotechnologists need to meet the future and how professional organizations are developing meaningful tools and resources to meet the expressed needs. These articles are as follows:

The workgroup has now expanded to include representatives from other societies, both non-profit and governmental, as deemed necessary to continue development of educational programs, both live and online, including the continuing successful annual launch of the Advanced Cytopathology Education (ACE) program, collaboratively designed to bring cutting-edge updates in cytopathology to professionals who may not have the resources to travel to ASCP or ASC meetings. Online educational endeavors are focused on ACE University - Advanced Cytopathology Education, a work-in-progress intended to provide practitioners and cytotechnology schools with educational modules designed to fill revealed practice gaps. The first online module focuses on Rapid Onsite Evaluation (ROSE) as a model for future development. ASCP will provide additional updates on this project as its progress continues.



Rural Healthcare Disparities in Laboratory Medicine Research Featured in ASCP Critical Values

Uneven distribution and a relative shortage of medical providers have long been characteristics of health care in rural areas. While much research exists on the maldistribution of physicians across the United States, there has been a lack of literature focusing on the challenges that impact the laboratory field in the same geographic areas. Recently published “Disparities in Rural Health Care: A Look at the Field of Laboratory Medicine” aims to both address the challenges faced by rural laboratory professionals and propose recommendations which directly address vacancy issues facing many laboratory facilities by improving education, recruitment, and retention across the United States, especially in rural areas.

Education and recruitment, retention, resource limitations, and service access are highlighted as the five main categories of challenges facing rural laboratory professionals. Understanding these challenges is an essential part of relieving the relative shortage and uneven distribution of qualified and certified laboratory professionals. While it is crucial to note that rural health care is not a one-size-fits-all model, analysis of the obstacles faced by the laboratory field makes possible the critical examination of healthcare systems within a context that encompasses the complex intersections of socioeconomic and demographic factors as well as healthcare infrastructure.

Although the barriers to rural health care are persistent and pervasive, the paper emphasizes that community-specific healthcare plans, focused on partnership building and supportive of creative and sustainable alliances, will mitigate disparities between urban and rural areas.

*Deanna Marie Giraldi was the 2018 ASCP Carter Stephen Ainsworth Fellow who conducted this research.


For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202-408-1110).


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