Is the Cures Act a Cure-All?

Hello everyone and welcome back! Thank you to all those that read the previous piece on life and loss, personal growth, and—of course—vaccines. This month, let’s explore something relatively new on the horizon that has the potential to change pathology as we know it: The Cures Act

Okay, well, new-“ish”; the Cures Act (114th Congress, H.R. 34) was signed into law on December 13, 2016…so you snooze, you lose I suppose. But don’t worry, this signed law faded into seeming obscurity and is now resurfacing because it’s being implemented and enforced based on some of the language of the bill. Along with supporting measures in research and innovation, the Cures Act has an aim at empowering patients with health record accessibility. 

Image 1. Outlined here in a graphic from The Office of the National Coordinator for Health Information Technology (ONC Health IT), are the three major take-home points of how the Cures Act will affect patient access to health information. (Source: HealthIT.gov)

I will state this plainly. This means that, soon, whether folks like it or not, patients will directly be able to access their medical record en toto without an intermediary office or provider. Pathology reports and other diagnostic materials are not exempt from this. Within the next few months, more hospital systems will implement direct access and release protocols for patients who will now be able to directly read their pathology reports without their primary care physician or specialist’s filter. 

Some of you reading are rejoicing and thrilled. Others may be projecting harsh words this way if I’m the first time you’ve seen this. To the former group: If you were a part of the last ASCP Annual Meeting, I was fortunate to be a part of a panel with Dr. Jeffrey Meyers discussing the role “Patient-Facing-Pathology” where he talked about practical applications of involving patients in our work. I discussed concepts like “Pathology Explanation Clinics” and other reimbursable potential encounters we in pathology might soon be involved in. The idea of bringing pathology out of the basement, out from behind the curtain, and in the forefront of the patient healthcare experience has become a large part of our professional discourse for the past few decades—and the Cures Act is an exciting potential catalyst.

Image 2. Excuse the stock-photo watermark, but if you’re expecting encounters like these. Well…you’re half right. (Source Cartoonstock.com)

To the latter group: don’t panic. It’s going to be fine. You’re (probably) not going to get a 03:00 am call from an anxious patient expressing confused consternation over your frozen section report of “low grade oncocytic malignancy” or “defer to permanent…” Well, at least for now. Most programs are implementing a sort of “proofreading delay” before reports are actually released, with enough time to compile addendum reports and amended notes, etc. Even still, the notion that we may be implicated in a tsunami of impending requisite patient demands is indeed daunting.

I’ve spoken to several colleagues inside and outside my department who can’t seem to come to a consensus (very specific joke there) about the nature of how the Cures Act will change our work. Dr. Imran Uraizee, a surgical pathology fellow with me here at Loyola who’s written on here before, shared much of the same sentiment. The double edged sword. The initial hesitation. The problematic “translatability” and readability of our material. The potential benefits… It led to a great discussion, and ultimately, with comparisons to HIPAA rollouts and other large-scale changes in our healthcare delivery, we agreed that there are going to be growing pains. But growing is good right?

And you’re right! Why should we have to add more responsibilities onto our overcrowded plates? We’ve all just accepted the reality of advancing technologies time and time again, adding infinite immunohistochemical capabilities to our testing/send out menus, incorporating as much molecular testing as our department funds can accommodate, and (some of you) painfully tolerating the advent of digital microscopy and—if I may—artificial intelligent software tools. That’s already so much that has changed our landscape. While we figure out ways to get out of the basement so we can finally have windows, why should we change the way we file and release our reports? Or should we? Will we be directly answering the phone calls of exceptionally-involved-in-their-care patients without some kind or reimbursable encounter? Will residents? Think of our administrative support and ancillary staff—we may not have enough phones. When you add more, you expect some burden to shift. This will undoubtedly tax someone’s productivity; we just haven’t figured out who, what, where, or how yet.

But let’s go back to the positives… This is, in fact, a double-edged sword. And while, on the one hand, we might worry over the implications of diving in too deep, this really has potential to advance our profession in such a positive way. First of all, patients’ direct access to pathology reports may do us all a favor an slowly increase the medical literacy challenges we face today. Let’s be honest, pathology reports are not user-friendly and, as much as we may like to admit that our autopsy reports are written so that decedents’ families may find solace or comfort, we’re not writing for them directly. Behind our medico-legalese, our coded clinical content, and high-expert level commentary that far supersedes the standard 7th grade reading level, are decades of evolution in a field of medicine that has catered to fellow clinicians over patients. We write for heralded concepts in high-reliability and high output departments that demand precision, accuracy, and volume. To some, this may have contributed to some of the medical mistrust we face in this country and with increased transparency and open doors, we may even reduce the litigious nature of the patient-physician dynamic. And hey! If we can actually charge for these encounters like our clinical compatriots—which we have the potential too, by the way—then why not? The average CPT reimbursement in 2018 was $75 for a 15 minute encounter. Let’s say a full day of meeting patients includes four of these consults per hour. That’s about $300 per hour, $2,400 per full work day; with a faculty of about 20-30, just a handful doing consults for a day would be nearly $10,000. I can do more math. So could you. But hey we just bought new state-of-the-art IHC stainers and a boatload of shiny clinical analyzers with matching middleware support. Let’s not look a gift horse in the mouth? Wishful budgets aside, I don’t have any definitive answers for you—I know, I usually do, I’m sorry. But if the last two years have taught me anything, it’s that we can’t know what we don’t know unless we figure out what we do know.

We know we’ve been wanting to get out from the “paraffin curtain” for quite some time.

We know we’ve wanted to play a larger part in clinical patient care for decades.

We know we’ve got excellent professionals and experts in every nook and cranny this blog finds readers.

Well… careful what you wish for.

Is the Cures Act a cure all? Probably not. But maybe this is a chance for us to have some positive growth within our profession and an opportunity to connect with patients and simply make healthcare at-large better.

What do you think? Contact me on social media, leave a comment below, or share this piece with your colleagues to spark some conversations in your department.

Thanks for reading, see you next time!

Constantine E. Kanakis MD, MSc, MLS(ASCP)CM is a first-year resident physician in the Pathology and Laboratory Medicine Department at Loyola University Medical Center in Chicago with interests in hematopathology, transfusion medicine, bioethics, public health, and graphic medicine. He is a certified CAP inspector, holds an ASCP LMU certificate, and xxx. He was named on the 2017 ASCP Forty Under 40 list, The Pathologist magazine’s 2020 Power List and serves on ASCP’s Commission for Continuing Professional Development, Social Media Committee, and Patient Champions Advisory Board. He was featured in several online forums during the peak of the COVID pandemic discussing laboratory-related testing considerations, delivered a TEDx talk called “Unrecognizable Medicine,” and sits on the Auxiliary Board of the American Red Cross in Illinois. Dr. Kanakis is active on social media; follow him at @CEKanakisMD.

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