First Place - Sara Acree, MD (USC) "Leukemic Synovitis"
Second Place - Fernando Antelo, MD (Harbor) "Adult T-cell Leukemia/Lymphoma"
Third Place - Monica Phillips, MD (CSMC) "Epithelioid Sarcoma"

 

D Frishberg with... S Acree                      F Antelo                             M Phillips 

Hosted by: Dr. Louis Dubeau, Department of Pathology
USC/Norris Comprehensive Cancer Center 
Click to see the Symposium Program (2-page .pdf)

December 16, 2008 (Atlanta, Georgia) — The first trial to show an overall survival advantage for radiotherapy in the primary treatment of prostate cancer has been published online December 16 in the Lancet. It also shows that for older men with locally advanced prostate cancer, adding radiation to androgen-deprivation therapy halves their risk of dying from the disease. The 10-year prostate-cancer-specific mortality in men treated with endocrine therapy alone was 11.9%, compared with 23.9% in men who received only endocrine therapy. The relative risk for cancer-specific death was 0.44 (P < .0001). There was also a significant reduction in 10-year overall mortality: 29.6% in the combined-therapy group vs 39.4% in the endocrine-therapy group. The relative risk for overall death was 0.68 (P = .004). These results come from the Scandinavian Prostate Cancer Group Study 7 (SPCG-7), also known as the Swedish Association for Urological Oncology-3 (SFUO-3) trial. The authors, headed by Anders Widmark, MD, professor of radiation oncology at Umeå University, in Sweden, say that endocrine therapy plus radiation should be the new standard of care for such patients. For the complete article, please visit http://www.medscape.com/viewarticle/585414?sssdmh=dm1.415001&sr c=nldne.

December 9, 2008

Dear Dr. Heredia:

On behalf of the Los Angeles Society of Pathology, I want to congratulate your successful completion of a 6-month sabbatical in surgical pathology. From July 7, 2008 until December 19,2008 you spent your time at the University of Southern California Medical Center under the supervision of Drs. Para Chandrasoma, Juan Felix, the resident staff and others being mentored in various aspects of anatomic pathology. You were exposed to some of the best teaching available in the United States during your stay. The Los Angeles Society of Pathology Education Fund was assisted by a $10,000 grant from the College of American Pathology Foundation to make this project possible. We are very grateful for the generous contribution made by 8 pathologists who volunteered to travel to Pulcalpa, Peru during your time with us in order to provide coverage for your duties while you were here. These pathologists were organized by Victor Lee, M.D and Heinz Honecke, M.D., through their organization, “Pathologists Overseas”. They were able to recruit the following pathologists to participate, they are the following:

            Harriet Fremland, MD                Burton Vanderbilt, MD
            Bertha M. Garcia, MD                Cecilia Carrick, MD
            Richard Sampson, MD               Vincente Loyola, MD
            Gonzalo Camblor, MD                Sofia Alvarez, CT

Your sabbatical was made possible by an amazing team effort. In addition to those mentioned above, the following members of the USC Medical staff played major roles in your education:

            Raul Simental-Pizzaro, MD        Nancy Barr, MD
            Richard Xing, MD                     Zera Tann, MD
            Weng Yang, MD                       Sulochana Wijetunje, MD
            Yanling Ma, MD                        Priyanthi Jinadasa, MD
            Wesley Naritoku, MD                Carol Combs
            Nancy Klipfel, MD                   

We are proud to have been able to support your education and look forward to hearing from you in the future regarding the impact that this project will make in your ability to deliver quality medical care to the patients in your home country of Peru.

Sincerely yours,
James F. Keefe, M.D.
- Coordinator of the Los Angeles Society of Pathology Education Fund

Hello Everyone:

As you probably know by now, the LASOP Education Fund has taken the opportunity to invite Arturo Heredia, MD to spend a 6 month anatomic pathology sabbatical in our Los Angeles Community starting on July 1, 2008. Arturo will be our third pathologist from an undeveloped country to partake in this program. Dr. Heredia recently finished his residency in Lima, Peru and is working by himself in a small hospital in the Amazon jungle called Pulcalpa.

We are sponsoring two events in the near future in order to raise additional funds for this program and we want to invite your participation. The first event is the seventh annual Pete Schwinn Memorial Golf Tournament. This will be held on Saturday May 10, 2008 at Los Verdes Golf Course. The first tee off time will be at 11:30 AM. The tournament fee will be $ 150.00. and $ 75.00 for residents. We have always had a great time at these events and this year should be no exception. Prizes are awarded for the best low net and gross scores in addition to the traveling trophy. If you are interested in playing send me an email (jimk528467@aol.com) and I will send you a brochure.

The second event will be a wine tasting party. This will take place on Sunday afternoon July 13, 2008. Dr. Heredia will have recently arrived in Los Angeles and so we will be able to have a great time and welcome him to our community. The party will be held at the home of Juan Felix, M.D. So please save this date. By the way my friend and pathologist Jim Navin, M.D. from Honolulu has contributed $ 1,000 to offset the cost of the wine for this party and so all tax-deductible money contributed will go to directly into the LASOP Education Fund. Thank you so much in advance for your support of this worthy project.

Jim Keefe, MD

Roger Terry, a long time member of the LASOP, recently passed away after a long battle with cancer.

Dr. Terry only fairly recently retired from active practice in pathology in 2003. A past president of LASOP back in 1974, he received a lifetime achievement award in 2006. He graduated from the University of Rochester School of Medicine in 1944. After his internship and residency there, he did a fellowship at the AFIP in Washington, D.C. and returned to Rochester as associate professor and then professor of pathology from 1956-1969. He then moved to California and served as professor of pathology at LAC/USC Medical Center from 1969-1982. Undeterred by the mandatory retirement age of 65, he then went on to work part time another 21 years at San Gabriel Valley Medical Center. He contributed to many articles in professional journals over the years and maintained memberships in many academic societies besides LASOP.

He held many positions of distinction including time spent as:
- Executive Director of the California Tumor Tissue Registry in LA 1969 – 1984.
- Captain in the US Air Force 1954-56
- Fellow in the American Society of Clinical Pathologists

Dr. Terry also belonged to the:
- American College of Pathologists
- International Academy of Pathology (councilor 1973 – 1976)
- American Society of Investigative Pathology
- American Society of Cytopathology
- International Society of Dermatopathology
- Phi Beta Kappa
- Alpha Omega Alpha
- Sigma Xi

Dr. Terry had a deep and unending enthusiasm for all aspects of surgical pathology, hence the often seen “perpetual” smile on his face. He will surely be remembered by many past students and residents who studied with him at the University of Rochester and LAC/USC residency programs. Despite his numerous academic awards and achievements, he was an extraordinarily kindly, humble and patient man. I never knew him to ever do anything in anger or haste. One of his favorite sayings was that “the success of a professor is best measured by the accomplishments of his students”.

He is survived by his wife of 65 years, Eleanor – his devoted partner both in life and on the dance floor, son Orrin and his beloved granddaughters Jennifer and Allison.

Orrin Terry, M.D.

As I promised last month, those words were “almost” my last as Dr. Craig’s administrative support person. I will try to keep this short and of course sweet as I have many people to thank for my many years of interesting interaction with the Men and Women of Pathology, not only in Southern California but throughout the US and in a couple of instances the World.

I wish to thank –

George Kypridakis, M.D., who left me alone with all of you in 1990 – Yes Dr. Kyp, it worked out just great.

White Memorial Medical Center and its wonderful administrators, who have chosen to support the LASOP in so many ways during the more than 45 years that the Society has used their address, their telephones, their copiers/graphic center and their mail room without expectation of reimbursement. Heck, they even included me on their E & O Insurance listing as being a member of a non-profit community society. Thankfully, I never had to use it.

All of the past board members, who have managed not to smile, while I asked how to spell those unbelievably long Pathology words – as with any language not yet mastered, I have over the years, learned to recognize most of those words when misspelled but still do not “speak” it fluently. A special thanks to Dr. Craig, who was always there for consult, to Dr. Drachenberg who forgave me for calling him Juan instead of Milton (I knew his father) and to Dr. Burke, a long time South Pasadena friend who happened to turn up later as a Pathologist on the LASOP Board. As she recently stated “See you at Costco”.

And of course to all of you long and short time members, with whom I have spent time and conversation at one time or another. Thank you for a wonderful experience.

A really well qualified individual, Lynn Taylor, will be taking my place (you may see me in the background now and then for training support). Her contact information will be forthcoming shortly.

As most of you are aware by now, I have formally resigned as of February 1, 2008 from my long time duties as Assistant to the Secretary Treasurer for the Society.

My memories of getting to know all of you are vast and indeed wonderful. It seems like only yesterday that Dr. George Kypridakis, then Secretary-Treasurer of the Society, walked into my Medical Education office at White Memorial Medical Center. I knew him at that time only as the Director of Medical Education and the Chairman of Pathology at WMMC. It was his intention to request that I stop by his Pathology Department upstairs to help his secretary apply for CME Accreditation for the LASOP Scientific Programs. I agreed to do so, he applied for CME Accreditation and got it. Kyp, as he was known, felt that CME Accreditation for the LASOP Scientific Programs would encourage a better attendance at the meetings. As I recall, that was sometime in the early 1980s. A couple of years later, Kyp stopped by again to ask that I get a bit more involved with the Society, as his assistant. I did by typing up the monthly Newsletter, attending the December Memorial Scientific Program and later the Board meetings. Then in 1990, following his death from a massive cerebral hemorrhage, Dr. Kyp left me with all of you. I found myself becoming more and more attached to and involved with the Society. Each year, as the Board Officers changed, I would offer to step down for another, however my offer was never accepted and I finally stopped asking.

Now as February approaches, I know that I shall miss you all. The new assistant, Lynn Taylor, will step right in and you will probably not even notice that I have gone. Please welcome and help her.

I look forward to seeing you at the January 19 Program at City of Hope National Medical Center. Wow! My last all day program!

Jules Kernen, a long-time member and former president of the LASOP, recently passed away after a long battle with Parkinson's Disease.

Jules retired from the active practice of pathology in 1993. He was, for many years, a partner in the Clinical Laboratory Medical Group, a pathologist at the Good Samaritan Hospital, and a Clinical Professor of Pathology at the Keck USC School of Medicine. He was an exceptionally talented pathologist, scientist, and teacher with a great sense of humor. Dr. Kernen was appreciated, respected and liked by colleagues, clinicians, residents and employees.

He excelled academically at an early age in his home town of St. Louis, skipping two grades in High School and receiving several national academic awards. He enrolled at Harvard University with a scholarship at age 16 and graduated from it at the age of 19 summa cum laude, majoring in chemistry. He received his M.D. degree at Washington University where he was consistently ranked first academically in his class throughout medical school. Dr. Kernen then took his residency in pathology at the same institution under Dr. Lauren Ackerman. He co-authored papers with Dr. Ackerman on malignant melanoma and other subjects, and remained a life-long friend of Lauren's. Jules was a credit to the LASOP and to all institutions with which he became affiliated and will be missed by all who had the pleasure of knowing him.

Our deepest sympathy goes out to his wife, Rita Kernen.

The following slate has been approved by the 2007 Board of Directors in line with Society Bylaws. Special thank you should be extended to Dr. Randi Burke, Chair of the Nomination Subcommittee as well as to Drs. Richard Horowitz and John Craig for their assistance on that subcommittee.

A final VOTE will be made at the 2007 Annual George Kypridakis, MD Memorial Scientific Program for the following Board positions:

President Milton Drachenberg, M.D.
Long Beach Memorial Med Center

Vice President David Frishberg, M.D.
Cedars Sinai Medical Center

Secretary/Treasurer TBD

Member At Large David Cassarino, M.D. (2009)
UCLA

Member At Large Sathima Natarajan (2011)
Kaiser Hospital, Los Angeles

Member At Large Barbara Florentine (2011)
Henry Mayo Hospital

CONTINUING BOARD MEMBERS – NO VOTE NEEDED

Past President Stuart Sostrin, M.D.
Century City Doctors Hospital

Member At Large Lester Thompson, M.D. (2008)
Kaiser, Woodland Hills

Member At Large Kumari Wickramasinge, M.D. (2008)
St. Francis Medical Center

Member At Large Peiguo Chu, M.D. (2009)
City of Hope

Member At Large Andrew Burg, M.D. (2010)
Long Beach Memorial Med Cntr

Member At Large Wesley Naritoku, M.D. (2010)
LAC/USC Medical Center

A very special thank you to Randi Burke, MD, who came to the board to fill a short term position and has remained for many years to complete an additional full term of service ending with the Past President position on December 31, 2007.

The sixth annual Pete Schwinn Memorial Golf Tournament was held on Saturday September 29, 2007 at Los Verdes Golf Course. A great time was had by all participants. Including contributions from our membership and golf tournament participants we raised $3800 for our fund. In addition the fund will receive $10,000 from the CAP Foundation Humanitarian Grant. The Zeiss Corporation has pledge to donate a $15,000 digital camera and microscope to Arturo Heredia, our candidate pathologist from Peru, who will be arriving in Los Angeles next July for a six month sabbatical. Finally, Para Chandrasoma, M.D. is individually supporting our second pathologist from Sri Lanka, Sulochana Woketimge. She arrived this month and is now being mentored at USC Medical Center.

The grand total for this year including pledged funds comes to $ 40,800. This is a great accomplishment for our society! We want to acknowledge the following contributors:
 

P. Chandrasoma, M.D. J. Pachciarz, M.D. R. Henke, M.D. W. Naritoku, M.D. C. Osborn, M.D. R. Terry, M.D. M. Itano, M.D. V. Lee, M.D. D. Luthinger, M.D. W. Coulson, M.D. G. Smith, M.D. S. Geller, M.D. J. Nelson, M.D. R. Nieberg, M.D. K. Nieberg, M.D. M. Sibug-Sager, M.D. N.Sun, M.D. B. Hartman, M.D. G. Stevanovic, M.D. Karen Hammerberg C. Treling, M.D.

E. Wagar, M.D. A. Yamamoto, M.D. Alex. Williamson, M.D. Hank Williams, M.D. S. Romansky, M.D. R. Turner, M.D. Mary Schwinn Robert Schwinn Cindy Schwinn Bob Matsumoto Jim Roach Julian Ryder Christian Ryder Rand Billing Corporation Zeiss Corporation Centinela Hospital Med. Ctr Clarient Diagnostics Abbott Laboratories Pathsync LLC

Separate and very special congratulations are due to Dr. Keefe. At the most recent meeting of the CAP Awards 2007, he was awarded the CAP Foundation Humanitarian Grant Award in the amount of $10,000.00 to be applied toward further U.S. training for Pathologists from other countries.

The award brochure documented that:

“James F. Keefe, MD, FCAP is recognized for his commitment to helping developing countries through his involvement in the Los Angeles Society of Pathologists’ Education Fund (LASOP), a group that trains pathologists from third-world countries so they can return to their native countries with enhanced knowledge of pathology.”

Members of the Society have contributed at least partially to the following books – have a look:

*Forensic Neuropathology – provides superior visual examples of the more commonly encountered conditions in forensic neuropathology and answers the most frequently asked questions that arise regarding neuropathological findings.

Hideo Itabashi, M.D., John A. Andrews, M.D., Uwamie Tomiyasu, M.D., Stephanie S. Erlich, M.D. and Lakshmanan Sathyavagiswaran, M.D.

See page 9 if you are receiving this Newsletter via snail mail. For further information if receiving the Newsletter via E-Mail or to secure online ordering view http://books.elsevier.com/forensicneuropathology
Enter Discount Code 90834 when ordering or call +1 314.579.3300

*Language of Cells: A Doctor and His Patients –
Published by Random House, On New York Best Seller List
Spencer Nadler, M.D. is currently working on a second book that should be available next year.

Online Review: “Spencer Nadler is a pathologist who would be a clinical physician. He is a doctor of medicine who would be a literary artist. He demonstrates in these exquisitely wrought pages a deep sense of identification and empathy with the very real human beings whose cells he sees in his microscope. He writes about intersecting with their lives in a style both concrete and moving so that we cannot help but also identify with the heart-wrenching experience of disease.”

Available through Amazon.com

Cytopathologic evaluations of fine needle aspirates are reported with codes 88172-88173. It is quite understandable that there may be some confusion regarding the proper use of CPT code 88172 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine the adequacy of specimen(s). Code 88172 is a physician code and may not be reported when a cytotechnologist assesses specimen adequacy. In order to clear up any potential confusion, we offer this explanation of the code. The unit of service for this code is best understood as per site, per evaluation, and it is not dependent upon the number of slides examined. The number of “passes” or “aliquots” of material obtained do not define the service.

An example of a real case study will provide further clarification.

A radiologist performs a fine needle aspiration of a lung lesion in a patient with lung and liver lesions. The radiologist makes one "pass," two passes," or more and material is presented to the pathologist for evaluation. There may be one slide or many slides. The pathologist makes a determination (professional judgment). The pathologist determines that there was insufficient tissue for a diagnosis. The pathologist transmits the information to the radiologist and this episode (evaluation) constitutes one unit of 88172.

To continue the example, ten minutes later the radiologist now sends material from an FNA (fine needle aspiration) of the liver for immediate evaluation by the pathologist. [The radiologist may have made one "pass" or more into the liver. The material may include one slide or more. There may be one "aliquot" or more.] The pathologist now needs to start the evaluation of the new specimen. In this example, the pathologist determines that there are malignant cells present in this sample and communicates this information to the radiologist. This evaluation constitutes one unit of 88172.

To continue the example further, the radiologist now goes back to sample the lung lesion again. The pathologist is now presented another set of slides with which to evaluate. The slides are examined. The pathologist now confirms (on this sample) that malignant cells are present. This constitutes the third unit of service of an 88172.

There are two very important concepts demonstrated in this clinical example. First, the unit of service for 88172 is independent of the number of slides, “passes” or “aliquots” generated during the FNA procedure. As illustrated above, the unit of service for code 88172 is best defined as per site, per evaluation. Second, multiple units of service on the same day of service are a common occurrence and depend upon the clinical circumstances for each patient.

The proper billing of CPT codes 88172 and 88173 has been detailed in a number of publications including CPT Assistant and CAP Today. The coding advice given in this letter is consistent with the previous advice rendered by the AMA and by the College of American Pathologists.
 

A couple years after I moved from Los Angeles, I sent an inquiry to the College about the correct CPT coding of bone marrow exams. It was in 1999. I appreciated the advice I got. But six months later I read in a College publication that the College had to retract its advice. Whoa! I was none too pleased by that and I sent a letter of inquiry to the College asking how such a think could happen. The College's response was to toss me into the Economic Affairs Committee. (I should have kept my mouth shut.)

There are a large number of organizations and billing services who will help you with CPT coding issues. One of the better resources available to pathologists are the services provided by the College (College of American Pathologists). Of course the AMA also runs a coding service (for a fee) but the College is often consulted in the preparation of the AMA's answers.

Go to the College's web site (http://www.cap.org/apps/cap.portal) and you will find a variety of tools to help you and your practice with CPT coding. Once you are at the web site it is useful to login as the CPT Coding Tutorials are considered to be a member benefit. After you log in, go to the "Education Programs" area of the highlighted bar and click it. Under the category of "Featured Education Programs," you will see "CPT Coding Tutorial" under the Practice Management bullet. Click the tutorial you want (by date and topic) and at the completion of the course you will receive CME credits for your efforts.

I know of a number of practices who use the tutorial for their own internal compliance program, as documentation of training in correct coding.

Which is not to say that we are always right! As much as I and the other members of the Economic Affairs Committee who help me compose these courses want to get it right, we have made errors in some of the vignettes. We are in the process of creating a new set of ten vignettes on bone and soft tissue codes and if you have specific ideas about our plans, feel free to e-mail me (jalmas@stdom.com) or the College (awoodin@cap.org).

There is also a very practical (but unendorsed) use of the CAP web site that may help you with coding issues. You don't need a CAP membership to take advantage of it. Go to the CAP web site (http://www.cap.org/apps/cap.portal). In the upper right hand corner of the screen is a box called "Site Search." Work inside that box by clicking in it. Say you have questions about how the College has interpreted the pathology consultation codes (e.g., 88321, 88323, and 88325). Simply type in the box 88325 (representing the code you have questions about) and click Go. The CAP's web site will now bring you a listing of many relevant articles published in CAP publications concerning that code. You will find some excellent advice in the summaries.
 

Due to the quantity of abstracts submitted, please click here to go to a separate page.
 

Download printer-friendly version of this announcement

PAPERS OR ABSTRACTS DUE: 12:00 Noon, Friday, April 6, 2007

DELIVER PAPERS TO:

      Georgia Froberg
      LASOP Administrative Office
      C/O White Memorial Medical Center
      1720 Cesar E. Chavez Avenue
      Los Angeles, CA 90033

PRESENTATION POLICIES:

1. A statement, signed by the Residency/Fellowship Director of the submitting Resident/Fellow’s Training Program, should accompany each paper and/or abstract. This statement should attest to the fact that the majority of the research and work was completed by the submitting resident/fellow. Information should also include a telephone contact number and an E-Mail address for each submitting resident/fellow.

2. All papers/abstracts submitted before deadline, will be read by each member of the Society’s Board of Directors. After careful consideration, four Pathology residents and/or fellows will be asked to present to the general membership in final competition on May 8, 2007. Notification regarding the final four papers/abstracts to be presented on that date will be made on or before April 23, 2007.

3. All participants must be enrolled in a Pathology Resident or Fellowship Program.

4. Abstracts received via E-Mail to LASOP@ mindspring.com will be published with authors’ names in the April Society Newsletter, which will be mailed to all society members during that month.

5. Presentation of any paper/abstract submitted and chosen for final competition must be made by the Resident/Fellow author only.

6. Presentation of the final four papers/abstracts will be made at 6:30 pm, Tuesday, May 8, 2007 at the Moseley Salvatori Conference Center, 637 South Lucas Avenue, Los Angeles, CA 90017.

7. Resulting awards will be presented at the June 12, 2007 Scientific Meeting as follows:

          Best Paper: $500.00 Honorable Mention: $350.00

8. Questions? Please call 323 260-5781

Dear LASOP member,

I would like your assistance in securing heart cases which had a stent procedure for occlusive coronary artery disease. Stent procedures are now in the forefront in cardiac revascularization procedures, probably outstripping routine aorto coronary bypass procedures by 9/1. The pathology of A/C bypass is well documented but little is known about stents. Since stents are not retrieved in restenting procedures, therefore retrieval of stents will essentially be confined to cases which had a fatal outcome due to a cardiac or other problem in a given patient. In the US, stents were approved in 1996, ten years later than introduced originally by Sigwart and Peul at the University of Toulouse, France. Coated Stents were approved by the FDA in 2003 and 2004. The principal US Manufactures are J/J Cypher, stent coated with Sirolimus and Bosten Scientific coated with Taxol. Coated stents have reduced thrombotic occlusions from double to single digits. Recent reports from the NEJM indicate increased thrombosis in coated stents following cessation of anticoagulation therapy. Those findings have created concerns in the cardiology circles. My interest is strictly scientific and I would appreciate any information you may have about cases in your practice.

My telephone number is 213 999 3870
My fax is 818 717 8804
My E-mail is ArnoRoscher@aol.com
Thanks for your consideration

Yours,
ARNO A. ROSCHER M.D.

Assembly Bill 1195 - Continuing Education: Cultural and Linguistic Competency

On October 4, 2005, Governor Arnold Schwarzenegger signed Assembly Bill 1195 (AB 1195) into law. AB 1195, “Continuing Education: Cultural and Linguistic Competency,” went into effect July 2006. The law mandates that the CME accrediting agencies (the ACCME and IMQ/CMA) must develop standards for compliance.

Therefore on and after July 1, 2006, all continuing medical education courses must contain curriculum that includes cultural and linguistic competency in the practice of medicine. California-based providers planning courses within the State of California must comply with this law.

What is Linguistic and/or Cultural Competency in CME?

1. “Cultural competency” means a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities. At a minimum, cultural competency is recommended to include the following:
     a. Applying linguistic skills to communicate effectively with the target population.
     b. Utilizing cultural information to establish therapeutic relationships.
     c. Eliciting and incorporating pertinent cultural data in diagnosis and treatment.
     d. Understanding and applying cultural and ethnic data to the process of clinical care.

2. “Linguistic competency” means the ability of a physician and surgeon to provide patients who do not speak English or who have limited ability to speak English, direct communication in the patient’s primary language.

Exempt Courses

This law does not apply to all CME courses. A continuing medical education course dedicated solely to research or other issues that does not include a direct patient care component is not required to contain curriculum that includes cultural and linguistic competency in the practice of medicine. All other courses are considered non-exempt. LASOP has moved to become compliant with this new bill by completing the following:

1. All of its scientific program speakers for programs planned after July 1, 2006 are asked to address this need within their presentations wherever this information is available. If not applicable, a form noting this fact signed by the speaker, will be requested and documented.
2. Addition of a program objective to each planned program which addresses this mandate. If the speaker considers this component to be N/A, this will be documented on the evaluation form of the program provided to each attendee.
3. Provision at the planned scientific program, when available, of a bibliography listing location of information which addresses cultural/linguistic information on the topic being presented.

The date of the 5th annual Pete Schwinn Golf Tournament benefiting the LASOP Education Fund is going to be Saturday, September 29, 2007. I know that many of you on this list are not golfers, but in some way know and support the work that we are doing to raise funds for this worthy cause. After this tournament we will have enough funds to support the next Pathologist to spend a sabbatical year here in our Los Angeles community. Dr. Para Chandrasoma is already in the process of sponsoring another Pathologist from his home country of Sri Lanka. We have always had a great time at this tournament and this year should be another wonderful experience for all of us. We will be playing at the Los Verdes Golf Course once again, so please save the date. I will get back to you later with more news. When you receive this communication and find that you wish to participate, please let me know via E-Mail at JimK528467@aol.com

Sincerely,
Jim Keefe

Hello Everyone:

Great news!!!! I recently received a letter from Mary Kass, M.D, the current president of the C.A.P. Foundation informing me that they are awarding the LASOP Education Fund a grant of $10,000 to fund our project. As you know, we have successfully supported two pathologists from underdeveloped countries to receive additional training in anatomic pathology here in our Los Angeles community. The first was Krishna Sharma from Bhutan and the second Sonali Rodrigo from Sri Lanka. With the assistance of Victor Lee, M.D., representing Pathologists Overseas, we have made contact with our next candidate. His name is Arturo Heredia.* Dr. Heredia recently completed his formal training in Pathology in Lima, Peru. He is working by himself in a small village in the Amazon jungle of eastern Peru. Zeiss corporation has informed me that they will be donating a microscope and digital camera and software for his use in Peru. This scope will allow him to view a slide and transmit the image in real time to anywhere on the internet. Dr. Heredia will be spending his time in Los Angeles in 2008.

Download a copy of the brochure and registration form for the 6th annual Pete Schwinn, M.D. Memorial Golf Tournament. It will be held at Los Verdes Golf Course on Saturday, September 29, 2007. I want to invite everyone to participate in this event. I would love for all of you to play on that day, if that is not possible, please reach for your check book and make a financial contribution to the fund and send it to Georgia Froberg at White Memorial Hospital. If you want to reach me use my email at jimk528467@aol.com. 

*Here is a picture of Arturo.

Jim Keefe

Our friend, colleague and teacher, Juan Lechago, died on Friday, September 29, 2006.

Juan was an internationally renowned pathologist who educated and inspired pathologists and other physicians for more than thirty years. He was widely respected for his expertise in gastrointestinal pathology and was acknowledged as one of the world's authorities on neuroendocrine tumors.

Juan was born in Barcelona, Spain. He received his undergraduate and medical degrees in Cordoba, Argentina and his M. Sc. (Pathology) and Ph.D. from Queen's University, in Ontario, Canada. He completed his residency in Pathology at Kingston General Hospital and Hotel Dieu Hospital in Kingston and then joined the faculty at Harbor-UCLA Medical Center in 1973 where he remained for 14 years, rising to the rank of Professor at the UCLA School of Medicine. He moved to University of Texas Southwestern Medical School, Dallas, in 1987 to be Professor and Vice-Chairman of the Department of Pathology and Chief of the Laboratory Service at the Veterans Affairs Medical Center, as well as Director of the Morphology Core of the Center for Diabetes Research. In 1990 he moved to Baylor College of Medicine in Houston as Professor of Pathology and Professor of Medicine (Gastroenterology) and Director of the Surgical Pathology Service at the Methodist Hospital.

In 2002 we recruited him to be head of the gastrointestinal pathology and endocrine services in the Department of Pathology and Laboratory Medicine at Cedars-Sinai Medical Center where he earned the greatest respect, admiration and affection from his colleagues, residents and fellows and support staff in Pathology as well as from clinicians.

Dr. Lechago had more than a hundred articles in peer-reviewed journals and 25 book chapters. He edited or co-edited four books, including Cellular Basis of Chemical Messengers in the Digestive System, Endocrine Pathology Update, and Bloodworth's Endocrine Pathology. His newest book, Intraoperative Pathology is to be published. He was a gifted, highly articulate and entertaining speaker and was an invited lecturer at medical centers and at scientific symposia throughout the world.

His many friends will particularly remember him for his great warmth, the extraordinary depth of his medical knowledge, his support of colleagues and students, and his unswerving devotion to, and love for, the practice of Pathology. He delighted in studying cases, rendering diagnoses and teaching. He was highly cultured and loved music, art, travel, good food and wine and was as informed in these areas as in medicine. He delighted in sharing his knowledge and experiences and was the most genial professional associate and social companion. Juan was without guile or artifice and, despite his extraordinary abilities and accomplishments, was modest and unassuming.

His greatest love was for his family. He revered and admired his mother, recounting that much of his abilities and accomplishments came from her guidance and teaching. He found great love with his first wife, Lea with whom he had three children, and after her death with his current wife, Zunilda, who became his mate, his companion, his comfort and his inspiration. He had the greatest pleasure in talking about his children, who he greatly and unconditionally loved. He was proud of the accomplishments of John and James and Sarah, but mostly found joy in their personal qualities. He was especially proud to have contributed to the development of three such fine human beings.

The passing away of this legendary pathologist leaves an immeasurable void in our discipline. He will be greatly missed by all who knew him.

Mahul B. Amin, M.D.
Chairman, Department of Pathology and Laboratory Medicine
Cedars Sinai Medical Center

Last month the LASOP Board received notice that the CMA Quality Institute had awarded the Society continuing accreditation for its ongoing offering of Continuing Medical Education Programs. This accreditation was awarded with commendation for the maximum time available, 4 years beginning February 1, 2006 until February 28, 2010.

Senate Bill 169 was signed into law by Governor Schwarzenegger on Wednesday, March 29. This bill has extended the deadline for phlebotomists to be certified to January 1, 2007. Current law had required that all unlicensed individuals functioning as phlebotomists on or before April 2003 to submit an application and be approved by April 2006. There was such a backlog of applications that LFS could not have completed the process. Now an application must be submitted by July 1, 2006. There are some limitations that need to be recognized and communicated to your laboratories.

* This extension only applies to those phlebotomists employed on or before April 9, 2003 who held the "old" certification. These are the persons impacted by this legislation.

* All applications from phlebotomists subject to the extension must be received by Lab Field Services on or before July 1, 2006, or they must stop working. Those that apply on or before that date may keep working until January 1, 2007. There is no extension beyond that date. * Any persons employed as phlebotomists after April 9, 2003 do not qualify for the extension and must have the new certification.

* All newly trained phlebotomists do not qualify for the extension and cannot work until they have the new certification. Lab Field Services is encouraging all applicants to apply online so they can get notification that their application has been received. The URL is https://secure.cps.ca.gov/cltreg/pt_certinfo.asp.

Cal Path Facts: California Society of Pathologists

We have heard from some pathology groups about recent denials on Medicare EOMBs where the quantity billed exceeds more then one unit. It was happening with 88342, 88361, 88305 etc. where multiple quantities are not unusual. The claims are being submitted electronically and will often pay for only one unit. The provider appeals and it was successful in getting the additional procedures paid.

We contacted NHIC, the California Medicare carrier to inquire as to any new claims processing procedures. We were informed that there may have been some sporadic inappropriate denials due to insufficient training of staff. Providers who may have had that experience are encouraged to resubmit those claims.

Cal Path Facts: California Society of Pathologists

We previously informed you that the CSP is supporting SB 1369 introduced by Senator Maldonado which will require direct billing for all anatomic pathology services. Current law requires both disclosure and anti-markup provisions for all clinical laboratory services, but only direct billing requirements for GYN cytology would require the laboratory providing the anatomic pathology service to directly bill the patient or their insurer, except for very limited situations. The Senator introduced this bill in response to the Wall Street Journal article last year that highlighted the practice of some physicians in marking up tests performed by outside labs.

SB 1369 currently does not define anatomic pathology but amendments were added prior to its first hearing that will include a specific definition. That definition will include surgical pathology, cytopathology, hematology, molecular pathology, and blood banking.

The Bill has passed the Senate Health Committee by unanimous vote. It will now be heard in the Senate Business & Professions Committee. We will be providing you with more information on how to contact the Business & Professions Committee in a separate e-mail.

Cal Path Facts: California Society of Pathologists

Dr. Keefe has asked that I share this letter with the Society.

Dear Dr. Jim Keefe,

It was nice to hear from you again. It is great to hear you are keeping the golf tournament spirit high and thus assist young pathologists from the developing world to better equip them to deal with the complexities of pathology. I hope the one this year too will be a success.

Undoubtedly, the exposure one gets there at the LA community is very useful to the pathologists from the developing world, who have to work with very basic technology and many times with no one to take a second opinion. The training there gives much confidence and strength to tackle difficult cases back home. Your and the effort of the LASOP that enabled me to spend 15 months there in LA has helped me and my country Bhutan provide better patient care and also helped guide the development of diagnostic services in the right direction. The contacts I made there during my sabbatical , has made me a better and confident pathologist since I have so many to bank upon when faced with difficulties. I fondly remember those great days at LA and can not end my mail without thanking each one of you who has jointly made this difference.

Warm regards to all.

Krishna Sharma,MD
Head, Pathology & Laboratory Services
JDW National Referral Hospital
Thimphu BHUTAN
email: drukpath@yahoo.com

An Educator, Pioneering Pathologist and War Hero
01/06/1908 - 03/28/2006

Weldon Kimball Bullock M.D., a pioneering Southern-California pathologist, died March 28, 2006 from the complications of a heart attack and fall. He was 98 years old. For six decades he influenced the diagnosis of tumors and their successful removal through his education of students, pathology residents, pathologists, and surgeons at LAC-USC and by his directorship of the California Tumor Tissue Registry. In later years, he received lifetime achievement awards from both the Los Angeles Society of Pathology and the California Society of Pathology. Those who knew him respected and loved an unselfish, unassuming, and modest man.

Dr. Bullock was born in Vernal, Utah to parents who taught him the importance of love and tolerance. As a child he shook the hand of President Theodore “Teddy” Roosevelt during a barnstorming campaign.

On December 26th, 1931 he married Dosia Opal Newton in San Diego, California and they remained married until her death in 2004. They had two sons, John Kimball Bullock and James Kay Bullock (now deceased).

His chosen field was medicine, and he graduated from Northwestern University Medical School in 1934. He did an internal medicine residency at Cook County Hospital, and later a pathology residency at LAC-USC. At this time he decided to devote his life to the understanding of tumor diagnosis and studied biochemistry and physiology at Harvard (1946). He then became the first James Ewing Fellow at Memorial Hospital (New York, 1948-1949).

His career was interrupted by World War II. From 1941-1945 he served as a medical doctor in the Asiatic-Pacific theatre, particularly Australia and New Guinea. He rose to the rank of Lt. Colonel and was awarded the American Defense Service Medal as well as the Asiatic Pacific Service Medal with Bronze Star. When demobilized from active duty he resumed his civilian medical career and never discussed these awards.

Dr. Bullock decided to practice pathology in Southern California. His passion was education and he taught pathology at LA County-USC medical center for more than twenty years while he was chief of surgical pathology (1949-1969). He was also chief of pathology at L.A. Orthopedic Hospital from 1956-1963, and was a consultant with them until his death. He also served as chief pathologist at St. Luke Hospital in Pasadena.

In the mid-fifties he upgraded a local continuing medical education program to state and national levels. Until that time the pathologic diagnosis of tumors had been somewhat subjective. But with his idea of a “sharing program” pathologists in multiple institutions could see the diagnoses of their distant colleagues. His newly founded organization became funded by the American Cancer Society and eventually became known as the California Tumor Tissue Registry (CTTR, www.cttr.org). He directed it for over forty years. Even in retirement and up to his passing, Dr. Bullock continued to work in the Registry. In his final years he helped elevate the Registry to its internationally renowned status.

His personal avocation was aviation and he held a commercial license with instrument rating. His last flight was at the age of 79. He logged over 6000 hours, mostly in a turbocharged Beechcraft Bonanza.

Weldon Bullock, M.D. was respected by his peers and students for his teaching and devotion to pathology. His directorship of the CTTR was only one of his many legacies. With his passing the profession of pathology loses one of its founders and patriarchs.

He is survived by his son, John Bullock, daughter-in-law, Cathy Bullock, grandchildren Heidi Bullock and her husband Anthony Tam, Matthew Bullock and his wife Sunni, granddaughters Lauren Bullock and Melanie Bullock, and great-granddaughter Maci Jean Bullock, daughter of Matthew and Sunni. He is also survived by Sheryl Bullock (Arnold), who was married to the late James K. Bullock.

The family suggests that tax-deductible donations be made to the Weldon Bullock Endowment Fund for Education and Research, California Tumor Tissue Registry, 11021 Campus Avenue, AH 335, Loma Linda, CA 92350


Weldon K. Bullock
Pathology Patriarch and My Friend
Donald Chase

Although I only met Weldon in 1991, I’ve really known him for over 30 years. Like thousands of others, I learned pathology through his monthly study sets and national seminars. When he came to Loma Linda he “interviewed” me in my office where he said, “this is the place”, meaning that I was to become his successor. The phrase also seemed a paraphrase of something Joseph Smith once said in Utah. Although Weldon wasn’t an actively religious man, in my eyes he was truly righteous.

So, at the age of 82, Weldon became my close friend, taking up residence at campus pathology where he became a father figure to myself and to our four lady employees. Since then, to his current age of 98, he commuted 70+ miles each week to research our study set cases and to be a presence at the California Tumor Tissue Registry (www.cttr.org).

I found in Weldon a friend who was 43 years my elder. As legend has it, as a child he shook the hand of Teddy Roosevelt, and through his life, he was truly Americana. He served in World War II, an experience that he downplayed. About ten years ago, however, he wore his uniform proudly as I took his picture. It still fit perfectly!

During his career he wrote over 40 articles with luminaries such as Drs. Hugh Edmonson, Al Hirst, George Hummer, Dr. Thompson, Gordon Hadley, and others.

He served on numerous national and regional medical committees, both for pathology and surgery, and in 1948, was the first James Ewing Fellow at Memorial Hospital in New York.

But these facts are only ink on a page. Weldon was a truly fine gentleman, someone who you’d expect to greet you when you enter the pearly gates. He was always the first one to say something nice about a person. His passion for teaching pathology residents was monumental.

I will miss my friend, Dr. Weldon Bullock, as will the California Tumor Tissue Registry, and as will the entire profession of pathology. Let us celebrate his life!


A Tribute to Dad
Sheryl Bullock Arnold

Weldon Bullock was my father-in-law. I was married to his son, Jim Bullock, who passed away in 1992. After Jim passed away I continued to be close to him and to his wife, Dosia. We had built a loving relationship over many years and neither of us wanted that to change.

Dad was always a kind and loving father-in-law to me and after my own father passed away in 1997 I relied on him to be a father figure in my life. We would visit and I would talk to him about his now adult grandchildren and how they were doing. Sometimes I would seek his advice on medical situations with my family or friends. And he would tell great stories about growing up in Vernal, Utah, and about being a country doctor in Emmett, Idaho. He gave new meaning to Michener’s title, “Tales of the South Pacific,” as he recounted fascinating stories about World War II and working as a medical officer at one of the headquarters of General Douglas MacArthur.

Dad was a man I deeply admired. His dedication to his life’s work was such an example to me of self-sacrificing commitment. Only those who worked with him really know how tirelessly he worked to create for the California Tumor Tissue Registry the reputation it has today. During the years since the Registry has been at Loma Linda he made the drive nearly every week from the Pasadena/Alhambra area out to Loma Linda to work all day at the Registry, spend the night, and work all the next day. Then he would drive back to Alhambra- all this he was still doing at 98!

Dad was very generous with his time and was always willing to have a slide sent to him that came from a biopsy of a friend or family member. He would read the slide and get back to the doctors with his highly respected opinion. We always felt better knowing that dad was involved.

Dad was also very generous outside the medical field with his time and with his money. There were many people I know he quietly helped when times were difficult for them, offering them emotional support and financial assistance. He took people under his wing and made sure they were taken care of. There were people I know he was still concerned about and helped even as he lay in his hospital bed during the last weeks of his life. He was a great example to me of charity and kindness.

Dad was also an example to me of love and devotion after his wife, Dosia, had to be put in the PEO home. He visited with her nearly every day and determined where he lived by whether or not it was close enough to the home where she was living. He continued being faithful in his visits long after she stopped knowing who he was.

Four and a half years after Jim Bullock (dad’s son and my husband) died, I remarried. One of my greatest concerns was my relationship with Dad and Mom Bullock and how they would be able to adjust to my new husband. A great testimony to the kind of loving people that they were is the fact that they accepted my new husband with great love and kindness. Dad would always say to me: “You found a good man there. I’m so happy for you”. This generous attitude allowed us to continue our close relationship and for that I am so thankful. He was a wonderful father-in-law to me and I loved him dearly.

Read a summary of this fun day - complete with pictures!

An appellate decision was issued on 2/17/06 that provided a favorable and important ruling on the rights of non-contracted hospital based physicians to balance bill for their portion of the fees that are not paid by a health plan or their delegated medical group.

The ruling came in the case of Prospect Medical Group vs. Northridge Emergency Medical Group which was appealed by Prospect Medical Group after a judgment in the favor of the E.R. group at the trial court level.

The case involved a suit by Prospect against a non-contracted emergency medical group that provided emergency services to patients for which Prospect was the delegate of the health care service plan and therefore responsible for those services. There were three issues decided by Court of Appeal in the second appellate district that were raised by Prospect in their appeal.

Prospect alleged that under California law, section 1379 of the Health and Safety Code, non-contracted physicians are prohibited from balance billing individual patients/subscribers any amount not paid by the plan or its delegated medical group. The Court ruled that section 1379 does not prohibit balance billing when there is no contract between the physician group and the plan or delegated medical group. Section 1379 does protect the enrollee/subscriber of a plan from being billed excess charges by a contracted provider but finding no evidence of a contract the section has no effect. Prospect had argued that there was an "implied contract" not reduced to writing based upon; (1) federal law requires E.R. physicians to treat all patients without ability to pay, and (2) as a delegated medical group, Prospect is obligated to pay for these emergency services. The Court ruled that 1379 only applies to voluntarily negotiated agreements and would not include any "implied contracts."

Prospect also argued that the E.R physicians must accept 100% of the equivalent Medicare payment for the same services and that any charge is excess of that amount was unreasonable. The Court rejected that argument noting that Prospect cited no authority, statutory or otherwise, that would allow them to set that rate or any other as the only reasonable rate. The Department of Managed Health Care did publish a regulation setting forth factors that could be used in determining the rate of payment for non-contracted providers using criteria from a prior court decision in the Gould case. Those criteria included prevailing charges in the geographic area, UCR, providers training, etc., but the Court was not persuaded that 100% of Medicare was what was intended.

The last issue raised by Prospect is whether they could litigate the reasonableness of the fees charged by the E.R. group for their services. The Court concluded that since Prospect is a delegated medical group and responsible to pay for the services of the E.R. physicians that they could litigate whether or not those charges were in fact reasonable. The case was remanded for that purpose. The Court also dismissed a cause of action against the E.R. physicians wherein Prospect claimed that the act of balance billing was prohibited as an unfair business practice under section 17200 of the Business and Professions Code.

This is obviously a very important decision for hospital based physicians. This issue is still the subject of potential legislation this year. There is no active bill that negatively impacts balance billing but the proponents of the ban might still seek amendments to other existing legislation. The California Radiological Society has participated in a workgroup assembled by the CMA in an attempt to find an agreeable dispute resolution mechanism between non-contracted HBPs and plans or medical groups. The DMHC has also released a draft plan for resolution.

Cal Path Facts: California Society of Pathologists

The CSP strongly supports newly introduced SB 1245 by Senator Figueroa that would require effective 1/1/07 that health plans and insurers cover HPV testing when ordered by their physician. The CSP supported enactment of legislation several years ago that required coverage of other FDA approved pap smear techniques using liquid based preparation. It is sponsored and supported by a variety of consumer healthcare groups.

Cal Path Facts: California Society of Pathologists

The CSP is supporting SB 1369 by Senator Maldonado which will require direct billing for all anatomic pathology services. Current law requires has both disclosure and anti-markup provisions for all clinical laboratory services, but only direct billing requirements for GYN cytology would require the laboratory providing the anatomic pathology service to directly bill the patient or their insurer, except for very limited situations. The Senator introduced this bill in response to the Wall Street Journal article last year that highlighted the practice of some physicians in marking up tests performed by outside labs.

SB 1369 currently does not define anatomic pathology but amendments were added prior to its first hearing that will include a specific definition. That definition will include surgical pathology, cytopathology, hematology, molecular pathology, and blood banking.

We expect that there will be some opposition to SB 1369 and all pathologists need to contact their legislators to ask for support for this important legislation. We have listed the members of the Senate Health Committee and their contact information that will hear SB 1369 on March 29th. Here are some talking points for your letters;

* Direct billing by the pathologist or laboratory is necessary to prevent referring physicians from choosing a lab based upon discounts that allow them to mark-up the actual cost and profit from a service that they did not supervise or provide.

* Existing law is supposed to prohibit mark-up of outside lab work but enforcement is difficult. The practice raised serious concerns with AMA ethical guidelines and can insert the profit motive in increasing utilization.

* Medicare has required direct billings for all laboratory services by the actual provider since 1984.

* A September Wall Street Journal article indicated that out of state labs are garnering referrals from California physicians based upon these practices and neither payers nor patients may be aware of this practice.

* AMA ethical guidelines states that with regard to lab services that a "physician should not charge a mark-up, commission or profit on the services rendered by others." The AMA code also says that a doctor " who chooses a laboratory solely because it provides low-cost laboratory services on which the patient is charged a profit is not acting in the best interest of the patient".

* Nine other states have enacted direct billing requirements for anatomic pathology.

* California enacted direct billing requirements for pap smears many years ago to reduce the growth of out of state "pap smear mills" where quality was suspect and referrals were increased by the offering of client/physician billing based upon low cost and mark-up potential.

PLEASE WRITE LETTERS TO THE LEGISLATORS LISTED BELOW AND TELL THEM ABOUT YOUR EXPERIENCE WITH THIS ISSUE AND THE IMPACT ON YOUR PRACTICE.

Senator Deborah Ortiz (Chair)
State Capitol, Room 5114
Sacramento, CA 95814
(916) 651-4006
Fax (916) 323-2263

Senator George Runner (Vice-Chair)
State Capitol, Room 4066
Sacramento, CA 95814
(916) 651-4017
Fax: 916-445-4662

Senator Samuel Aanestad
State Capitol, Room 2054
Sacramento, CA 95814
(916) 651-4004

Senator Elaine Alquist
State Capitol, Room 4088
Sacramento, CA 95814
(916) 651-4013

Senator Wesley Chesbro
State Capitol, Room 5035
Sacramento CA 95814
(916) 651-4002
Fax: (916) 323-6958

Senator Dave Cox
State Capitol, Room 2068
Sacramento, CA 95814
(916) 651-4001

Senator Liz Figueroa
State Capitol, Room 4061
Sacramento, CA 95814
(916) 651-4010
Fax: (916) 327-2433

Senator Sheila Kuehl
State Capitol, Room 5108
Sacramento, CA 95814
(916) 651-4023
Fax: (916) 324-4823

Senator Abel Maldonado
State Capitol, Room 4082
Sacramento, CA 95814
(916) 651-4015
Fax: (916) 445-8081

You can fax copies of your letters to the CSP office at (916) 444-7462 or email them to Executive Director Bob Achermann at bachermann@amgroup.us.

Cal Path Facts: California Society of Pathologists

The 4.4. Medicare physician rate cut has technically taken effect on 1/1/06. You should be aware that the House will need to consider the budget act when they return on 2/1/06 and most observers believe they will adopt a revised version that eliminates the cut and keeps rates at the 2005 levels. CMS has even advised their carriers that this action is likely and that any claims that are incorrectly paid in January will be reprocessed without the need for provider action.

We have been contacted by members who have asked what the best approach is for billing during January to minimize problems. We have contacted NHIC and they have provided the following guidance:

Participating physicians, and those non-participating physicians who accept assignment on a claim, can submit claims using their usual and customary rates. We do not recommend they submit their claims billing the fee schedule amount. If additional payments are due, they will not be able to increase their fees just to receive the additional amount.

Non-participating physicians who do not accept assignment are still bound by the limiting charges. They may not submit their claims for more than the limiting charge for the fee schedule that is presently in effect. Since they may bill at 115% of the fee schedule (the limiting charge), they will still have room to receive additional reimbursement. However, they will not be able to increase the limiting charge on previously submitted claims, so they will not be able to collect that difference from the patient.

Please keep in mind that only the percentage is changing. If a code had RVU changes that resulted in a lesser payment, those RVU's will not change.

We will contact you with any future updates.

Cal Path Facts: California Society of Pathologists

Hi Everyone:

The fifth annual Pete Schwinn, M.D. Memorial Golf Tournament will be held on Saturday April 29, 2006 at the Los Verdes Golf Course. The starting time will be 10 AM. Last year thirty-six golfers, representing 10 hospitals and 3 corporations competed for the Beckman Trophy. Alfred Yamamoto M.D. from Greater El Monte Hospital scored a low net of 61 and took home the trophy. Hank Williams M.D. scored the lowest gross score of 74.

Everyone had a lot of fun and we raised an additional $6,000 for the LASOP Education Fund. Many nongolfers have chipped in financially so far to make this happen. To date we have raised $52, 000 in the last 4 years. With these funds we have supported two visiting pathologists to spend one and two years respectively in our Los Angeles Pathology community. If you would like to be a part of this financial family, please send your tax deductible contribution to LASOP Education Fund c/o Georgia Froberg, White Memorial Hospital, 1720 Cesar Chavez Ave. Los Angeles, California 90033.

This year Kenneth Frankel, M.D. (jfrankel02@spynet.com) and Bob Schwinn (rschwinn@socal.rr.com) will be the co-chairmen of the tournament. If you have played in the tournament in the past, we have your e-mail and phone number and will stay in touch with you. . If you have never participated in the past and would like to this year, please contact us. My email is jimk528467@aol.com

Sincerely,
Jim Keefe, MD

Klaus J. Lewin, M.D. (1936 -2005)

We are truly sad to report that Klaus Lewin, a longstanding and active member and former President of the Society, died on October 25th, 2005 at his home in Pacific Palisades.

Klaus was born on August 10th, 1936 in Jerusalem and was educated at Victoria College in Alexandria, Egypt, before pursuing a medical degree at the Westminster Hospital in London. After residency and early experience in England he moved to Stanford University where he developed his interest in gastrointestinal pathology, an interest that started at the Gordon Hospital in London when Klaus undertook pioneering work on Paneth cells with the renowned Dr Dawson.. He was recruited to Pathology at UCLA by Chairman Julien van Lancker and Walter Coulson, Chief of Surgical Pathology in 1976. The choice of Klaus Lewin as a new faculty member in Surgical Pathology at UCLA was a highly significant recruitment for the Department. Dr. Lewin went on to make an enormous impact in academic gastrointestinal, liver and pancreatic pathology. His accomplishments are evidenced by his world renown as a diagnostician, researcher, and teacher

Dr. Lewin was Chief of GI/liver/ and pancreatic pathology at UCLA from 1989 to 2003 and innumerable pathologists within and beyond UCLA came to depend on his consultative opinion. He was a noted exponent of the integration of clinical assessment with pathologic findings in the determination of the final pathologic diagnosis; to the great benefit of the patient. His research achievements are reflected by his extensive publication record (169 papers, 3 books, 39 chapters, 82 abstracts). The fields of GI inflammatory disorders, neoplasia and liver transplantation were all substantially advanced by his work. Dr. Lewin’s high and unwavering professionalism gave credibility to his academic works. However, it was the personable manner in which he conveyed his great store of information that made the experience of instruction by Klaus Lewin truly memorable. As a highly sought after international speaker (262 speaking engagements) he engaged many pathologists to such a degree that in no time they were visiting the Department and working along side him as friends and colleagues. These relationships proved enduring. Dr. Lewin mentored many pathologists-in-training who all testify to his endearing nature and encyclopedic knowledge He established a GI pathology fellowship training program at UCLA, and graduates of that program enhance programs at Yale, University of Chicago, UCLA, UC Davis, UC Irvine, the Medical University of South Carolina, and abroad. Additionally, Dr. Lewin initiated the highly appreciated and enduring weekly Pathology Grand Rounds at UCLA. Another significant achievement for the Department was his early development of an effective and compendious Immunohistochemistry Service.

He taught Pathology in every continent. His protégés include chiefs of GI Pathology in prominent academic centers around this country and current and former members of the Department at UCLA. They include his son David, now a full Professor at the Medical University of South Carolina. Klaus was very proud of all the generations of his family: many of whom were and are physicians

Klaus and his wife Patricia were generous hosts in their elegant and happy home Klaus was skilled in the preparation of delectable desserts, and easily could have been a professional patissier. All who have had the privilege of knowing the Lewins personally have been touched and inspired by Patricia’s devotion to Klaus and the kindness and warmth of spirit of their family.

Dr. Lewin was a leader in his field and a true and kind gentleman. He gave his many talents willingly and unstintingly to UCLA, to his community, to his profession and to his specialty. He is and will continue to be greatly missed.

Klaus passed away at home in Pacific Palisades surrounded by the mountains and ocean that were so important to him. He is survived by his wife Patricia, three children, David, Nicola, and Bruno (all physicians) and five grandchildren.

Galen Cortina, Alistair J. Cochran, Walter F. Coulson

Health care providers are required by law to apply for a National Provider Identifier (NPI). To apply online, visit: https://nppes.cms.hhs.gov.

Announcing the new CMS web page dedicated to providing all the latest NPI news for Fee-For-Service (FFS) Medicare providers! Visit http://www.cmshhs.gov/providers/npi/default.asp on the web. While this page is dedicated to the FFS community, it contains helpful information and links that may benefit all health care providers.

CMS has decided not to place the 2006 fees on the CD-ROM this year in order to have greater flexibility for making any last minute changes to the 2006 payment rates. Fee schedules will be available on the NHIC website at www.medicarenhic.com about the middle of November. Placing the fees on the carrier Web site assures that providers will have the most current and correct fees available. (CR 4051)

All carriers will, however, mail CDs to their physician community. The mailing of the CD-ROM containing the FY 2006 Medicare Participation Announcement and Agreement and supplemental materials will begin in November 2005.

Cal Path Facts: California Society of Pathologists

Pathologists Exempt From Pain Management CME Requirement

We have gotten many calls from members on the issue of physician CME requirements for pain management education that is required as of 12/31/06. AB 487 (Aroner) was signed into law in 2002 and created new continuing education requirements for physicians on the subject of pain management and end of life issues.

The law requires all physicians to obtain 12 hours of CME by 12/31/06 on pain management and end of life issues. The bill was sponsored by a patient advocacy group who was concerned about the perceived practice of some physicians to under-medicate patients with chronic or intractable pain due to concerns about sanctions from the Medical Board or a lack of knowledge regarding appropriate treatment of terminally ill or dying patients. The CMA had negotiated an agreement to remove their opposition and had accepted a new requirement for specific CME courses.

The CSP was able to advocate for and obtain an amendment to exempt pathologists from the requirement. Pathology was one of only two specialties that were exempt from the new CME requirement.

Discussions Continue on Possible Solution to Balance Billing Prohibition

We have previously described the various proposals introduced this year that would impact the ability of a hospital based physician who did not contract with a health plan or delegated medical group to either bill the patient/enrollee directly or to balance bill. None of those proposals have passed the Legislature but the issue is getting a great deal of attention and there is a real risk of some from of restriction being passed. The CSP has supported and opposed the different bills based upon their specific provisions.

In the meantime the CSP is participating in a task force convened by the CMA Board of Trustees to try and develop some from of possible solution to avert the prospect of a more egregious solution. Those meeting continue and we expect a report to and action by the CMA Board of Trustees in the next several months. We will keep you informed.

Cal Path Facts: California Society of Pathologists

Medicare Fee Schedule Updates

The 2006 Physician Fee Schedules have been posted to the Medicare NHIC Website at http://www.medicarenhic.com/cal_prov/fee_sched.shtml You will also find the Medicare Participation Agreement, the cover letter and Key Medicare News for 2006. If you download the PDF file version of the fee schedule, you will see a “Find by Code” quick link in the upper right hand corner to assist you in locating a particular code.

The CD’s that physicians will receive this week will not contain the fee schedule this year. The Participation Agreement and other CMS information will be on the CD, as will other valuable billing information. The newsletters for the past two years will also be on the CD. If you have any questions, please contact Customer Service at 877-527-8613.

Cal Path Facts: California Society of Pathologists

Medi-Cal Cancels Lab Contracting Proposal

The Department of Health Services announced yesterday that they were canceling their clinical lab procurement or contracting proposal for clinical lab service under Medi-Cal. The Procurement and RFA process had been completed for almost one year but DHS had not announced any awarding of contracts. The CSP was aware that the evaluation of individual applications by DHS and the scoring of those proposals had been more difficult then expected.

All clinical laboratories, whether they submitted an RFA or not, will be sent a letter indicating that the process has been abandoned. You can see a copy of the letter by going to the DHS website at www.dhs.ca.gov/omcp and reviewing Administrative Bulletin 12.

DHS indicates that they will continue to explore other processes and procedures that could help them achieve their contracting goals. The specifics are unknown, but we assume those could include additional quality assurance standards and anti-fraud mechanisms. We will keep you informed and the CSP will be a part of that dialogue.

Cal Path Facts: California Society of Pathologists

Balance Billing Bill Stalls

AB 1321 (Yee) would have prohibited hospital based physicians (HBPs) from balance billing any health plan enrollee if the HBP’s hospital had a contract with the plan. In those situations the HBP would have to bill the plan or the delegated medical group if they were capitated or contracted for the enrollee’s care. The balance billing prohibition would take effect on March 1, 2006 but only if the Department of Managed Health Care had developed an independent dispute resolution system to resolve disputes.

AB 1321 did not pass the Assembly Appropriations Committee due to the estimated cost of several million dollars for DMHC to develop and implement this dispute resolution system. AB 1321 cannot be considered until January of next year and is on a two year track.

This issue continues to attract legislative interest and there is great sympathy for the patient who is caught between the plans and physicians. SB 417 (Ortiz) deals with the issue in a different way by prohibiting HBPs from engaging in a pattern of billing patients without first submitting a claim to the patients health plan, where they know or should have known that the patient has health care coverage for those services. SB 417 has passed the Senate over the objections of the health plans.

Cal Path Facts: California Society of Pathologists

State Acts to License All POLs

DHS recently mailed letters to all clinical labs indicating that all labs including POLs (Physician Office Labs) must be licensed or registered with Lab Field Services in addition to any CLIA registration/ license. We have included a copy of the DHS letter and a Q&A document which address many of the issues and questions.

When the state adopted CLIA conformity legislation in 1995 the CMA argued for the inclusion of an exemption from any fees for POLs to avoid the payment of duplicate fees under state and federal law. Since that time LFS has never imposed any state license fees on any POLs whether they existed before or after 1995. LFS withdrew their previous attempt at becoming an exempt state under CLIA due to the high administrative fees requested by the federal government.

LFS has consistently suffered from a lack of sufficient funding largely due to the exemption from any fees for POLs, which we believe number in excess of 14,000 in California. This change will provide that funding and allow the state to re-initiate their efforts to become an exempt state under CLIA. The CMA, which has strongly opposed any fees for POLs, did sponsor the introduction of legislation this year to exempt POLs from any state license fees. That bill has strong opposition from the lab community and did not move this year. It is technically a two year bill.

Cal Path Facts: California Society of Pathologists

Update on Cytology Proficiency Testing
By CSP President, David B. Kaminsky, M.D., FIAC

It is of considerable concern to pathologists nationally that annual Cytology Proficiency Testing is being implemented in 2005 based on 1992 federal regulations related to CLIA 1988 with individual punitive sanctions, ignoring serious issues about the contemporary need for or validity of proficiency testing, the mechanism of test administration and scoring, lack of field validation of test slides, the clinical relevance of the penalty-laden mandate to distinguish unequivocally low from high grade squamous intraepithelial lesions, existing quality assurance programs, and scientific/technologic advances in cytopathology such as image-guided screening of liquid based preparations that have advanced the discipline, rescinding the concept of “pap mills”; Implementation of CPT targets pathologists interpreting cervical cytology preparations as the only physician group subjected to a federal regulatory examination that effectively supersedes state medical licensing and medical specialty certification boards. Costs associated with testing and outcomes of testing are exorbitant.

Organized pathology is responding to CPT and the California Society of Pathologists is proactive in supporting federal reconsideration of implications and consequences of cytology proficiency testing. The intent is to de-emphasize the individual and evaluate the laboratory as a collaborative team, reclassify the program as a non-punitive educational pilot at least through 2007, validate the test material and modify the scoring, and redefine the periodicity of the testing procedure.

As liaison to the Executive Board of the American Society of Cytopathology , I’ve attempted to facilitate communication between the ASC and CSP leadership. Representatives of the ASC who serve in leadership roles at the CAP and AMA have collaborated for the following actions endorsed by CSP Board of Directors and Executive Director:

* The CSP is a signatory with other state pathology societies to a letter sent to the Honorable Michael O. Leavitt, Secretary of Health and Human Services, delineating the issues imposed by CPT and justifications for suggested modifications. This letter can be accessed on the CSP website.

* The Cytopathology Education and Technology Consortium has developed a document to provide guidance to CMS and other regulatory bodies regarding revisions of the Cytology Proficiency Test Regulations.

* The College of American Pathologists has introduced a resolution to retain CLIA Cytology PT Program as Educational: Excerpted from the document is this closing statement: Resolved that the AMA advocate to the relevant government agencies that the cytology PT program, implemented as a result of the Clinical Laboratory Improvement Amendments of 1988, remain as an educational pilot program at least through 2007 or until such time as the Clinical Laboratory Improvement Advisory Committee can review the scientific data and provide an opinion on the validity of the grading criteria, the clinical relevance of the grading criteria, the importance of using field validated Pap test slides and the need for a testing frequency of once a year.

Assembly Committee Passes Modified Balance Billing Prohibition

Last Wednesday the Assembly Health Committee, on a bare majority vote, passed AB 1321 (Yee) that deals with balance billing of plan enrollees by non-contracted hospital-based physicians. Last year a similar bill died in the Senate but there has been great interest in the Legislature in removing the potential liability of the patient when there is no contract between the provider and the plan and the enrollee ends up paying the charges.

The CSP is actively opposing the bill and testified at the hearing. There has also been on-going discussion at the Department of Managed Health Care (DMHC) about how to resolve this situation and how to control or remove the financial liability of the plan enrollee. AB 1321 as presented would have simply required the non-contracted hospital based physician to only be able to bill the plan or delegated responsible medical group. It said nothing about how the rate of payment would be determined.

During the hearing the bill was amended at the urging of the chair and vice-chair to require the DMHC, in consultation with interested parties, to develop a dispute resolution process by 3/1/06. It would also not allow the balance billing prohibition to go into effect until the resolution process is shown to work. We will continue to pursue amendments to this bill to require that plans and medical groups provide reasonable compensation and that pathologist’s ability to negotiate and contract are not impaired.

Cal Path Facts: California Society of Pathologists

March 13, 2005 - LASOP/CAP Educational Fund News

Hi Everyone,

The Fourth Annual LASOP Education Fund Golf Tournament will be held on Sunday, March 13, 2005. The first tee off time will be at 11:15. I am also sending you the brochure along with this E-mail. I want to emphasize the fact that the recipient of this year’s LASOP Education Fund support will be Doctor Sonali Rodrigo. She has been living in Los Angeles for the past year under the supervision of Para Chandrasoma, M.D. Sonali is going to be spending her time this year with Sue Ellen Martin, M.D. in cytopathology at USC. Sonali is from the country of Sri Lanka. You can imagine what an impact her training is going to have on the patients she will serve once she returns home. If you are going to participate this year, either by playing or making a contribution, please return a short note to me on this E-mail so that I can start to keep track of this project. Thanks again for all the support you have demonstrated in the past.

Jim Keefe, M.D.

In 2004, the following members made voluntary contributions to the LASOP/CAP Educational Fund:

Warren Allen, MD
Randi Burke, MD
Richard Henke, MD
Geoffrey Moyer, MD
Scott Binder, MD
M. Itano, MD
Jules Kernen, MD
Charles Osborn, MD
Nancy Warner, MD
Lesther Winkler, MD
Steven Romansky, MD
Jerome Wollman, MD
Patrick Fitzgibbons, MD
John Ohara, MD
John Craig, MD
Roger Terry, MD
Eric Glassy, MD
Sue Ellen Martin, MD
Alberto Marchevsky, MD
Rod Turner, MD
Spencer Nadler, MD
Nora Sun, MD
Kenneth Nieberg, MD
Roberta Nieberg, MD
Gordana Stevanovic, MD
James Keefe, MD
Carl Treling, MD
Stephen Geller, MD
Wes Naritoku, MD
Diana Rogers, MD
Najeeb Alshak, MD
George Smith, MD
John Yamashita, MD
Juan Lechago, MD

The following members have contributed to this cause thus far in 2005:

Randy Burke, MD
Diana Rogers, MD
Rod Turner, MD
Patrick Fitzgibbons, MD
Milton Drachenberg, MD
James Keefe, MD
Daniel Luthringer, MD
Scott Binder, MD
Wes Naritoku, MD
Geoffrey Moyer, MD
Roger Terry, MD
Janice Nelson, MD
Lesther Winkler, MD

Cal Path Facts: DMHC Action on HealthNet Underpayments

California Society of Pathologists
One Capitol Mall, Suite 320
Sacramento, CA 95814 (916) 446-6001, (916) 444-7462 - fax
Website: http://www.calpath.org/ E-Mail: bachermann@amgroup.us

On January 13, 2005, the Department of Managed Health Care issued a press release regarding an enforcement action taken against Health Net for failing to comply with AB 1455 regulations. According to the release, the action was a result of a six-month investigation. Attached is a copy of the press release (See pages 10-11).

The action relates to the rates paid by HealthNet for services by non-contract providers, specifically hospital based physicians, for the period 1/1/04 through 10/12/04. The rate of reimbursement for non-contract providers was 80% of Medicare. DMHC fined HealthNet $250,000 for violating the prompt and proper payment statute by using a system of payment that systematically undervalued payment. The underpayments for this period are estimated at $7-8 million.

In some cases patients may have been under reimbursed through balance billing by the non-contract provider. It appears HealthNet is instructed to reprocess the affected claims and provide proper payment. We will provide more information as it becomes available. You might also go to the DMHC website for updates at www.dmhc.ca.gov.

MARK YOUR CALENDAR November 30 - December 3, 2005 CSP 58th Annual Conference ”California Seminars in Pathology” Hyatt Grand Manchester San Diego, CA

Cal Path Facts is a benefit provided to members of the California Society of Pathologists (CSP). It is published periodically to brief members about new developments or resolutions on legislative, regulatory, or practice management issues that affect pathologists. Inquiries should be addressed to Bob Achermann at the CSP office by phone at (916) 446-6001 or e-mail at bachermann@amgroup.us.

Cal Path Facts: California Society of Pathologists 

LASOP Educational Fund News - James Keefe, MD

Hi Everyone:

I have just received a letter from Victor Lee, M.D. He is visiting Bhutan and Krishna as a representative from the Pathologists Overseas. Take a moment after you read this letter and pat yourself on the back for all the support you afforded the LASOP Education Fund and the difference we are and will continue to make for that country. Rick Davis from Olympic Corporation is now in the process of having his company donate an even more sophisticated camera for Krishna's use than the one that he already has in his possession from Nikon. While I am at it, I want to have all of you golfers save the date of Sunday, March 13, 2005. That will be the date for the fourth annual Pete Schwinn Memorial Golf Tournament at Los Verdes Golf Course.

Hi, all:

It’s my last day in Bhutan and I think the trip went quite well. I accomplished what I came for.

This all started Saturday with a 3 A.M. wake up call in Bangkok so I can get to the airport in time for a 7 A.M. flight into Bhutan. When I got there, the check in counter was almost empty and I found out that the flight was delayed until 10 am. I could have had an extra three hours of sleep! As it turned out, the flight from Bhutan to Bangkok the previous day was delayed and the flight crew (the one and only crew!) had to have their mandatory rest period before they can fly again, so they were resting peacefully in their hotel while I dragged myself to the airport in that un-Godly hour. They did take off promptly at 10 and we got in after a smooth flight. I met up with Jack and Ruth at the airport and was greeted by Krishna and Langa on arrival.

We stayed overnight at Paro and Krishna drove me in to Thimphu early Sunday morning. He had the entire histology crew come in on a Sunday to work with me, so we went straight to the lab. I unpacked all the reagents I brought with me and went over the staining principles and procedures with them. They were very receptive and the main histotech (Sumitra) caught on real fast. In fact, after she read over the written procedures, she told Krishna that it should not be too difficult to do. At 4:30, we finished our first test run but, unfortunately, it did not work. The crew did not seem too disappointed, though, and we made plans to try something else the next day.

Monday morning, I got them started with the PR and bcl-2 stains. Jack and I met with a bunch of health officials all day. They were very receptive and appreciative, now that we have established a strong relationship with them, and they promised full support for the QA and LIS programs that we wanted to help establish there. I got back to the lab at 4, just as the slides were coming out of the hematoxylin counterstain. This time, they worked! The negative tissue control was giving strong background staining with the PR so we will need to make some adjustments. Everyone was excited - we accomplished the first immuno stain in Bhutan. The Health Department gave us a dinner reception that evening.

Tuesday morning, I gave them the assignment to do CK-7, CK-20 and TTF-1. Then Jack and I headed off to see the hospital’s superintendent and medical director. We toured the rest of the lab. At noon, they had a luncheon reception at the hospital, with some clinicians and lab personnel in attendance. Unfortunately, there is no free lunch. Right after lunch, we had a ceremony where the Director, Department of Medical Services, thanked Pathologists Overseas and LASOP for the help we have given them and Jack ceremoniously presented him with a list of all the lab equipment he had donated. Then it was our turn to address the audience. Jack talked about the concept and importance of laboratory QA and I briefed them on the principles and applications of immunohistochemistry. Surprisingly, I had a very enthusiastic response from the medical staff. A surgeon commented on how useful he thinks ER and PR will be and even a psychiatrist said he was glad to see such new technology introduced to Bhutan. You all know how much I like to speak in public so you’ll know how glad I am to have this over with. Krishna and Devika (and Sanjayee) invited us to their home for dinner.

Today, is R&R. We’ll go out to the zoo/park in the morning. After lunch, I’ll go to the lab and go over the stained slides with them, with the teaching microscope, to give them some feedback and reassurance. We still need to fine-tune the procedures. Tomorrow is another 3 A.M. wake up to catch a 7 A.M. flight to Kathmandu (Thimphu is an hour and a half away from Paro where the airport is).

By the way, Jim, I got the adaptor for the Nikon camera and it seems to work very well on Krishna’s scope. We stuck it on one of his eyepieces and it seems quite stable. I’ll have to try it on their teaching scope that has a trinocular head.

Hope all is well back home.

Victor