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Membership Matters

Explore the early beginnings of the American Society for Clinical Laboratory Science (ASCLS) and the clinical laboratory science (CLS) profession. Learn about the development of public health labs, the challenges faced by women in entering scientific careers, and the progression towards greater autonomy for medical technologists.

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Membership Matters

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  1. Membership Matters ASCLS Recruitment Series Part I

  2. History of ASCLS and the CLS Profession

  3. CLS - The Beginning • Can be traced back to the early 1900s • Development of public health labs to help combat the outbreak of infectious diseases • Employed women • Had been discouraged from entering scientific careers • Women’s conceptual abilities were considered to be inferior to men’s • Were willing to work for low wages January 2, 2020 3

  4. CLS – The Beginning • 1919 – American College of Surgeons • Wanted to assure minimum standards for hospital care • Must establish a clinical laboratory • Must have a physician in charge, preferably a pathologist

  5. CLS – The Beginning • Early 1930’s • American Society of Clinical Laboratory Technicians (ASCLT) formed • Membership limited to BOR certified professionals • Inception of a Journal • Establishment of a Constitution and Bylaws • Began educating the public about the profession • Placed emphasis on importance of medical technology becoming a profession January 2, 2020 5

  6. ASCLT to ASMT • 1936 • Changed name from ASCLT to American Society of Medical Technologists (ASMT) • 500 members in 1937 • Held an annual convention • Appointed Advisory Board to meet with BOR • 1939 • First State Charter • Texas Society of Medical Technologists January 2, 2020 6

  7. ASMT and the BOR • Before 1940 • Membership in BOR restricted to pathologists who were members of ASCP • 1940 • BOR amended constitution to allow MTs on the BOR with advisory duties only, no voting rights • Allowed 2 MTs from ASMT • Appointed 3 MTs at large • 1946 • BOR permitted the addition of 1 ASMT member for a total of 3 ASMT members January 2, 2020 7

  8. ASMT and the BOR • 1948 • Board of Schools (BOS) took over the BOR’s accreditation function • Elected Board • 6 members of ASCP and 3 members of ASMT • 1949 • Allowed full voting rights to MTs • Total of 5 MTs • Total of 6 Pathologists

  9. Standards and Studies Research Legislation Finance Education ASMT Moves Toward Independence • 1947 • ASMT held its first annual meeting independent of physicians’ organizations • 1948 • Established Committees • Education and Research • Publications and Awards • Membership • Constitution and Bylaws • Nominations and Elections January 2, 2020 9

  10. Developing Professional Identity • 1945-1962 • Membership grew in ASMT • Diminished its reliance on ASCP for annual meetings and continuing education • Provided more services for its members • Expanded its range of activities • Late 1950’s • Took first steps toward seeking governmental recognition through personnel licensure laws • Educational qualifications • Scope of practice January 2, 2020 10

  11. ASMT the Professional Organization • 1958 • Well-defined organizational structure • Purpose: • to promote higher standards in clinical laboratory methods and research; • to elevate the status of those specializing in medical laboratory technology; • to create mutual understanding between the medical technologist and the physicians and all others who are employed in the interest of individual or public health; • to issue charters to constituent societies; • to promote the mutual aid and benefits of its members. January 2, 2020 11 By-laws of the American Society of Medical Technologists. Am J Med Tech 1958;14:1-15.

  12. 1960s – 1970s: Greater Autonomy • Legal actions • 1968 – Supreme Court of New Jersey • Set limits on the BOR’s control over MTs • BOR could not revoke certification of a MT if they decided to work in a laboratory operated by non-physician bioanalysts • 1969 – U.S. Department of Justice • Forbade the practice of decertifying personnel working for non-physicians • Annual registration became voluntary January 2, 2020 12

  13. 1960s – 1970s: Greater Autonomy • Legal actions (continued) • Justice Department criticized ASMT by saying the organization was “too supine and docile” • ASMT demanded equal representation on the BOR for MTs for the establishment of policies and procedures affecting accreditation and certification • ASMT advocated that the BOR be independent from both ASMT and ASCP • 1969 • Dr. William Selden, former Executive Director of the National Commission on Accrediting state that • A professional association must have full responsibility for admission of its members • This supported ASMT’s advocacy for independent certification processes January 2, 2020 13

  14. 1960s – 1970s: Greater Autonomy • 1973 • Commissioner of the U.S. Office of Education and the National Commission of Accreditating • Said BOS should have an autonomous relationship with ASCP • ASCP disbanded BOS • 1974 • National Accrediting Agency for Clinical Laboratory Sciences was formed • 1977 • National Credentialing Agency for Laboratory Personnel was created

  15. ASMT in the 1970s • Grew in numbers • Over 30,000 in 1976 • P.A.C.E was introduced • Documentation of continuing education • Provided graduate programs • In conjunction with Central Michigan University • Future Direction Plan • Statements of competence • Arranged for the introduction of the annual National Medical Laboratory Week • Increased public awareness of profession • Members testified before congressional committees • Changed name from America Society of Medical Technologists to American Society for Medical Technology January 2, 2020 15

  16. ASMT in the 1980s • More involvement in national politics • Started • Clinical Laboratory Educators Conference • Legislative Symposium • Moved office from Houston, Texas to Washington, D.C. • Became more involved in legislation that would advance the profession January 2, 2020 16

  17. ASMT/ASCLS in the 1990s • ASMT became the American Society for Clinical Laboratory Science (ASCLS). • Joined forces with the American Association for Clinical Chemistry (AACC). • Holds one of the largest annual meetings and vendor expo’s in the country • Provided input to the National Labor Relations board. • Medical Technologists were finally recognized as PROFESSIONALS January 2, 2020 17

  18. What Has ASCLS Done for Us ? • Over the Past Seven Decades, ASCLS has: • Advocated for the profession • Set standards • Provided education (professional and continuing) • Influenced legislation that impacted the field of clinical laboratory science • Fought for the rights of laboratorians • Has represented the best interests of laboratorians as individuals and collectively January 2, 2020 18

  19. References • Kotlarz, V. R. Clinical Laboratory Science, 1998 • Vol 11, No 1, pp 5-7 • Vol 11, No 2, pp97-100 • Vol 11, No 3, pp 161-166 • Vol 11, No 4, pp 209-213 • Vol 11, No 5, pp 275-279 • Vol 11, No 6, pp 339-345 • Kotlarz, V. R. Clinical Laboratory Science, 1999 • Vol 12, No 2, pp 91-97 • Vol 12, No 6, pp 336-341 • Kotlarz, V. R. Clinical Laboratory Science, 2000 • Vol 13, No 3, pp 166-171 • Kotlarz, V. R. Clinical Laboratory Science, 2001 • Vol 14, No 1, pp 13-17 • Karni, K. History of ASCLS. • Retrieved from http://www.ascls.org/docs/HistoryofASCLS.pdf January 2, 2020 19

  20. Benefits of Being an ASCLS Member

  21. Continuing Education Matters • Audio conferences • Workshops • Online Courses • Journal Quizzes • CD-Rom • Online CE Organizer January 2, 2020 21

  22. Scholarships / Awards • Education scholarships (including graduate) • Research grants • Leadership, authorship, and membership awards January 2, 2020 22

  23. Networking Matters • National Meeting and Exposition • State Society Meetings • Local Branch Meetings • Social Events • Networking Opportunities January 2, 2020 23

  24. Membership Perks • Discounts on credit cards, hotels, and car rentals • Insurance Programs (health, liability, auto) • Real Estate commission rebate January 2, 2020 24

  25. Publications • Clinical Laboratory Science (quarterly journal) • ASCLS Today (monthly newsletter) • State Society Newsletters January 2, 2020 25

  26. Legislation Matters • Legislative Symposium • Liaisons to Congress, Federal, and State Agencies • Monitor and influence laws affecting profession January 2, 2020 26

  27. Invaluable Resources • Scientific Assembly • Forums • Library • Online bookstore • Clinical Laboratory Marketplace • Website links January 2, 2020 27

  28. Advocacy Matters ASCLS is our voice for the following issues: • CCCLW – workforce shortage • Doctoral Level CLS professional • Personnel Licensure • NCA and ASCP BOR Credentialing Initiative • Medical Laboratory Errors and Safety • Scope of Practice • Career Ladder Task Force January 2, 2020 28

  29. Leadership Matters • Leadership Academy • Networking • Opportunities to serve the society in many capacities • Committees • Task forces • Executive officers January 2, 2020 29

  30. Legislative Issues facing ASCLS and the Profession

  31. Current Issues • Competitive Bidding • Laboratory Fee Schedule • Workforce Shortage and the Allied Health Reinvestment Act • State Licensure • What Can You Do? January 2, 2020 31

  32. Competitive Bidding Defined • A method for setting the price of health care services through a bidding process in order to establish payment rates based on the lowest price submitted by providers. Medicare would require that its beneficiaries’ lab work be outsourced to the “winning bid” sites. January 2, 2020 32

  33. Competitive Bidding Congress and the Centers for Medicare and Medicaid Services (CMS) have considered competitive bidding for procurement of Medicare laboratory testing services as one possible measure to reduce cuts to the Medicare program. January 2, 2020 33

  34. Competitive Bidding • In 1985, the Secretary of Health and Human Services issued a request for proposals to establish demonstration projects for the provision of clinical laboratory services for Medicare beneficiaries on a competitive bidding basis. • The Budget Reconciliation Act of 1985 prohibited any such projects. January 2, 2020 34

  35. Competitive Bidding • The Balanced Budget Act of 1997 lifted the prohibition and permitted CMS/HCFA to develop demo projects on competitive bidding. • Up to 5 demos were mandated, one being laboratory services for Medicare Part B. • This marks the first time a lab demo made it into law. January 2, 2020 35

  36. July 1, 2008--Demonstration would be initiated Fall 2008--Second demo site to be selected Competitive Bidding • October 2007--San Diego-Carlsbad-San Marcos MSA selected as first demo site • February 2008--Bids were submitted • April 11, 2008--Winning labs would be notified January 2, 2020 36

  37. Competitive Bidding • FY 2009 budget calls for a competitive bidding PROGRAM prior to the completion of the demo, and a 5% decrease in reimbursement for these services. January 2, 2020 37

  38. Competitive Bidding • Covers 330 most commonly ordered tests. • All beneficiaries permanently living in designated ZIP code. • Excludes ESRD bundled tests. • Beneficiaries who travel outside the area will be able to obtain testing, but the lab will be reimbursed at the demonstration fee schedule rate. January 2, 2020 38

  39. Competitive Bidding • Criteria for Demo sites • Single state with 1-4 million total population • Medicare population 100,000-400,000 • Medicare managed care population 5-50% January 2, 2020 39

  40. Competitive Bidding • Definition of non-patient varies depending on issue. • Bid package says non-patient has specimen drawn by hospital personnel but not registered as an in- or outpatient. • Medicare manuals have multiple definitions: • Patient whose specimen is drawn and sent to hospital for analysis • Patient who is neither in- or outpatient; has specimen submitted for analysis but is not present January 2, 2020 40

  41. Competitive Bidding Patient having blood drawn in hospital collection site is considered outpatient for Medicare Secondary Payer (MSP), but is considered non-patient for competitive bidding. January 2, 2020 41

  42. Competitive Bidding • Participation determined by whether participants live in ZIP codes included in MSA. • If a lab’s volume increases, and the $100,000 ceiling is exceeded by $25,000 or more, that lab cannot continue to do testing covered in the demonstration. • If subcontractor loses as a prime bidder, lab can provide testing as a subcontractor but cannot bill Medicare directly. January 2, 2020 42

  43. Competitive Bidding • Winning bidders must agree to demonstration terms and conditions • Includes a requirement to serve all beneficiaries in an included ZIP code. • Labs will not be able to pick only those patients they want to serve. • Significant for nursing homes in that large national labs characteristically do not serve nursing home patients; large labs will have to develop new relationships to serve nursing homes. January 2, 2020 43

  44. Competitive Bidding • Will CMS terminate demonstration if patient care suffers? • What provisions have been made for national disasters? • Restrict Physician choice • No connection to electronic medical record • Physicians required to use even more laboratories for their patients January 2, 2020 44

  45. Lawsuit Against Demonstration • 3 San Diego area laboratories, Sharp HealthCare; Scripps Health; and Internist Laboratory of Oceanside, filed suit against U.S. Department of Health and Human Services (HHS) on January 29, 2008. • Plaintiffs assert: • HHS failed to follow required rulemaking process, adequate input not obtained from all stakeholders • Inadequate protection for small business • Demo will cause irreparable harm to Medicare beneficiaries and labs • Requested temporary injunction to stop project January 2, 2020 45

  46. Lawsuit Against Demonstration • Court denied injunction February 14, 2008. • Labs sought another injunction to block project and asked CMS to return bids submitted in February unopened. • At hearing on April 8, 2008, the court granted a preliminary injunction (PI). January 2, 2020 46

  47. Lawsuit Against Demonstration • According to PI, CMS was not to: • Proceed with implementation of the demonstration project in San Diego • Announce the winning bidders on April 11, 2008 • Disclose information on any bids submitted • The injunction will stay in place until there is a full trial on the merits of the case.

  48. Competitive Bidding Repeal ? • Congressional Repeal • Attempted to add legislation to Medicare bill at end of 2007, but Congress extended provisions until their next session. • On June 24, 2008, the House passed the Medicare bill H.R. 6331 approving a repeal of the demonstration project. • On July 9, 2008, the Senate passed Medicare legislation by virtue of a cloture vote 69 to 30. • If this bill becomes law, it would repeal the demonstration project for clinical laboratory services.   January 2, 2020 48

  49. Fee Schedule • Fear is that bids submitted in the San Diego competitive bidding process could be used to reset the fee schedule. • Currently using the same fee schedule established in 1984. • Original agreement was that co-payment would be dropped if fee schedule was instituted. • In 1984 the fee schedule was set at 115% of the median fee, now at 74%. January 2, 2020 49

  50. Fee Schedule • Balanced Budget Act of 1997 eliminated the CPI increase for lab tests from 1998 through 2002. • Subsequent freezes to the fee schedule have been applied since that date. • The current freeze will expire December 31, 2008. • Legislation is ready to be introduced in July proposing a restructuring of the fee schedule. January 2, 2020 50

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