September 26, 2019 -- ORLANDO, FL - Nowadays, it's hard to think of a disease process that the clinical laboratory doesn't outright diagnose or manage. But it hasn't always been that way, commented Dr. Patrick Godbey, the new president of the College of American Pathologists (CAP), in an interview at the organization's annual meeting.
Godbey was inaugurated as president at the meeting, which was held from September 21-25 at the Gaylord Palms Resort and Convention Center in Kissimmee, FL, near Orlando. On opening night, he was welcomed in a Kentucky Derby-themed party.
Godbey graduated from the Medical College of Georgia in Augusta in 1979, specialized in obstetrics and gynecology, and later switched to anatomic and clinical pathology. Speaking to LabPulse.com, he noted many of the transformations in patient care made possible by lab tests. Back in the late 1970s, if a pregnant woman presented with pain and bleeding, an ectopic pregnancy would be suspected and a culdocentesis was typically performed. During a pelvic exam, a spinal needle was inserted through the back of the patient's vagina into the peritoneal cavity to look for blood.
"This was a horrible procedure," he recalled.
Now, Godbey went on to say, the diagnosis is made using a blood test performed in the laboratory, aided by ultrasound. And because of the availability and use of this blood test, many unnecessary surgical procedures can be avoided.
That's just one example of how the lab is at the center of managing patient care. Down syndrome used to be diagnosed by clinical features at birth, whereas today a chromosomal blood test does the job. Hypertension? It's the lab that tells you the damage done and when to go on dialysis. Chest pain? A lab test can show that it's a myocardial infarction.
"It's an exciting time to be in the lab business," Godbey said.
In oncology, lab tests are increasingly being used to guide targeted treatment with expensive drugs, based on mutation status. The CAP meeting featured several sessions on oncologic companion diagnostics, including the interpretation of results for programmed cell death ligand 1 (PD-L1), a key biomarker for immunotherapies.
"We don't prescribe medication, but we decide whether that medication will work or not," Godbey said.
There was a heavy presence of pharmaceutical companies at CAP 2019, continuing a trend seen over the past five years. The top sponsors were AstraZeneca, Merck, Roche, and Bristol-Myers Squibb.
"That's indicative of the tremendous changes going on in medicine and that the foundation for medicine is pathology," he said.
CAP has extensive continuing medical education offerings to help pathologists keep pace with changes in the field, as well as partnerships with other specialty organizations, such as the American Society of Clinical Oncology.
Clinician and CEO
Godbey is the founder, CEO, and laboratory director of Southeastern Pathology Assoc., a practice of 45 board-certified pathologists in Brunswick, GA, which has a population of about 16,000 people. He said that during residency he rotated through a lab, and he maintained close contact with pathologists when he entered practice as an ob/gyn. Then he made his own switch into anatomic and clinical pathology.
"Many of the people I work with every day I delivered," he said. "It's very rewarding."
Godbey is also a faculty member at the Medical College of Georgia, and he has been a member of CAP for 25 years. He has played an active role in advocacy during his tenure: He was a member of the organization's board of governors from 2011 to 2017 and has been chair of CAP's Council on Government and Professional Affairs, which oversees legislative and regulatory advocacy initiatives.
CAP's top advocacy issue, Godbey said, is balance billing legislation. Four bills have been introduced on the federal level that address surprise billing for out-of-network expenses. CAP wants to ensure that patients are held harmless by insurance companies that refuse to pay for laboratory treatments when a hospital is in-network but pathologists are out-of-network, he said. CAP participated in a day of action by U.S. physicians in July, encouraging pathologists to call their representatives in Congress directly and communicate their concerns about out-of-network bills.
"We want to make sure patients have access to pathologists in their network," Godbey said.
CAP is also pushing for fair compensation and an arbitration process for pathologists and insurers to negotiate rates. The organization's agenda also includes defending pathologists against draconian cuts by Anthem Blue Cross and Blue Shield, and the Protecting Access to Medicare Act's effects on payments for lab services is another big concern.
"Decisions made now by the lab have more and more of an impact on patient care, and it would be horrible if patients -- because of untenable reimbursement schemes -- couldn't have access to that," Godbey said.
Meanwhile, CAP has been active in helping members respond to the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), which established the Merit-Based Incentive Payment System (MIPS) for Medicare and Medicaid services, effective this year. Among other things, CAP developed a Qualified Clinical Data Registry (QCDR) with pathology-specific metrics as a tool to help members comply with the new payment system and provided guidance on the improvement activities required with the new system.
"Some people say MACRA is going to go away, but in my opinion it's not," Godbey said. "We need to learn to live with it, and the best way for pathologists to learn to live with it is through the CAP's QCDR."