One of the goals of the order is the improvement in the transplant pipeline. Since histocompatibility is so critical for transplants to occur, we are in the frontline of that process. Maybe we should use the momentum to become more visible and proudly expose our important contribution to the organ allocation in the transplant process and to patients affected by ESRD pre- and post-transplant.

Furthermore, maybe this is the right time to resume our old battle for PhD directors/clinical consultants to be able to bill for the professional component related to test interpretations and virtual crossmatches/immunological assessments. If our expertise is required, why we cannot be appropriately compensated?

Well, do not think I do not know the old and silly excuse “because we are PhDs, not MDs”. What about the clinical psychologists, they are PhDs and still can bill Medicare for the professional component according to the CMS regulatory exception in terms of who can provide the supervision for psychological tests. This regulation allows both, a clinical psychologist (CP) or a physician, to perform the general supervision assigned to diagnostic psychological and neuropsychological tests, which is, basically, the interpretation of the test to reach a diagnosis.

The truth is that our services are needed and will be needed even more after this executive order takes effect. We all love what we do and I am sure many of us will still do it even in the absence of compensation; such is the passion that we feel for our field and for helping people in need. However, in view of justice and fairness, we should continue pursuing and fighting this battle. The most fundamental principle of justice defined by Aristotle more than two thousand years ago is the principle that “equals should be treated equally”. In its contemporary form, this principle could be expressed as “Individuals should be treated the same, unless they differ in ways that are relevant to the situation in which they are involved”. Hence, the obvious question is: How our role as PhD HLA lab directors/clinical consultants differ from the role of MD HLA lab directors/clinical consultants? The obvious answer is “there is no difference” and yet, PhDs cannot be compensated while MDs, in the very same role, can.

  You make so many good points that it's hard to really comment on just one!  Personally, I believe the action of an executive order for kidney treatments is the wrong one, but, given how badly the government is broken, what else is there?

  ASHI, through the Directors' Affairs Committee and the National Clinical Affairs Committee has begun trying to influence all of the policy and decision makers that we can think of.  Through our government affairs advisers at Polsinelli, we are identifying key legislative players and making efforts to contact them. 

We have been more reactive that proactive because we've been mostly commenting on pending and proposed legislation, especially extending Medicare coverage for post-transplant immunosuppressives, the hare-brained attempt to change the organ allocation system by creating yet another layer of bureaucracy for UNOS and OPOs to jump through, and the attempt by FDA to regulate clinical laboratory tests as "medical devices".

  Your point about allowing PhDs to bill professional component test interpretation is an excellent one, and, potentially workable now, in light of virtual crossmatching.  We're still (since 2014!) waiting for CMS to rule whether a virual crossmatch is allowed under CLIA. 

But, if it is allowed, is it a clinical test?  I have thoughts that go both ways, but, I do know one thing, it is an interpretation and a clinical opinion.  If some PhDs can bill for clinical interpretations, then all should, provided the PhDs, in this case, meet the CLIA requirements.

  I am rotating off of the NCAC at the ASHI meeting.  John Schmitz will be the next chair of the committee.  I will bring this to the NCAC's attention as a future work item and let the Polsinellt group know that this is an important area to look at.

Mike