What happens when a 50+-year-old terminology, with a long-standing, evidence-based, rigorous infrastructure, faces off against the stresses and challenges brought on by a pandemic and overnight shift in care delivery? In part one of this two-part series on Moving Medicine, guests Chris Jagmin, MD, vice chair of the CPT® Editorial Panel and chair of the CPT Assistant Editorial Board along with Mark Synovec, MD, chair of the CPT® Editorial Panel during the COVID-19 pandemic, discuss the influence of CPT in the health care system.
- Mark Synovec, MD, chair, CPT Editorial Panel
- Chris Jagmin, MD, vice chair, CPT Editorial Panel; chair, CPT Assistant Editorial board
- Leslie Prellwitz, director, CPT Content Management & Development, AMA
- Todd Unger, chief experience officer, American Medical Association
Dr. Synovec: We often joke that CPT at a trial panel is the only place where you can spend 15 minutes talking about putting in a comma someplace, but we're down to that level of detail because those things can mean millions of dollars depending on how you do that, so we have to be very deliberate with that process.
Unger: That’s Dr. Mark Synovec, chair of the CPT® Editorial Panel. In today’s episode of Moving Medicine, he's joined by Dr. Chris Jagmin, vice chair of the CPT Editorial Panel and chair of the CPT Assistant Editorial Board.
In this part one of a two-part series on Moving Medicine, Dr. Synovec and Dr. Jagmin are interviewed by Leslie Prellwitz—director of CPT Content Management and Development at the AMA. Together, they talk about how CPT evolved to meet challenges brought on by the COVID-19 pandemic and why its evolution matters in health care crises. Here’s Leslie Prellwitz.
Prellwitz: Hello and welcome to Moving Medicine. I'm Leslie Prellwitz, director of CPT Content Management and Development at the AMA. I have two special guests here with me to discuss some important questions about CPT, specifically how a 50-plus-year-old credible terminology faces off against the challenges of health care crises like the COVID pandemic. Our guests are Dr. Chris Jagmin, vice chair of the CPT Editorial Panel and chair of the CPT Assistant Editorial Board, and Dr. Mark Synovec, chair of the CPT Editorial Panel and chair during the COVID-19 pandemic. How are each of you doing today?
Dr. Synovec: We're great.
Dr. Jagmin: Doing well, Leslie.
Prellwitz: Wonderful. Great. Thank you both for being with us today. To start us off, I'd like to take some time and have each of you tell us how you progressed on your respective CPT journeys. Dr. Synovec, would you like to go first?
Dr. Synovec: Wow, it started a long, long time ago, when I had hair and it wasn't all gray. I actually got involved in the early 1990s through my specialty society, the College of American Pathologists, and I kind of got into that area about the same time that a lot of organized medicine was understanding the importance of having residents involved. So, I was one of the first residents involved in the CAP committee structure and they were looking for someone to be the CPT advisor. At that time, I barely knew what CPT was, and I said, "Sure, that sounds fun. I'm interested in getting involved." And it's just progressed from that point on.
I started out as an advisor, obviously, through the '90s and the early 2000s, and I just kept being interested and involved, and then got involved through the CPT Editorial Panel about the time that molecular diagnostics was really becoming a push to the forefront. So, that kind of threw me into a special niche that was obviously something that happened—I guess we started that process in 2009—and it continues to grow in complexity, and fortunately, we had other people helping me at the helm. One of those, including Dr. Jagmin, who's went from the family practice into molecular diagnostics, being thrust into that, but has done a great job through that. So, it's been a long run, but very enjoyable at the same time.
Prellwitz: Wow, that is amazing evolutionary story that you've got there, and that sounds like you and Dr. Jagmin have a little bit of past history. So, Dr. Jagmin, I'll ask you the same question to talk a little bit about your CPT journey. Before getting into the CPT process and infrastructure, what was your connection? Did you follow a similar path?
Dr. Jagmin: No, I didn't. Mine was a little more precipitous. I was running a coding committee for America's Health Insurance Plan, the trade organization for health plans in the United States. And I casually mentioned that I'd like to learn more about this CPT process thing someday, and they said, "Well, we'll put you in line to think about it. AHIP has a representative on the panel who serves in one of the seats." So, three days prior to the meeting in San Francisco in 2011, the nominee for that seat vacated because his company wouldn't let him do it, and I received a phone call saying, "Oh, we know it's short notice, but how would you like to be on the CPT Editorial Panel?" It was three-days’ notice. I jumped on a plane to San Francisco. I walked into a subcommittee meeting for molecular pathology workgroup, of which I was now the co-chair, and the chair or the other coach here, Dr. Synovec, was nowhere to be found. So, I had a very interesting start to my CPT career.
Prellwitz: Oh, my goodness. Well, I have a feeling that's one of those questions where you expressed an interest, and you probably got more than you ever thought you would get in terms of a response on that one.
Dr. Jagmin: That I did.
Prellwitz: Yeah. But an amazing path, an amazing path. It's very interesting. The differences that I see when talking to someone who is working in a practicing specialty versus from a payer perspective, two very different viewpoints there. Dr. Synovec, I'd like to ask you. As a practicing pathologist, you were in a unique position to see a lot of the advancements you led in CPT during this unprecedented time and we'll get a little bit more into some of the details of the COVID pandemic in a little bit. But obviously, I'm sure you saw a lot of this directly impact the work you do every day. So, I'd be very curious, in what ways does your day job fuel and inform your CPT leadership work?
Dr. Synovec: Well, that's a great question, Leslie. Obviously, there's a lot of different ways to look at it, but I can tell you from my perception. I'm obviously hospital-based and I'm practiced on the medical staff, so I'm involved in and interact with a lot of different specialties. The thing that's nice here is that when you're in CPT, Dr. Jagmin doesn't sit solely as a payor rep. I don't sit as a pathologist. We sit there as physicians for the AMA, trying to use our better or best judgment to come up with the right answers and ask the right questions for the code set.
In that process, it requires us to be knowledgeable about all these different areas because I look at every tab, and Dr. Jagmin and all the other panel looks at all those different tabs, and it forces us to stay contemporary. So, a lot of the future of medicine seems like we’re getting more and more pigeonholed and more siloed. This forces us to jump out of that. So, I clearly think I have a better understanding, than the average pathologist on what's going on in behavioral health and surgery and all the gamuts of medicine, which is really refreshing and it really helps me communicate back at the home, so to speak, to deal with those things and I think it makes us all better balanced in that process.
Prellwitz: Wow, fantastic. You raised an interesting point there, that participation in the CPT Editorial Panel process really helps you to expand your horizons beyond what you might have done had you focused specifically in the specialty that you're trained and practicing in, which raises an interesting question. Dr. Jagmin, you kind of put this together a little bit before about the aspect of surprises or things you didn't expect, and I would find it very helpful and I think our listeners would find it helpful if each of you could share any unexpected surprises that you discovered about CPT that you wouldn't have known had you not opted to become a part of the CPT process. Dr. Jagmin, I'm going to start with you on that one.
Dr. Jagmin: Yeah. I walked in and I was immediately struck by how many people were taking time voluntarily, 250, 300 people to come out of busy practices, out of busy professions, and sit and have a three or four or five-day debate about very detailed issues. That depth of understanding was beyond me, so I, as a first-year panel person, I was learning from the advisors. I was learning from people in the room, learning from my fellow colleagues on the panel. I was just surprised at how deep the expertise was. That was the number one thing for me.
Prellwitz: Okay, fantastic. Dr. Synovec.
Dr. Synovec: No. I totally agree with Chris. I think the one thing, as a practicing physician, you see the CPT code set and it's a lot. It's really easy when you're really down into a subspecialty and saying, "Well, that's the stupidest way than anybody could create a code." And it's obviously been done by a lot of people wearing suits that have no practice experience at all and you'll realize that no, there is a dumb person in the room, but it happened to be the one that was just saying that, not those other people because there are a lot of complexities in CPT coding, and I think you have to sit in that room and listen to the debates.
We often joke that CPT at a trial panel is the only place where you can spend 15 minutes talking about putting in a comma someplace, but we're down to that level of detail because those things can mean millions of dollars depending on how you do that, so we have to be very deliberate with that process. But it really is very technical, and like Dr. Jagmin said, we try to get everybody in the room to provide all of their expertise, so we can come up with the best possible answer.
Prellwitz: Okay. Fantastic answer. From a staff perspective, I would agree with you, Dr. Jagmin. Just the prospect of seeing hundreds of amazing minds coming together on a volunteer basis to make this happen is truly astounding. It really is. It's also interesting how that process sustained itself during the COVID pandemic. So many of us, we had a shelter in place and quarantine and travel restrictions of all types, and I'm sure that had an impact on the CPT process itself.
So, I'll ask both of you, but Dr. Synovec, particularly your perspective as chair, I'd really like to hear how you saw CPT change to address those stresses and challenges during the pandemic. It's a very rigid structured process. That's part of its strength. But how that needed to flex to meet the pandemic challenges, a little bit about that process was like and what you saw in terms of some of the changes that take place, certainly a change in process, but possibly a change in mindset as well. So, I'd like to hear your opinion on that. And then, Dr. Jagmin, I'll ask you the same question.
Dr. Synovec: Well, it was an interesting time to be the chair of CPT, to say the least. I still remember because we were actually at a CPT Editorial Panel meeting in San Francisco in February 2020, and we were trying to figure out what is this COVID thing all about and what are we going to have to do. Before this, we had a fairly structured ... I mean, we had three meetings a year essentially, aside from some ancillary meetings. Very structured through that process. I remember talking to some of the people in the government and saying, "Well, we think we're going to need a code for testing." And we said, "Well, what do you really want for a code?" And they kind of gave us some ideas but really didn't have an idea because nobody did at that time, and it's like, "Well, when you guys figure that out, let us know," because that's the way CPT works. It's like you said, "Submitted application." And then, we work with that.
Retrospectively, that was the wrong answer to that question because we really needed to work with them, and I think February 2020 will be a day that lives on in infamy for CPT along with a lot of our country or the world for that matter. But we really realized that we had to mobilize and we had a central function in health care. We needed to provide a coding set and we needed to be rapid. So, we started having multiple virtual meetings whenever we needed those. We activated the editorial panel, executive committee, to help us with that, just because it's so hard to get so many people together at the same time. Through that process, we'll never go back to that more structured. We become a lot more nimble by necessity, but we still need to maintain that integrity, so we constantly battle that. We want to go as fast as possible. We need to get it right the first time as well. And sometimes the horizon is very cloudy, as you know, and it's very difficult.
Then we go back to our structured meetings, which we also had because it wasn't just COVID that was going on. There was technology and changes also happening, so we had to go to a virtual format. Our favorite story about that is we had our first virtual meeting. I tried to do it from home. I live on the farm. A thunderstorm went through and I started, and all of a sudden, Dr. Jagmin was thrust to chair because I lost my internet connection. So, there were a lot of interesting stories in that process, but it's so nice to be able to get back and have the in-person meetings because the quality's just so much better. Yeah. The interaction's better. Hopefully, we can get back to normal and see this different but somewhat more familiar.
Prellwitz: Okay. Deal. Dr. Jagmin, your thoughts?
Dr. Jagmin: Yeah. I work in a corporate environment where virtual meetings are the norm and face-to-face meetings are an exception. So, for me, the technology and such was not so much of a change. However, shepherding all those folks who have diverse interests in a virtual environment where some people tend to speak up, some people tend to fade away, some people don't want to participate. So, it became one of my roles, I think, as vice chair was to make sure every person got an opportunity to speak and we slowed things down, that we asked for more questions because when we're face to face and you can see the verbal cues and see the visual cues, hear the verbal cues, wow, it's a different environment. But once we're virtual, you really can't rely upon that as well, so we had to learn on the fly what works in this large environment.
Prellwitz: Very interesting and I think I hear that echoed with many people who had to move to a virtual world. There's the meeting you see and the meeting you hear, and they're not always exactly the same meeting. You're right. It's almost like one of your senses has been taken away and having to relearn that and bring everyone along is quite the task.
Prellwitz: Well, it was a pleasure speaking with both of you today. Thank you so much. I'm Leslie Prellwitz and thank you for joining us on Moving Medicine.
Unger: Join us soon for part two of this conversation on Moving Medicine. You can subscribe to Moving Medicine and other great AMA podcasts anywhere you listen to yours or visit ama-assn.org/podcasts. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.