CAP 2013 Financial Information horror-show

[AFM]

We have discussed CAP's financial information here before.

Pathologyblawg has posted with their financial information for 2013.

Here is my comment from over there.

CAPE
(College of American Pathologist Employers)

CAP cannot continue to masquerade as an organization that advocates in the interests of individual pathologists. The organization's revenue generated from LIP and accreditation are 45x the revenue from member dues.

If you wonder why CAP continues to call for expansion of GME pathology positions despite a horrific job market and inability to fill programs with American medical graduates, I think the revenue numbers are revealing (even moreso if you think the dire warnings about the so-called 'retirement cliff' are complete bunk). CAP's position is in support of the large laboratories and pathologist employers who have a vested interest in maintaining an expanded supply of pathologists to drive labor costs and bargaining power down. Their advocacy is directly opposed to the interests of individual pathologists who are directly at risk of decreased wages in the face of commodity work output by foreign medical graduates willing to accept down-market wages.

It is quite apparent that the C-suite executives running CAP with grossly inflated salaries know that pathologist employers are the ones paying the LIP/accreditation bill.

If you believe CAP is an organization that you can trust to advocate on your behalf, I would not be so certain.

---

Members don't see this ad.

 

[Over9000]

They won't see a cent from me. I urge you to eschew their accreditation as well, opting for alternatives.

 

[2121115]

The CEO and chief marketing officer both get a housing allowance? While making $1.2 million and $544k respectively?

Lol.

Wow. Just wow. Unreal.

 

[Thrombus]

This is nothing more than abuse of the system that is so prevalent in government and it's friendly regulatory agencies. There is ZERO accountability. If one were to show up and protest these outrageous salaries at the next CAP meeting for chief junk e-mail and mail officer, one would be regulated to death, de-certified, de-licensed, and possibly sent to prison.

 

[Over9000]

CAP accreditation, as a whole, is not technically required for anything legally, hence the numerous pod-labs operating without the CAP seal of approval. CAP's marketing has convinced the unwashed pathologist masses that their accreditation is the gold standard. This is patently false, and is very costly in more ways than just the obvious one.

I urge those who manage labs to switch to JCAHO accreditation. According to a poster on the blawg, MGH is JCAHO accredited.

The only concern the CAP has is lab accreditation. Let's take it away from them. The membership should be the CAP's highest priority, not accreditation.

 

[scienceguy19]

Check out the linked in profile of the CEO of CAP.

https://www.linkedin.com/pub/charles-roussel/4b/721/739

"Lead second largest US medical association (in revenues) with 625 employees and customers in over 90 countries. CAP is the world leader in laboratory quality assurance and proficiency testing. Since 2008, CAP revenues have grown 28%. We’ve increased the number of labs we accredit by 13% and are the largest provider of continuing medical education among pathology specialty societies."

He's not even a pathologist but a businessman. Maybe he has some special relationship with the big business executives at the reference labs. Perhaps to increase the supply of pathologists to pay us low wages

Partner and Managing Partner
Accenture
1988 – 2004 (16 years)
Founded Mergers, Acquisitions, and Alliances practice; led global consumer electronics practice; counseled clients on large scale change programs.

 

[Zarniwoop]

Do any of you know if other specialty societies have such a blatant financial incentive to advocate for the few instead of the masses?

 

[Over9000]

Hit them where it hurts. Stop all proficiency testing and accreditation through CAP. Use another organization.

It is shameful, embarrassing, and antithetical for physicians to be represented by such an organization. Whereas our specialty society should exist to improve the practice of pathology and its impact on patients, it currently exists to sell accreditation services. We are represented by salesmen. The derms are not. The surgeons are not. The internists are not. We are.

The ABIM is getting its butt kicked in because its members are unhappy about MOC requirements. I cannot even imagine what would happen if a specialty society for physicians with cojones decided to concentrate on selling inspections rather than actually, you know, representing the specialty.

Their focus explains a lot about our specialty and where it is today - the oversupply, the weak FMG labor market, the proliferation of corporate labs and podlabs.

We need a specialty society that stands for the specialty. CAP does not.

Stop paying them a thing.

 

[Zarniwoop]

So does this mean I should question the results of the CAP-funded study proving that in office labs are unethical?

Is there anything the CAP does that is a positive for the unwashed masses of pathologists? Perhaps free dotting pens at USCAP meetings?

 

[AFM]

Another post was also put up over there with more information.

I looked up the 990 tax form for the American Academy of Dermatology, an organization that does an amazing job of advocating for their members.

Their CEO gets paid $326,644.

Here's my comment from over at the pathologyblawg:

A, thank you very much for shining some much needed light into the financial aspects of CAP. It is an organization that has aligned its interests with those of the largest contributors to their revenue: large laboratories employing pathologists.

Pathologist employers have an incentive to keep an excess of pathologists in training. The presence of excess pathologists in the job market depresses wages for those pathologists, especially when a number of the pathologists are foreign medical graduates willing to accept below-market salary in exchange for a position.

Since CAP’s revenue is largely driven by laboratory improvement and accreditation it is not dependent upon member contributions. This situation creates a perverse incentive for CAP to advocate against member pathologists in the setting of labor and compensation issues. Their projected retirement and workforce estimates fail to account for both likely technology-based productivity gains and decreased specimen submission scenarios. Yet, they continue to call for increased GME funding and training spots. This directly benefits large academic labs that get cheap grossing labor in the form of foreign medical graduates (GME spots are routinely filled by <50% American graduates).

Bottom line, CAP does a terrible job advocating for individual member pathologists.

If you would like a look at a professional organization that does a fantastic job advocating for its members, check out the American Academy of Dermatology. Their form 990 can be found online by going to:

http://foundationcenter.org/findfunders/990finder/

and searching for dermatology.

Their CEO/executive was compensated only $326,644.

 

[path24]

The people running the top pathology organization exploits pathologists. MBA>MD in the world of pathology. Screw pathology I want to work for cap!

Have we reached the bottom? Academics, cap, ascp....will get us lower don't worry. It will get worse.

 

[Over9000]

http://pathologyblawg.com/pathology...ds-disclosure-financial-information/#comments

Did you check out the official response from the CAP regarding the financial information?

It answers nothing.

What is this "best practices" approach they speak of when it comes to executive compensation?

Did you also notice that they encourage email inquiries through CAPconnect/email, rather than answering through public discourse? If there's one thing I know about email, it is a great way to be ignored. Furthermore, individual responses are more likely to stay secret than public postings. Less need for them to have to defend their positions.

Is what they're doing legal? As a not-for-profit, they sure make a lot of money, and their primary not-for-profit mandate which is supposed to be specialty representation pales in comparison to their efforts in highly profitable lab accreditation activities. Should the IRS be informed of that fact? It sounds like it may fall under the umbrella of a true for-profit enterprise which would cause it to be subject to numerous taxes and unpaid backtaxes, and maybe even a few fraud charges.

Before anyone mentions that the CAP is our biggest ally on Capitol Hill, realize that pathPAC, our lobby organization, has had less funding granted to it (approx 250k) than Charles Roussell's air travel expenses (500k). Of the 174 million dollars in CAP revenue (if my memory is correct), less than 1 percent of it is going towards federal representation. Contrast this with radPAC which raised 1.2 million in 2012.

 

[JeSuisPathology]

What is this "best practices" approach they speak of when it comes to executive compensation?

This mentality is rampant all over academia, of course including "nonprofit, tax-exempt" powerhouse institutions.

Read the following article: http://www.cancerletter.com/articles/20150417_2

As per MD Anderson Cancer Center’s "officials": “Understandably, our faculty and leadership are compensated at a higher level than some other cancer centers.”

MD Anderson officials said its Human Resources department reviews market surveys, which include Towers Watson Top Management Survey, Mercer Benchmark Database–Executive, and Mercer Integrated Health Networks Compensation Survey.

"Our goal is to set wages at a fair level." -this is with regards to the president projected to make over $1.8 million, executive VP over $1.6 million, and physician in chief over $1.3 million.

Must be nice to be oh so personally profitable at America's premier nonprofit cancer center.

"It receives additional taxpayer dollars through federal and state grants and contracts. It also benefits from generous philanthropic gifts from private and corporate donors. If the six MD Anderson senior executives were paid even one-half of their current salaries, they would be more than adequately compensated for what they do. The $4.5 million savings could then be used to provide annual bonuses of $3,000 each for the 1,500 most deserving employees, those who work in the trenches and give their all to the mission of MD Anderson.

Alternatively, it could be used to support the cancer treatment bills of 150 needy families, each to the tune of $30,000."

 

[Over9000]

This mentality is rampant all over academia, of course including "nonprofit, tax-exempt" powerhouse institutions.

Read the following article: http://www.cancerletter.com/articles/20150417_2

As per MD Anderson Cancer Center’s "officials": “Understandably, our faculty and leadership are compensated at a higher level than some other cancer centers.”

MD Anderson officials said its Human Resources department reviews market surveys, which include Towers Watson Top Management Survey, Mercer Benchmark Database–Executive, and Mercer Integrated Health Networks Compensation Survey.

"Our goal is to set wages at a fair level." -this is with regards to the president projected to make over $1.8 million, executive VP over $1.6 million, and physician in chief over $1.3 million.

Must be nice to be oh so personally profitable at America's premier nonprofit cancer center.

"It receives additional taxpayer dollars through federal and state grants and contracts. It also benefits from generous philanthropic gifts from private and corporate donors. If the six MD Anderson senior executives were paid even one-half of their current salaries, they would be more than adequately compensated for what they do. The $4.5 million savings could then be used to provide annual bonuses of $3,000 each for the 1,500 most deserving employees, those who work in the trenches and give their all to the mission of MD Anderson.

Alternatively, it could be used to support the cancer treatment bills of 150 needy families, each to the tune of $30,000.".

We have to do something about the CAP's structure. It's not becoming of a professional society. MDA might be corrupt, but we at least have some power to weaken the CAP, and that's by stopping all PT and accreditation. Paying for membership is a waste of money which is why you should stop; even if the CAP had no members, it would still survive quite on the PT profits. To hit them where it hurts, stop utilizing them for PT/accreditation. Don't pay them a cent.

 

[yaah]

This has been the increasing trend in most administrative fields over the past decade, it is far from limited to the CAP. You can blame increasing complexity or competition or whatever, but it is a definite trend. More adminstrative positions are created, and the compensation for those at the highest level keeps increasing because many of these executives bounce from job to job and play them off of each other. Then when they become successful enough they sit on the board. And the board then perpetuates the system. It's like politics.

If it were up to me, salary/pay for executives at places like the CAP would be directly tied to reimbursement/pay for practicing pathologists. Thus, when revenue declines significantly, so does reimbursement/pay for higher administration. But the opposite seems to be happening. Declining reimbursement leads to more need to cost cut, more need to cost cut leads to more need for adminstrators to organize this. More need for administrators to organize this leads to bonuses and incentives to do so, which leads to higher pay for administrators.

But I agree, the concept of a "housing allowance" for senior executives is something I essentially find offensive. If you're making north of $500k, you don't need a housing allowance. If you want to live somewhere else and travel a lot, then take a smaller salary. That's your choice. But it happens everywhere. The more money you make, the more perks you get. Housing allowances. Cars. Drivers. Food budgets. Living expenses. Expensive travel. Assistants. It's kind of obscene to be honest. And then it perpetuates because once you start increasing it, you can't decrease it.

I personally don't think the CAP is being malicious about this, it's just the way business is done, unfortunately, nowadays. And it becomes second nature to just perpetuate the system as opposed to actually bucking the trend.

 

[AZpath]

I think the inspection-proficiency testing business has become the center of a CAP empire not it's membership.
We are producing value for a few fat cats.


There is no end to the check lists.
So each year teams of pathologists volunteer our efforts to increase the regulatory burden for fellow pathologists and laboratories.

Are we actually making things better or just finding more work for everyone to do?

We serve a few fat cats by doing free inspections to boot! This is administrative bloat.

Furthermore, we should have a lot of surplus dollars for education and government advocacy etc.

( Lab Corp and Quest donate 15-25 million to our representatives each year. )

May be it is time to sell the inspection-proficiency business to someone else and have an endowment.
It would purify our ranks from these parasites.

Btw, for profit verses non for profit is meaningless. Even the IRS does not have a good handle on where to draw the line.
Some of the biggest healthcare companies in america are non for profit.

 

[gbwillner]

It's easy to say that we should stop supporting CAP or stop being accredited by CAP. In reality, losing your CAP accreditation could mean losing your clients and your lunch. If other accreditation processes had the same weight or respect, then we could do it. CAP has probably worked hard to ensure that it remains the king of the hill.

 

[AZpath]

It's easy to say that we should stop supporting CAP or stop being accredited by CAP. In reality, losing your CAP accreditation could mean losing your clients and your lunch. If other accreditation processes had the same weight or respect, then we could do it. CAP has probably worked hard to ensure that it remains the king of the hill.

Are you serious? CAP offers no market advantage.
Your lab could change to another agency tomorrow. Your clients might yawn if you lucky.
I speak from experience the accrediting agency has no effect on business.

 

[path24]

No one cares if its cap. Your clients have no idea. The only people that ask if your lab is cap certified are other pathologists. Joint commissions works for the rest of the hospital....it can work for the lab also. Save your time and money...something admin will like. Get the cap out of your lab.

 

[Over9000]

It's easy to say that we should stop supporting CAP or stop being accredited by CAP. In reality, losing your CAP accreditation could mean losing your clients and your lunch. If other accreditation processes had the same weight or respect, then we could do it. CAP has probably worked hard to ensure that it remains the king of the hill.

What's your experience with this, and do you have any data to back up your claim?

Something tells me CAP's chief marketing officer, who gets paid north of 600k, is still underpaid...

 

[Zarniwoop]

Sadly, I have seen the clinical MD's as well as pathologists consider the CAP as the gold standard for all that is holy in pathology.
Many people seem to consider the CAP as if it is a government agency that has all power over pathology. It is as if the CMS doesn't even exist.

My opinion is that the CAP does a poor job representing pathologists in general, and I'd love to see them kicked off their throne, but I fear they are well entrenched as king, and that they are here to stay.

 

[Over9000]

Sadly, I have seen the clinical MD's as well as pathologists consider the CAP as the gold standard for all that is holy in pathology.
Many people seem to consider the CAP as if it is a government agency that has all power over pathology. It is as if the CMS doesn't even exist.

My opinion is that the CAP does a poor job representing pathologists in general, and I'd love to see them kicked off their throne, but I fear they are well entrenched as king, and that they are here to stay.

Fear is indeed the mind-killer.

I've learned that MGH doesn't use CAP. If "Harvard", arguably the most accomplished academic institution in the world, has no need for CAP, we shouldn't either.

"Clinicians" (we should really stop using that term) can go pound sand, and so can other pathologists. CAP is a failure of an organization and deserves nobody's money. If your referring physician colleagues think anything useful of CAP, remind them that they are a private organization and that Harvard doesn't even use them.


I'm done with CAP. If you stick with them because you're scared, then you suck.

 

[gbwillner]

Are you serious? CAP offers no market advantage.
Your lab could change to another agency tomorrow. Your clients might yawn if you lucky.
I speak from experience the accrediting agency has no effect on business.

I have DIRECT communication with clients who flat out told us they cannot release specimens to my lab unless we are CAP certified. I work with not just individual groups but with hospital networks and cancer centers. Some groups waited for us to get CAP accredited before sending us anything. It's not everywhere, but there are institutional policies in place that can prevent you from walking away from CAP. It may be OK once you secure business, but it is a real liability prior to securing that business.

 

[Zarniwoop]

I have DIRECT communication with clients who flat out told us they cannot release specimens to my lab unless we are CAP certified. I work with not just individual groups but with hospital networks and cancer centers. Some groups waited for us to get CAP accredited before sending us anything. It's not everywhere, but there are institutional policies in place that can prevent you from walking away from CAP. It may be OK once you secure business, but it is a real liability prior to securing that business.

I agree completely. Hospital admin people, other docs, etc have lots of false impressions about the CAP and their importance. Perceived importance can hold more weight than the real thing, so the CAP's marketing people have in this regard done an amazing job for themselves over the years.

We can try to educate these people, but most don't want to be educated. They would rather keep up with the Joneses, and from what they see, the CAP is the dope.

I am glad MGH doesn't use CAP for accreditation, but do you know why? It might be that JCAHO is just easier for them, not that they are avoiding the CAP. I'd bet anything MGH still sends a hefty check to the CAP every year for proficiency testing, etc. If the MGH has a beef with the CAP (which I doubt), wouldn't they drop them for everything, and not just accreditation?

 

[LADoc00]

Holy crap this is insane...I knew it was bad at CAP but not this bad. Basically it is all a sham? Top players making millions?

Do any of these players have the surname of Madoff?

 

[AZpath]

We need to press for reform rather than switching to another accreditation. The tails waging the dog.

The CAP needs to represent their members. Other it would better if to spin off the inspection business.

Right now there is corporate machine with it is own incentives in the way.

 

[KluverB]

http://www.jsonline.com/watchdog/wa...ilures-to-put-patients-at-risk-303445851.html

Weak oversight allows lab failures to put patients at risk

...
Another major accrediting group, the College of American Pathologists, or CAP, had a 17% disparity rate in 2013. The group accredits about 7,700 labs each year. Even the previous year, when CAP had a 11% disparity rate, labs it had accredited were found by federal auditors to be an "immediate jeopardy" to patients. ...