88305 TC cut 52%

[pathstudent]

Well yeah but patient's come into the hospital to get labwork done too. That's not the point. They don't typically choose the hospital because of the imaging or the lab, that is my point.

No they don't. In general out patient lab work is forced to go to Quest or Labcorp or somewhere else by insurance contracts. Exception being a closed systems like Kaiser or the VA. Outpatient Medicare can go to the hospital because Medicare pays the same to everyone.

And hospitals don't, in general, own lab equipment anymore. It is all done "cost per reportable" or "pay for the reagents".

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[WEBB PINKERTON]

Hospitals are buying physician practices like crazy and forcing the lab work to come to the hospital. Labcorp and quest are trying to address this by purchasing more hospital labs, like UMASS. In my area, almost every practice in the town is owned by the hospital and has the hospital logo.

 

[Johnny Sunshine]

The hospitals don't even need to buy the lab equipment anymore. Much of it can just be rented from the production companies.

 

[pathstudent]

Hospitals are buying physician practices like crazy and forcing the lab work to come to the hospital. Labcorp and quest are trying to address this by purchasing more hospital labs, like UMASS. In my area, almost every practice in the town is owned by the hospital and has the hospital logo.

I am seeing that too, and it is a good thing. It is not so much to make big revenue for the lab, but as to increase productivity for the lab. But again the subset of patients that can have their outpatient blood work done at a hospital inpatient lab is not that big. Medicare patients are ok, but if the patient has bc/bs, united health care, Cigna, etc... as their insurance they are forced to go to a large corporate lab which the carrier contracted the lowest rates with. If they went to the hospital lab they would be out of network and be charged a hand a foot for simple lab work.

One exception I have seen is a rapid pth assay performed at our lab from a nearby stand alone physician owned surgery center. But that makes sense that the insurance would allow that as labcorp or something similar would not be option for a stat test.

 

[WEBB PINKERTON]

I am seeing that too, and it is a good thing. It is not so much to make big revenue for the lab, but as to increase productivity for the lab. But again the subset of patients that can have their outpatient blood work done at a hospital inpatient lab is not that big. Medicare patients are ok, but if the patient has bc/bs, united health care, Cigna, etc... as their insurance they are forced to go to a large corporate lab which the carrier contracted the lowest rates with. If they went to the hospital lab they would be out of network and be charged a hand a foot for simple lab work.

One exception I have seen is a rapid pth assay performed at our lab from a nearby stand alone physician owned surgery center. But that makes sense that the insurance would allow that as labcorp or something similar would not be option for a stat test.

We dont see many managed care contracts in my area. There are a few but the majority of the outpatient lab work comes to the hospital now. There are ways to get around managed care contracts also.

 

[MOHS_01]

..

Yes all specialties have challenges, but Path is in a particularly weak position as we don't steer patients to hospitals. So we are of no real value to the hospital. We get screwed by the specialists cherry picking our specimens. We get screwed by the governement and insurers (something all doctors put up with) and we got no play with hospital administrators. When subspecialty surgeons get hired by the hospital, they can negotiate good salaries (my ortho friend said the contract he was offered paid him more than he was able to make in private practice as the costs of running his office were so high). We got nothing(met a DC based pathologist who said the new COO/CEO came to her group and said they wanted to employ the pathologists and offered less than half of their lucrative private practice salary. When the said it was too little, they were told to take a hike and another group was brought in).

My advice too is to live well below your means because your means are like to come down.

You do realize this post could have just a few words changed and feel natural in any number of specialty forums, correct?

Bottom line -- if you are in a greater than median compensated field right now, get ready to get "redistributed". If you happen to be in a low numbers specialty that performs a high number of specialty specific procedures, you're an easy mark... so prepare to get hit first and hardest. If you don't drive the referral / revenue stream for a hospital don't be looking for any help there.

 

[lipomas]

You do realize this post could have just a few words changed and feel natural in any number of specialty forums, correct?

Bottom line -- if you are in a greater than median compensated field right now, get ready to get "redistributed". If you happen to be in a low numbers specialty that performs a high number of specialty specific procedures, you're an easy mark... so prepare to get hit first and hardest. If you don't drive the referral / revenue stream for a hospital don't be looking for any help there.

Ah, nice to have a non-pathologist come in here and call the bluff on all these blowhards who keep acting as though pathology is the only field that has problems. These people have no clue. They are comparing pathology now to radiology 15 years ago or dermatology 10 years ago or general surgery 30 years ago.

 

[univlad]

48% percent of the current TC is enough to make the H&E slides, easily. This just cuts most of the profit out of it.

How has this shaken out for labs and other groups over the past few years. Does 88305-TC cover making the slides? Our hospital is trying to recruit the AP business from a dermatology group in town.

 

[AZpath]

That's nuts. The TC side is a loser unless you have great contracts for commerical insurance.
It does not cover the cost and commercial insurers are now trying to pay 40-50 of CMS.
I like doing derm cases but I would do it for the TC business.

My guess is the derms are getting killed business on the TC and want out. The TC is not worth a penny these days.

 

[ygdrasil]

We're still doing fine on 88305 TC and are also looking to snap up the local derm business. Our medicare rate may be better than in some places, 30-40% depending on how you slice it (accessions vs. charges vs. actual $). Another way to look at it is while reimbursement on the average 88305 may be low, how much are you making on the 88342, 88360, 88312, 88331 and 88367s that sprout from your field of biopsies?
(Never thought I'd be this excited about coding and billing when I was in training.)