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Caris Diagnostics

Discussion in 'Pathology' started by trudyfae, Apr 7, 2011.

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  1. trudyfae

    trudyfae

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    Please someone tell me how Caris can give their GI docs EMRs, and why this does not constitute a bribe similar to, but on a much larger scale, than equipiment reps buying us dinner??? These folks are aggressively marketing to local GI docs and providing financial incentives they cannot refuse. No matter what a great service we provide, being local and accessible, fast TAT, great communication, supplies, etc, we cannot compete with their incentives. What are we to do? What can we do to stop them? HOW IS THIS LEGAL???
  2. pathstudent

    pathstudent Sound Kapital

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    I think they can say it is part of their service, like to obtain their reports they install a new computer system. There is nothing you can do about it. IMO the GI docs could refuse it. Do you do their conferences? You could refuse to do their pathology at their conferences. That's about your only leverage, and that probably isn't enough. The only thing you can do is learn to live off the hospital PC-only material until ACOs kick in and force all hospital based pathologists to become salaried employees. You could look into supplying them with your own EMR, it might cost you a fortune in the short run but, you got pay to play in private practice outpatient pathology.

    Don't forget that pathologists in some ways did this to themselves. When we started building our own outpatient labs, the TC was much less that the PC. We whined and whined to CMS that the TC was too low and not profitable, so CMS slashed the PC and gave it to the TC, so if you were charging global it was a no gain or loss. The TC for an 88305 used to be around 30 with the PC being around 70-80 and now those numbers have basically reversed. So back before this happened, medicare gave us 75 bucks to read out an 88305, now that number is down to 35-40 depending on where you live. Also lucrative TC component incentivized corporations along with the outpatient have biopsy practices (derm, GI, and urology) to attempt to capture the TC.

    Pathologists really did a lot to screw themselves. They got the PC slashed which lowers reimbursement for the stuff out of the O.R. and they got the TC super lucrative which generated the pod labs, got the reference labs in on AP, and created the specialty labs that have gutted the lucrative outpatient pathology market.
  3. Unty

    Unty New Member

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    Here's your answer: Help setup an in-house lab

    From: http://www.laboratoryeconomics.com/2010wordpress/wp-content/uploads/2010/11/LabEconomicsSample.pdf

    Who is the in-office lab trend hurting the most?

    The national pathology labs. When an in-house lab is opened they need to hire or contract with a local pathologist for professional services. The big labs don't fit in because they cannot provide on-site services.

    Don't consult the company. Help set it up on your own.
    Last edited: Apr 7, 2011
  4. caffeinegirl

    caffeinegirl

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    Caris' business practices have come up before

    http://forums.studentdoctor.net/showthread.php?t=652854

    And I don't think they're going to stop doing what they're doing. We have docs here in Cali who send their GI biopsies to Caris in Arizona..ridiculousness especially because we end up doing the resections, and having less 88305's in the process.
  5. pathstudent

    pathstudent Sound Kapital

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    Yeah and the pc on an 88309 is not that much more than the global on an 88305. And imagine how many gi biopsies you could sign out in the time it takes to gross, study, dictate a hemicolectomy.
    Last edited: Apr 7, 2011
  6. 2121115

    2121115

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    It isn't what you want to hear, but one way to do it is to help the GI docs set up an in-office lab and then have your group staff it. That way you at least hold on to some of the revenue and the profit that the GI docs get from the TC should cause them to pull them back from Caris.

    Eventually the in-office labs will go away (maybe not soon but long term) and the biopsies may come back, but even still, Caris won't be made illegal and the threat will still be there then too(not to mention another loophole in the Stark law may be found, it always seems to be).

    In the end, personal relationships trump everything but it still may not be enough when there is $$ involved. Although, it is much harder on the conscience to screw someone when your kids play soccer together and you play golf together every so often than if there is no relationship there (harder, but people still do it).
  7. WEBB PINKERTON

    WEBB PINKERTON

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    In house labs are not going away unless they get legislated out. I dont know why some people think they will disappear. Its really not too expensive an investment to set up a lab. There are plenty of businesses to help the process and keep costs down. Ever heard of Joe Plandowski?
    http://www.iopathology.com/founders.php

    I've learned that long relationships dont mean anything in lab medicine. Seen many docs threaten to pull business just cause some low balling lab is a dollar cheaper on the client price.
  8. Entgegen

    Entgegen

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    The reasoning I've heard is that with the proliferation of ACOs and the restructuring of reimbursement to potentially do away with individual technical and professional billing components, these IOLs will no longer be profitable (as they bank on the TC), and will be done away with. But who knows.
  9. 2121115

    2121115

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    Eventually it will come to light that they cause massive over-utilization of AP services. It won't be tomorrow or anytime soon, but eventually there will either be a legislative fix to the Stark law (unlikely) or payment reform will make them less profitable and more of a hassle to run (more likely, see latest STATline from CAP).
  10. WEBB PINKERTON

    WEBB PINKERTON

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    Reading anything from CAP is a waste of time. Best pathology articles are in the Dark Report. Everyone in pathology and lab medicine should read it religiously.

    I dont see how getting rid of the technical and professional billing components would make POD labs less profitable. Everyone finds ways to make money when the rules change. Just order more unnecessary tests. More FISH, more immunos etc.

    Pathologists never overutilize tests.
  11. 2121115

    2121115

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    CAP is virtually the only lobbying component that represents pathologists to the AMA, CMS and other regulatory agencies. So I think what they say is important. You can disagree with their methods/goals but they are the only organization that actually DOES anything about these things besides complain. So they actually have an affect on how things turn out.


    I agree they have good articles and everyone should be reading them. But the Dark Report is just that, a report, and not and organization that lobbies for pathologists' interests.
  12. lipomas

    lipomas

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    :laugh: There goes your credibility.

    Pathologists overuse tests all the time. It is utterly laughable to suggest otherwise. Sometimes it's for convenience. Sometimes it's for billing purposes. Sometimes it's because they are clueless. There are all kinds of reasons. When I was in residency I saw a prostate biopsy series where the triple stain had been done on every single block. Half of them were obviously positive on H&E, half were obviously negative on H&E. You can chalk this up to profit motive, being a poor pathologist, or ignorance or a combination thereof.

    Pathologists can also overuse tests indirectly - by failing to communicate with clinicians or failing to have adequate procedures for ordering tests.
  13. lipomas

    lipomas

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    Seems to me that these days 75% of the dark report emails are advertisements for dark report pod casts or teleconferences or whatever.
  14. WEBB PINKERTON

    WEBB PINKERTON

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    A lot of labs are really ripping patients off nowadays. That stupid Gynecor lab, part of Bostwick, is notorious for ordering a bunch of unnecessary fish and immunos. I lost business to them a few years ago but fortunantly got the office back after patients were getting charged 1500 bucks for endometrial biopsies. They really talked a good game to the obgyns in the area cause they were the only lab able to offer the Tau Brush. Who the hell would wanna diagnosis anything off a f*cking brush? I heard Bostwick is having a lot of problems and has closed many labs in recent months. Hopefully he and his specialty labs will die off.

    Meanwhile our insurance premiums continue to climb. System is so full of waste. Needs a huge enema.
  15. LADoc00

    LADoc00 híppos khlōrós

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    Yes...we are well aware of this. I though have plans to use the Caris style of shenanigans against them.

    Personal goal in 5 years: 8 figure operation, CEO: LADOC. It can be done.

    Bend the spoon.
  16. pathstudent

    pathstudent Sound Kapital

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    That is the Genoptix model. You offer clinicians all these ancillary tests. They don't know when they are indicated and order all possible tests on their cases, like ordering a "lymphoma FISH panel" which contains probes for Burkitt and that MALT lymphoma translocation and other stuff that is completely irrelevant and would never be ordered by a pathologist on a staging marrow for follicular lymphoma. I was told genoptix bills 15-20k per bone marrow and each one of their pathologists reads out 15-20 a day and they have 40 pathologists. It is an awesome business model.
    Last edited: Apr 12, 2011
  17. Unty

    Unty New Member

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    Why doesn't any pathologist tell the clinicians what is going on when their bone marrow is sent to the company with an elaborate presentation (filled with scientific references) and companies like this would lose business. Tell them that their patients are being ripped off (by how much compared to if things were done correctly) as well. Now, that my friends would open a lot of eyes. I can see it now...a nice presentation with bar graphs showing the amount of money your patients are being ripped off if specimens are being sent to Company X and how much if they are sent to you, the struggling community pathologist looking for business. This is a David and Goliath story.
    Last edited: Apr 12, 2011
  18. 2121115

    2121115

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    Because the clinicians are getting kick backs from the lab company and so they don't care.
  19. KeratinPearls

    KeratinPearls

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    Somebody educate me. How do these companies perform unecessary tests and get away with it? Isn't this fraud? Isnt there some type of governmental surveillance to detect this? Just like how the government cracked down on Home Health care companies defrauding Medicare recently (for billing unnecessary tests or for some tests that WEREN'T EVEN PERFORMED). These scumbags must be in jail by now.
  20. pathstudent

    pathstudent Sound Kapital

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    I don't think there are always kickbacks.

    There are two factors. One is good marketing, sales force, and attractive product.

    The second is a weak presence by the local pathologists. If the local pathologists are strong and involved, then they will get the business, unless the clinicians have significant monetary incentive to take it elsewhere or keep it for themselves (as the gastroenterologists and urologists do). Money trumps friendship and collegialness. A friend of mine who was in GI-training told me about how he heard of someone working on a business model to prepare GI biopsies in the US and then have them scanned and read by US trained pathologists in India who would do it for even less than what you had to pay your Pod Lab pathologists. I asked him about quality, patient care and collegial respect for your fellow physicians (pathologists) and he frankly said "Hey if it meant an extra 100k in my pocket then that would be all I needed to hear".
    Who could blame him?
    Last edited: Apr 12, 2011
  21. pathstudent

    pathstudent Sound Kapital

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    The labs like Gynecor and Geneoptix and claim ignorance and say "hey it is what the clinician ordered", rather than being helpful and cost concience, like only performing B-lymphoma antibodies rather than T-cell also on a flow cytometry specimen if the patient has a diagnosis of a B-cell lymphoma.

    They could put me in charge I will scour over all laboratory tests for all medicare patients and elimianate moronic ordering as long as they give me ten percent of what I save the government. I would make 100,000,000 a year, but then again I also support "death panels" (i.e. not spending globs of cash on 89 year-olds with widely metastatic end stage cancer).
  22. yaah

    yaah Boring Administrator

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    :laugh: Oh my goodness.
  23. zao275

    zao275 Assistant Professor

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    I was thinking this statement MUST have been intended as sarcasm.

    But since we are on the subject: Even for a metastatic tumor of unknown primary, 30 immunostains = overutilization...at least in my book.
    Last edited: Apr 12, 2011
  24. WEBB PINKERTON

    WEBB PINKERTON

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    Part of me is worried that if waste was eliminated even more pathologists would be laid off and entering an already tough market. Seems to me that a lot of "growth" in recent years has been waste. Expensive tests that dont lead to any better outcome. Keep people in the dark and rip em off.

    With jerks like Anthem BC/BS cutting reimbursement we gotta make money somehow. Sales rep told me yesterday good ole anthem is now only paying 18 bucks for a pap test and 36 bucks for an hpv test. They targeted those for cuts this year. No way in hell we making any money off those patients. I told my wife Belle, i will go without insurance before I ever buy a policy off them.
  25. lipomas

    lipomas

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    There is a big difference between medical unnecessary and "of questionable medical benefit." The latter can always be justified and provided the practice isn't overwhelmingly egregious it is hard to prove "fraud." Like doing p16 on every cervical biopsy - for an individual case you can always argue it was helpful. Or doing PIN cocktail on cores - for an individual case you can always argue it was helpful.

    There is a big difference between that and billing for something you didn't do, i.e. outright fraud, like much of the medical equipment fraud out there.

    Thus, reference labs and in office labs get away with overutilization because they skirt the boundaries of what is appropriate. I have been to CE lectures from reference lab experts who advocate doing a ROUTINE panel of 10 immunostains for anything you are working up for a lymphoma. And they can justify each one if you ask them.
  26. Doormat

    Doormat

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    I saw this and felt compelled to reply. You have got to go to the Caris diagnostics website and read the chairman's corner article entitled "Caris cares!". It is bombastic and hilarious. A must read.

    Unty's post is exactly correct. Caris's entire business model for anatomic pathology is vulnerable. An in-office anatomic pathology lab offers a larger kickback for each 88305 biopsy code to the clinician who performed the biopsy. Even when Caris participates in discounted client billing and EMR "donations", an in-office lab allows to a clinician to collect a larger wad of cash for each and every self-referred biopsy he or she performs. In-office labs replace smaller kickbacks and incentives (Caris kickbacks and EMR extortion schemes) with the much larger technical component fee kickbacks.

    Meet with the GI doctors. They should already know that building their own in-office lab is more profitable than sending biopsies to Caris. Our GI docs learn this from their national meetings where they learn how to exploit the stark law loophole for in-office ancillary services.
  27. 2121115

    2121115

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    ^^This^^

    As I posted above, right now it is the only way. It is not an optimal solution, obviously, but it will keep at least some of the revenue in your pocket (as opposed to none if they send them to Caris). Also, it maintains your relationship with the GI docs, as much as that is worth, and when/if the in office labs get phased out you will already have that relationship to bring the biopsies back to you.
  28. pathstudent

    pathstudent Sound Kapital

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    This makes the whole thing sound kind of pathetic, like choosing to whore out your daughter to keep the money from going to another whore.
    What are some Caris kickbacks other than EMR?
    Last edited: Apr 20, 2011
  29. KeratinPearls

    KeratinPearls

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    What has Ameripath/Caris/Bostwick done to counteract this trend? How common are these pod labs now?
  30. KeratinPearls

    KeratinPearls

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    Probably LA would say strippers, cocaine and bunga bunga parties.
  31. 2121115

    2121115

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    They are not "pod labs", which are illegal now. They are in office labs in clinician offices. They are becoming more common, I don't know the numbers exactly.
  32. WEBB PINKERTON

    WEBB PINKERTON

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    Only way to counteract POD labs is fee splitting on the technical component. There is a dermpath lab doing skin biopsies in my area for less than 10 bucks. The lab does paps for barely more than that. Only way to survive is to make your lab a sweatshop since the profit margins are so low. No way would I ever recommend going into lab medicine to anyone. The race to the bottom is reckless and putting patients in danger.

    CAP needs a leader like Tony Montana, instead it has Tony Orlando.
  33. 2121115

    2121115

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    It is interesting that many people think that someone can come in and just change established laws, change CMS policy and change reimbursement simply by being a badass and just wanting it bad enough.
  34. LADoc00

    LADoc00 híppos khlōrós

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    Definitely premium uncut cola and girls, not sure what bunga parties are. Is that a gay thing??
  35. Doormat

    Doormat

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    Caris gets creative with kickbacks and incentives. Caris recently introduced the "Cariosome" blood tests as a supposed marker for detection of prostate carcinoma that is superior to PSA. Caris sales reps are in urology offices selling this "revolutionary" blood test and trying to get the prostate biopsies sent to Caris so they can "verify" blood test results.

    Our urologists are hospital-employed so they don't send their biopsies to Caris. They send them to the hospital lab per their contract. Every time I get prostate core biopsies and see that this "cariosome" test is positive and my biopsies are negative (which is most of the time), I've called up the urologist and told them what a load of garbage this test is.

    I don't see how Caris would ever get the prostate biopsies even if the urologists were private. An in-office anatomic pathology lab always beats Caris, Bostwick, LabCorp, or Quest on revenue for the clinician. Of course revenue is all that matters.
  36. WEBB PINKERTON

    WEBB PINKERTON

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    Gotta grease the right politicians. Thats how the world works. Eat or be eaten.
  37. 2121115

    2121115

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    The GI docs and uro's are trying to grease the same politicians. It isn't that simple.
  38. zao275

    zao275 Assistant Professor

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    THIS. :thumbup:
  39. Chilicat

    Chilicat

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    While it's still listed on their website, it functionally no longer exists. They have stopped selling it due to "collection issues" but the simple truth is it was a bull**** test.

    Target now is the next one that should be trashed. It's a POS test.
    Nothing but smoke and mirrors.

    Caris is the most unethical company I'm aware of.
  40. WEBB PINKERTON

    WEBB PINKERTON

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    Bostwick and bio-reference are the most unethical. A bioreference labs sales rep came to my town and hit the physician offices hard. Made the physicians swoon over all those expensive, unnecessary molecular tests. Then he actually had the offices fill out requisitions and packaged specimens to be sent to bioreference. They used supplies that my lab pays for! Gotta love the lab business.
  41. KeratinPearls

    KeratinPearls

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    Pardone my ignorance, but why would clinicians have molecular tests performed on their patient if it was so expensive? These Bioreference reps really made an impression that these tests were absolutely necessary? So insurance companies are footing the bills for all the molecular testing?
  42. 2121115

    2121115

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    I wonder how pathologists who work for Caris live with themselves.

    If anyone here works for Caris post now. Here is your chance to set the record straight.
  43. trudyfae

    trudyfae

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    212115-
    looking for the "like" button...
    i am wondering the same thing!
  44. WEBB PINKERTON

    WEBB PINKERTON

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    I am beginning to wonder how anyone in health care lives with themselves. The system is FULL of waste and overhype.

    Lab medicine is really pathetic. Just a race to the bottom.
  45. TMZ2007

    TMZ2007

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    It's probably not that hard of a decision, actually. I bet it goes something like this: good pay, decent work hours, sign out only your organ/system of specialty (and mostly only small biopsies at that), good benefits, easy access to lots of intradepartmental consultation, no CP call/duties, no autopsies, etc.

    If you are willing to ignore the shady/unethical business side of things, and the fact that the corporation is only paying you a fraction of what you're billing, it sounds pretty good.
  46. trudyfae

    trudyfae

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    there is something afoot with one of our clients greater than the EMR "gift." this GI doc was very happy with us, was close friends with us, etc. and went to caris. got the emr and a year later is still with them. he says to me (today) it was nothing personal and nothing to do with us or our pathology, it was purely a business decision. sounds like kickbacks to me. what could be an ongoing incentive to keep him with them when he was so happy with us before?

    i love pathology and am so glad i went into it, but this is the downside. competing with the monster labs and worrying about keeping/gaining clients. you truly have to be part salesman, part businessperson, and all pathologist.
  47. KCShaw

    KCShaw

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    I think this applies way, Way, WAY more than some people estimate to any job anywhere. Either you're working for some other entity which is competing for its place in the market or you're the boss of an entity/private consulting and are competing for your place in the market. Even government jobs have to justify themselves somehow or risk being cut/replaced by something cheaper. Medicine is certainly not immune, least of all specialties which work essentially entirely on a consulting type basis, such as pathology and radiology. There's a lot of potential to be lucrative, but also a lot of potential to be driven to more work for less pay to the peons in an attempt to remain "competitive." It seems to me that in other fields eventually a tiny number of companies ends up with the vast majority of the business.. which tends to narrow down to a duopoly until one gains a significant upper hand, or essentially a monopoly, and everyone tends to relatively suffer except for the heads of the monopoly. But, that seems to be pretty much the expectation of the modern economy, which on the whole now seems to favor a few cents cheaper over a few percentage points "better" quality. Your "quality" difference often has to be much, much better (and quality is gauged in many different ways) to compete with cheap and fast.
  48. pathstudent

    pathstudent Sound Kapital

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    That does suck. The GI doc depends on his referral base for patients, so he should understand that you do to.

    He must be benefitting monetarily in some way. Maybe they charge him a flat rate for the TC which he turns around and bills insurance for.

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