$1000 pap

[dhpath]

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http://www.nejm.org/doi/full/10.1056/NEJMp1307295?query=TOC

who is/is not accountable?
Overutilization (greed) or butt saving or careless utilization?

Conclusion will be ........ combo!!!!!!!!!

 

[Johnny Sunshine]

One of my local gyn groups has started doing routine anal paps (and reflex anal HPV, regardless of the pap result) whenever they do a routine cervical exam. My lab, of course, encourages this behavior.

Why such ridiculous practices don't get immediately slapped with charges of fraud is beyond me.

 

[WEBB PINKERTON]

check out this consumer website about pap test costs

http://health.costhelper.com/pap-test.html


Sounds like Bio-Reference labs has charged some patients 2000 dollars according to that website.1000 dollars sounds like a bargain.

Many of these labs are pushing a LOT of wasteful testing. Unnecessary tests for candida, trichomonas or some obscure organism that isn't common here. I've seen a few labs that run 20+ tests off a single pap test. Many are just self-validated tests that may not even be accurate. It's a huge con. I feel bad for women that get these bills. Most have no insurance and are higher risk. It discourages them from getting screened for cervical dysplasia. The women that actually need the test are being discouraged from doing it thanks to nothing more than GREED.

 

[WEBB PINKERTON]

One of my local gyn groups has started doing routine anal paps (and reflex anal HPV, regardless of the pap result) whenever they do a routine cervical exam. My lab, of course, encourages this behavior.

Why such ridiculous practices don't get immediately slapped with charges of fraud is beyond me.

Of course labs encourage this. God forbid we actually police ourselves. I understand the fear of losing business and the need to make up for all the lost revenue from client billing, medicare cuts etc.

 

[Doormat]

check out this consumer website about pap test costs

http://health.costhelper.com/pap-test.html


Sounds like Bio-Reference labs has charged some patients 2000 dollars according to that website.1000 dollars sounds like a bargain.

Many of these labs are pushing a LOT of wasteful testing. Unnecessary tests for candida, trichomonas or some obscure organism that isn't common here. I've seen a few labs that run 20+ tests off a single pap test. Many are just self-validated tests that may not even be accurate. It's a huge con. I feel bad for women that get these bills. Most have no insurance and are higher risk. It discourages them from getting screened for cervical dysplasia. The women that actually need the test are being discouraged from doing it thanks to nothing more than GREED.

Totally agree. One of these "combo" Pap smear tests is a PCR test for Donovanosis (granuloma inguinale), which occurs like 50 times per year in the entire United States. Companies like Bio-Reference include this test in their Pap smear panels.

Totally outrageous. Women are not getting Pap smears because of this.

The anal Pap smear with cervical Pap smear story is similarly depraved. Those OB/Gyn docs are entrepreneurs first and physicians second.

 

[icpshootyz]

Those OB/Gyn docs are entrepreneurs first and physicians second.

Unfortunately this line describes far too many people in medicine today. It's sad, really. Maybe if there's less money to be made in medicine, less people will go into medicine for the money.

 

[LoaLoa]

Unfortunately this line describes far too many people in medicine today. It's sad, really. Maybe if there's less money to be made in medicine, less people will go into medicine for the money.

No matter how selfless and pure of heart this mythical ideal physician may be, rest assured that SOMEONE--some MBA or insurance company stockholder--is inevitably going to make a ****-ton of money off of our expertise and labor. To expect physicians to ignore this state of affairs and pay no attention to their compensation is not realistic.

The problem is not doctors making money. The problem is that that financial incentives are misaligned to reward excessive utilization.

 

[2121115]

No matter how selfless and pure of heart this mythical ideal physician may be, rest assured that SOMEONE--some MBA or insurance company stockholder--is inevitably going to make a ****-ton of money off of our expertise and labor. To expect physicians to ignore this state of affairs and pay no attention to their compensation is not realistic.

The problem is not doctors making money. The problem is that that financial incentives are misaligned to reward excessive utilization.

Agree. It's not as if the money goes to feed the homeless if doctors don't make it. It just goes to someone else in the food chain.

 

[WEBB PINKERTON]

Remember reading/hearing all that garbage about how pathologists were going to be "gatekeepers" that stop unnecessary testing? Boy that sure has worked out well. I'd like to see one instance where a pathologist stood up to these labs offering all these ridiculous tests and said enough is enough. It never happens cause they know they can be replaced in a minute.

 

[Johnny Sunshine]

The problem is that that financial incentives are misaligned to reward excessive utilization.

Agreed. And in my opinion, no fancy healthcare system will change that. What might help is if patients became informed consumers instead of blind lemmings.

 

[KluverB]

Agreed. And in my opinion, no fancy healthcare system will change that....

But that's the state of affairs in single-payer systems with finite/defined budgets, such as in Canada and at least some European countries.

 

[yaah]

Remember reading/hearing all that garbage about how pathologists were going to be "gatekeepers" that stop unnecessary testing? Boy that sure has worked out well. I'd like to see one instance where a pathologist stood up to these labs offering all these ridiculous tests and said enough is enough. It never happens cause they know they can be replaced in a minute.

Um, it happens all the time. There are all kinds of labs where the pathologists do reduce the number of tests ordered. When it becomes fairly standard the clinicians will often trust the pathologist judgment to order what's necessary - in our group bone marrows come with essentially open orders. Clinicians list things they would like to order but we only send what is necessary. This may not be "standing up to the reference labs" because it's not really the same thing - but in a sense local pathologists are typically bypassed when clinicians send certain tests to reference labs, so it isn't always under our control. We reject or advise on extra test ordering all the time. I don't really know many labs who don't. Some, of course, send everything possible.

 

[deleted314957]

Um, it happens all the time. There are all kinds of labs where the pathologists do reduce the number of tests ordered. When it becomes fairly standard the clinicians will often trust the pathologist judgment to order what's necessary - in our group bone marrows come with essentially open orders. Clinicians list things they would like to order but we only send what is necessary. This may not be "standing up to the reference labs" because it's not really the same thing - but in a sense local pathologists are typically bypassed when clinicians send certain tests to reference labs, so it isn't always under our control. We reject or advise on extra test ordering all the time. I don't really know many labs who don't. Some, of course, send everything possible.

This filtering or "pre-approval" will become much more commonplace as we become more socialized. When i was in the military ( a LONG time ago) we did it all the time and the clinicians had to bite the bullet. same thing happened in rads. my wife could not get an mri (mid 1980's) at a major military med institute that her neurologist wanted because of the gov't. we are headed to a "brave new world". I am glad I missed most of it.

 

[thefritz]

rest assured that SOMEONE--some MBA or insurance company stockholder--is inevitably going to make a ****-ton of money off of our expertise and labor..

Unless healthcare becomes nationalized and is paid for entirely by the government. Hard to make a "****-ton of money" off of physicians if there is no middleman.

 

[LoaLoa]

Unless healthcare becomes nationalized and is paid for entirely by the government. Hard to make a "****-ton of money" off of physicians if there is no middleman.

Agree, and a single-payer system is probably inevitable, eventually. But not anytime soon.

 

[thefritz]

Agree, and a single-payer system is probably inevitable, eventually. But not anytime soon.

gradual moves over the next few decades. Full nationalization in 20-30 years. All it takes is a single big enough crisis.