2021 CMS Fee Schedule

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Alteran

Alteran

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Though this is the proposal, the numbers speak for themselves.
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Piece of Sh1t academia has us in this deepsh1t!!
 
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Pathological_Liar said:
How closely did previous year proposed RVUs match actual?
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Don't know but CMS as of late doesn't really care what the value of our professional expertise is. They tend to stick to their guns and make the cuts anyway. In the few years I've been paying attention to the fee tables, I've only seen reversals on the TC side of the equation, which only affects a minority of pathologists - but I'm always welcome to be shown otherwise.
 
Crazy. Didn’t professional societies used to form guilds to protect themselves from things like this? It appears it’s time for the workers to do something and the only way to do that is as a collective. Even the super partners who run CAP should be on board with this, id hope. If not, somebody out there needs to form a more effective lobby.
 
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CMS has been strong arming the last few years probably has to do with current administrations fixation on looking like they are being tough on healthcare costs. But honestly they can’t value services correctly especially if everything needs to be budget neutral at the end of the day.

Their logic is basically: we have misvalued E&M Code’s but as a result of paying for it we will make deep cuts to everything not E&M related to keep a zero sum game.
 
cmz said:
Damn. -9 to -11% on most of the big ticket items...
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Well, as far as the patient and general public population are concerned they have NO idea what we do, they get bills from us while they have NO idea who we are or how we contribute to their care, we are not sympathetic figures like Dr. Marcus Welby, and, therefore, we lose. Because there are not enough teats for all the piglets.
 
Don't worry, the CAP has our back. They'll lobby CMS diligently on our behalf and get the 9% overall cut reduced to 8%. Then they'll spend the next year patting themselves on the back and telling us how lucky we are to have them.
 
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Oooof -

88304-26 - minus 13%
88305-26 - minus 12%
88307-26 - minus 12%
88342-26 - minus 12%
88341-26 - minus 12%
88312-26 - minus 12%
88313-26 - minus 11%

That's a solid 12% cut for pretty much all my billables, then. Following on the 20% loss of practice revenue so far this year, that should feel just swell.
 
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homer315 said:
Don't worry, the CAP has our back. They'll lobby CMS diligently on our behalf and get the 9% overall cut reduced to 8%. Then they'll spend the next year patting themselves on the back and telling us how lucky we are to have them.
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With CAP it’s always the “it could have been worse” mentality. For just over a decade that I’ve been paying attention to this stuff, I’ve never seen them have what can actually be called a success. Like everything else in this country, we seem to be paying them to manage the decline of our profession.
 
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Everything will be bundled at some point anyways. Then good luck getting any pie.
 
Rads also getting hit hard it appears.

Three specialties fare the best: endocrinology, with a 17% increase; rheumatology, with a 16% increase; and hematology/oncology, with a 14% increase. At the bottom are nurse anesthetists and radiologists, both with an 11% decrease; chiropractors, with a 10% decrease; and interventional radiology, pathology, physical and occupational therapy, and cardiac surgery, all with a 9% decrease.
 
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Ouch.

Looks like it's time to quit doing clinical medicine and join some biotech/molecular startup.

Or buy more leap calls in EXAS and GH.
 
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Seriously. It’s going to be Soviet Style Medicine soon. The government pretends to pay physicians and the physicians pretend to work.
 
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There's always the option of protesting. Imagine if pathologists threatened to not sign out reports for 2 weeks in protest of the cuts... radiologists threatened to not read imaging for 2 weeks... etc. That would get peoples' attention pretty quickly.
 
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msnbc2020 said:
Agree the numbers speak for themselves.
Most pathologists now expected to sign out 5000-6000 cases per year which is double the average workload of 20 years ago.
View attachment 315066
View attachment 315065
www.pathologyoutlines.com

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For surgical pathologists do not own a lab and are trying to survive off of professional component billing of 88304, 88305, 88307, 88309, 88312, 88313, 88341, 88342 - what do we now have?
Pick 88305 ($34.32) as an average case and also be generous and state that 6000 cases generates 1500 IHC stains.
With new fee schedule:
6000 cases x $34.32 = 205920
1500 IHC x $30 = $45000
So by doing a crapload of work you can generate $250K in billings.
Anyone who does not think salaries will be affected is in denial imo.
How was it in 2010?
View attachment 315069
Great field to be in, work doubles and pay goes down!!!
Click to expand...
Right as Med school loans get to an all-time high. Normally professional societies would come together to protect their turf in situations like this. Reducing supply of pathologists would probably be beneficial.
 
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msnbc2020 said:
Agree the numbers speak for themselves.
Most pathologists now expected to sign out 5000-6000 cases per year which is double the average workload of 20 years ago.
View attachment 315066
View attachment 315065
www.pathologyoutlines.com

Jobs

Pathology Outlines Job Search
www.pathologyoutlines.com www.pathologyoutlines.com
For surgical pathologists do not own a lab and are trying to survive off of professional component billing of 88304, 88305, 88307, 88309, 88312, 88313, 88341, 88342 - what do we now have?
Pick 88305 ($34.32) as an average case and also be generous and state that 6000 cases generates 1500 IHC stains.
With new fee schedule:
6000 cases x $34.32 = 205920
1500 IHC x $30 = $45000
So by doing a crapload of work you can generate $250K in billings.
Anyone who does not think salaries will be affected is in denial imo.
How was it in 2010?
View attachment 315069
Great field to be in, work doubles and pay goes down!!!
Click to expand...
I agree with you. But it’s worse than that. Not only are the cases going up per pathologist and reimbursement going down, but the expectation of quality in the diagnosis is going up too such as CAP checklists, granularity in separating out entities, etc.
 
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msnbc2020 said:
Great point!!! Such as computing the percent of cancer in each prostate core biopsy.
Click to expand...

And cost of labor and supplies, regulations and additional DAMN THE CAP regulations keep going up. Our profit margin (salary) will get hit 20-25% on a 9% cut.
 
msnbc2020 said:
www.pathologyoutlines.com

Jobs

Pathology Outlines Job Search
www.pathologyoutlines.com www.pathologyoutlines.com
For surgical pathologists do not own a lab and are trying to survive off of professional component billing of 88304, 88305, 88307, 88309, 88312, 88313, 88341, 88342 - what do we now have?
Pick 88305 ($34.32) as an average case and also be generous and state that 6000 cases generates 1500 IHC stains.
With new fee schedule:
6000 cases x $34.32 = 205920
1500 IHC x $30 = $45000
So by doing a crapload of work you can generate $250K in billings.
Anyone who does not think salaries will be affected is in denial imo.
How was it in 2010?
Click to expand...

You're assuming that you get paid for EVERY case you read... I wish that was the case.

I think we need a better definition of what a case counts as because "6000 cases" may translate into 14,000 88305s. A specialized dermatopathologist or GI pathologist can bang out 14K 88305s with no sweat. You're also leaving a lot of meat on your plate and leaving out other CPT codes like 88311, 88312, 88313, etc. All in all, it is what it is. It's a flat 9% cut. Salaries will stagnate or possibly drop.
 
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msnbc2020 said:
Agree the numbers speak for themselves.
Most pathologists now expected to sign out 5000-6000 cases per year which is double the average workload of 20 years ago.
View attachment 315066
View attachment 315065
www.pathologyoutlines.com

Jobs

Pathology Outlines Job Search
www.pathologyoutlines.com www.pathologyoutlines.com
For surgical pathologists do not own a lab and are trying to survive off of professional component billing of 88304, 88305, 88307, 88309, 88312, 88313, 88341, 88342 - what do we now have?
Pick 88305 ($34.32) as an average case and also be generous and state that 6000 cases generates 1500 IHC stains.
With new fee schedule:
6000 cases x $34.32 = 205920
1500 IHC x $30 = $45000
So by doing a crapload of work you can generate $250K in billings.
Anyone who does not think salaries will be affected is in denial imo.
How was it in 2010?
View attachment 315069
Great field to be in, work doubles and pay goes down!!!
[/QUOTE
^^agree and great post

you have to be involved with CP these days to survive. AP only will not cut it anymore. I truly feel sorry for anyone who’s career is based only on AP sign out.
Click to expand...
 
I feel sorry for the dermpaths making 600-700k a year as well.
 
KeratinPearls said:
I feel sorry for the dermpaths making 600-700k a year as well.
Click to expand...
I’m a dermpath and I don’t even know where u got that crazy salary! I wish I got a fraction of that number! I can’t even afford a second car! We are living paycheck to paycheck on coupons with tons of students loans sigh... our 88305 already got cut a few years ago.. seems like when everyone else salary goes up ours just goes down... something is wrong here! I hope this proposal doesn’t go through bc my rent is pretty high right now and I have 2 kids to support!
 
Our 88305? Everyone’s got the same 88305 lol
 
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KeratinPearls said:
Our 88305? Everyone’s got the same 88305 lol
Click to expand...
“Our” means “pathology”... Dermpath doesn’t come close to that salary that u quoted... I feel bad for our (pathology) specialty in general... ppl should get raises with time not pay check cuts
 
5 to 6 thousand cases a year ain't crap. We expect 10,000 plus in my neck of the woods.

Get ready to push glass till you toss some clots. Might be good idea to get on Warfarin anyways due to Covid right now.
 
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The plumber and electrician make better money!
 
Scrubs920 said:
“Our” means “pathology”... Dermpath doesn’t come close to that salary that u quoted... I feel bad for our (pathology) specialty in general... ppl should get raises with time not pay check cuts
Click to expand...
Some do just ask the guy with the name of Mario. On average most make less but do well.

Start your own dermpath practice. You can start on your own or with a friend. Market yourself and get the plenty of biopsies floating out there. Market your expertise and let the clinicians know how fast you can turnaround cases compared to the places they currently send to. Provide great service. If you work for someone all that money is going into someone’s pockets and it’s not yours. Talk to family docs, dermatologists, podiatrists and get business. As long as youre an employee, your employer will squeeze you as much as he or she can, especially in Pathology. That’s what I would do if I was a dermpath.
 
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doctor313 said:
There's always the option of protesting. Imagine if pathologists threatened to not sign out reports for 2 weeks in protest of the cuts... radiologists threatened to not read imaging for 2 weeks... etc. That would get peoples' attention pretty quickly.
Click to expand...

Someone would take your place for less money. THAT is our G D problem!
 
Alteran said:
Don't know but CMS as of late doesn't really care what the value of our professional expertise is. They tend to stick to their guns and make the cuts anyway. In the few years I've been paying attention to the fee tables, I've only seen reversals on the TC side of the equation, which only affects a minority of pathologists - but I'm always welcome to be shown otherwise.
Click to expand...

If you were paying attention since 2013 would have seen that TC was cut about 50-55%.
There have been a few increases in TC in the last few years that might be a return of 5% total.
So don't get too jealous of the TC side. It has been a terrible decade for labs billing TC.

TC fared better in this fee schedule. I think that the component costs effects the work time rather than materials.

Either way this is another bummer.
 
AZpath said:
If you were paying attention since 2013 would have seen that TC was cut about 50-55%.
There have been a few increases in TC in the last few years that might be a return of 5% total.
So don't get too jealous of the TC side. It has been a terrible decade for labs billing TC.

TC fared better in this fee schedule. I think that the component costs effects the work time rather than materials.

Either way this is another bummer.
Click to expand...

Yeah TC was like 80-90$. Lol
 
AZpath said:
If you were paying attention since 2013 would have seen that TC was cut about 50-55%.
There have been a few increases in TC in the last few years that might be a return of 5% total.
So don't get too jealous of the TC side. It has been a terrible decade for labs billing TC.

TC fared better in this fee schedule. I think that the component costs effects the work time rather than materials.

Either way this is another bummer.
Click to expand...

Oh, I was paying attention when CMS murdered the TC on the 88305. Ostensibly it was made to discourage the derm, urology, and GI docs from making vast sums of money in their POD labs. The sensible thing would have been to pass a rule where only a physician under the pathology taxonomy could own and operate such a lab with Stark level enforcement, but that would have made too much sense. Instead, they kill two birds with one stone: they hit the POD labs running up the tab and get to overall decrease what they pay on 88305 across the board. Win-win for them, lose-lose for us pathologists who played by the rules.
 
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Thanks to the pathologist surplus, PODs have a great future. Doubt the TC cuts slowed them down any.

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Not to be overly optimistic and sound like a 'Sunshine Sally'; but, don't wanna be a 'Negative Nellie' either. The key word is "Proposed" cuts. When these numbers get brought forth to CMS, there's no guarantee what the final fee schedule is until it is officially released.
 
coroner said:
Not to be overly optimistic and sound like a 'Sunshine Sally'; but, don't wanna be a 'Negative Nellie' either. The key word is "Proposed" cuts. When these numbers get brought forth to CMS, there's no guarantee what the final fee schedule is until it is officially released.
Click to expand...
True,but the ANTHEM BCBS cuts to 40% below MEDICARE certainly stuck.
 
y2k_free_radical said:
True,but the ANTHEM BCBS cuts to 40% below MEDICARE certainly stuck.
Click to expand...
In general, once the cuts are made they’re basically permanent as long as someone is willing to cash the meager checks.
 
True, but our group and all private groups in our state unified and sent a letter of refusal to BCBS not accepting their fee schedule. In addition, we preemptively notified administration of our hospitals to prepare them for any potential blowback. So far, 8 months later, we have held our own on the BCBS payor mix by billing out of network without taking a loss of revenue. In fact, it’s slightly higher now that we have been going out of network. It is a small victory, but better to take a ‘W’ than a ‘L’.

As far as the CMS fee schedule, this happens every year for the past decade or more. They always “propose” an average of a 7-10% decrease. Pathologists squawk, and then they say, “Ok, we’ll only make it 2-4%!” As if they’re throwing us a bone to make us feel better. In reality, it is the grim collectivization of the health care model which will slowly erode the last bastions of entrepreneurship in pathology and medicine as a whole. Death by a thousand cuts…:dead:
 
We collect more on out of network (OON) on many insurance companies .
We have an good AZ BCBS contract.
Managed to get a good contract with them years ago.
The Blues including Anthem are a bitch for OON since they send a check to the patient.
Then you have to convince the patient the money is meant for us.
They are only ones that can do this in our state since they are non for profit.
 
coroner said:
True, but our group and all private groups in our state unified and sent a letter of refusal to BCBS not accepting their fee schedule. In addition, we preemptively notified administration of our hospitals to prepare them for any potential blowback. So far, 8 months later, we have held our own on the BCBS payor mix by billing out of network without taking a loss of revenue. In fact, it’s slightly higher now that we have been going out of network. It is a small victory, but better to take a ‘W’ than a ‘L’.

As far as the CMS fee schedule, this happens every year for the past decade or more. They always “propose” an average of a 7-10% decrease. Pathologists squawk, and then they say, “Ok, we’ll only make it 2-4%!” As if they’re throwing us a bone to make us feel better. In reality, it is the grim collectivization of the health care model which will slowly erode the last bastions of entrepreneurship in pathology and medicine as a whole. Death by a thousand cuts…:dead:
Click to expand...

This is what happened when I went I OON.
We made more OON and got better at collecting over time.
The patients complained a lot and we directed them to BCBS.
It was enough push back to get them to come around.
 
The decrease in payments is a long term trend and I don't see an end to it unless the supply of pathologists decreases. So I agree with the majority of commentators on this forum. I do think that our profession is at least partly to blame and by this I mean the abuse of 88305 by pathology groups.
Most subspecialty labs have abused this. I'll use GU pathology as an example because it was the most egregious in my opinion. Most on here know the hx. We went from 2 to 6 then 12 and sometimes as many of 20 biopsies on a walnut sized organ with no clinical justification. I believe six is totally justified for routine cases. GU pod labs exploded, many with basically self referral by urologists. After about a decade CMS caught on and changed the compensation. Now it is rare to see over six biopsies in my experience. Another abuse was 88342 and again the coding got changed. CAP did nothing to stop pod labs, so much money was produced. CAP is about money not pathology in my opinion.

The tragedy of this is that resections, especially with all the additional work added are woefully under-compensated. Our profession is so weak that I think private practice positions will continue to pay less but still require longer hours. I know several experienced colleagues whose hours changed from 45 to 60 hours or more per week with no increase in compensation and the increase was due to resections and related tumor boards etc, not biopsies. If anyone here sees a brighter future for private practice, please comment. My only thought is that if there is a shortage of pathologists then hospitals will see our value. This and not letting credentialed clinicians send their biopsies out to subspecialty labs might stave off some the impending decline. Just a thought.
 
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It’s nice to see more people chiming in to discuss these real issues. Some of the radiology forums mentioned the idea of teaming up to lobby Washington together. Going into the future, both of those specialties will be so important in guiding care, especially now that many people ordering tests are not the most savvy.
 
RE-Tired said:
The decrease in payments is a long term trend and I don't see an end to it unless the supply of pathologists decreases. So I agree with the majority of commentators on this forum. I do think that our profession is at least partly to blame and by this I mean the abuse of 88305 by pathology groups.
Most subspecialty labs have abused this. I'll use GU pathology as an example because it was the most egregious in my opinion. Most on here know the hx. We went from 2 to 6 then 12 and sometimes as many of 20 biopsies on a walnut sized organ with no clinical justification. I believe six is totally justified for routine cases. GU pod labs exploded, many with basically self referral by urologists. After about a decade CMS caught on and changed the compensation. Now it is rare to see over six biopsies in my experience. Another abuse was 88342 and again the coding got changed. CAP did nothing to stop pod labs, so much money was produced. CAP is about money not pathology in my opinion.

The tragedy of this is that resections, especially with all the additional work added are woefully under-compensated. Our profession is so weak that I think private practice positions will continue to pay less but still require longer hours. I know several experienced colleagues whose hours changed from 45 to 60 hours or more per week with no increase in compensation and the increase was due to resections and related tumor boards etc, not biopsies. If anyone here sees a brighter future for private practice, please comment. My only thought is that if there is a shortage of pathologists then hospitals will see our value. This and not letting credentialed clinicians send their biopsies out to subspecialty labs might stave off some the impending decline. Just a thought.
Click to expand...
We routinely get 12 core prostate biopsies from the in office lab. In office labs serve no purpose in helping patient management from what I’ve seen thus far. We usually call in our diagnosis anyways and even then they are busy with their clinical work. They either don’t call us back until a few hours later or the next day.

Other than having the physical presence of the pathologist in house so they can put a face to the pathologist, I don’t know how an in office lab serves to provide better patient care than if the pathologist just phoned in the diagnosis and/or promptly sent a Path report.

It’s easy money for clinicians.
 
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msnbc2020 said:
The only specialty with lower USMLE scores than pathology is family medicine. Many weak students have little choice besides family medicine and pathology these days.
Click to expand...

I think the joke is on us though. Radiology, anesthesia, and pathology are being literally robbed to make fam med's paycheck bigger.

Fam med looks like a great deal now. The one major drawback of fam med that I saw in medical school were all the maladjusted, drug seeking, and/or time sink patients that tend to burn you out. But that problem has been solved as every fam med in my area has hired an army of NPs and PAs to do all their work and rake it in on the back end. Seriously, I think they just spend all their time just doing chart review rather than actual patient care. And if any specialists in town give them any lip, they just divert their patients to another specialist because unlike us, they can actually fight back in a meaningful way.

So yes, weak students tend to wind up in fam med or pathology. But between the two, fam med is definitely looking like the better option at the moment.

Edit: Forgot to mention that in fam med, you also appear to be allowed to have absolute overt disdain for your patients, and still be in business. Was told of one practice in town - still fully operational and apparently doing well - where on the registration window is states that if you ask more than 2 questions, you'll be billed for 2 visits. But if you're particularly talented in fam med, you go concierge and leave the doldrums of insurance haggling behind.
 
In what other business do customers get to set their own prices for goods or services? Only in medicine...

But do we have to accept the CMS fee schedule, as well as that of other insurers?

Is it illegal for us to reject it and set our own fee schedule, and if CMS or other insurances pay below our set fees for service, we bill the patients for the difference?

What if pathologists banded together via CAP or another organization and set our own fee schedule based on the actual costs of tests in terms of reagents, tech and pathologist time (with some sort of adjustment index to modify fees based on the cost of living for a lab's location)? If insurers agree to compensate according to our schedule, they are considered "in network" by all member labs of the organization, and are billed "at cost" per the schedule. And if they do not accept our schedule, they are considered out of network and are billed our fee schedule plus a 20-30% markup to cover cost of collection, and patients get billed for any shortfalls in insurance coverage.
 
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doctor313 said:
In what other business do customers get to set their own prices for goods or services? Only in medicine...

But do we have to accept the CMS fee schedule, as well as that of other insurers?

Is it illegal for us to reject it and set our own fee schedule, and if CMS or other insurances pay below our set fees for service, we bill the patients for the difference?

What if pathologists banded together via CAP or another organization and set our own fee schedule based on the actual costs of tests in terms of reagents, tech and pathologist time (with some sort of adjustment index to modify fees based on the cost of living for a lab's location)? If insurers agree to compensate according to our schedule, they are considered "in network" by all member labs of the organization, and are billed "at cost" per the schedule. And if they do not accept our schedule, they are considered out of network and are billed our fee schedule plus a 20-30% markup to cover cost of collection, and patients get billed for any shortfalls in insurance coverage.
Click to expand...
Agree fully. Procedures should pay for the effort in time- a 4 block 12 slide breast core biopsy takes much more time and effort than a GI or Derm but has equal billing. A colectomy with LN dissection is poorly compensated. How about when the high volume cases go to out of state labs but you get the resections. Two examples: 1.Prostate- The clinician tells me you must do all you can to find the prostate cancer because what am I going to tell the patient. How are my 2 extra hours dealing with this fairly compensated? If we got the biopsies it would be justified of course. 2.Skin- My former practice didn't do the derms but we had extensive frozen sections for margins for plastics with no access to the diagnosis until we called back the results. So why is it that as a general pathologist I am not qualified to read skin but very qualIfied to read skin margins and melanoma resections? If a practice does't get the bread and butter but gets more time consuming cases how can a general hospital practice survive without stagnating compensation and having longer hours? Now pathologist are complaining since corporate medicine has figured out how to get the high volume cases and reward the company while the dermpaths, Gi, prostate biopsy paths, etc are pushing more and more slides for less pay. These companies know that there are an excess number of fellows available to hire with the oversupply. Some of these companies spend far more on sales people to get more cases than compensation for their pathologist I have heard but hope it is not true.
Again agree fully with you but pathologists are in a weak spot and have few friends. I believe it is purely supply and demand my esteemed colleagues. Without a decreased supply I don't see the situation improving in the next decade.
 
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