88305 Reimbursement

[raider]

88305 professional component medicare reimbursement has taken a "nose-dive' from what it was in 1992 ($63) to 2011($31).

Discuss why:

Our "useless" organizations (especially the "impotent" CAP) are silent on the issue.

Sure they want to talk BS like in-vivo microscopy and other childish fantasies as it makes them look like they are "actually" doing something worthwhile.

The only real issues in pathology are:

(1) Supply-demand.

(2) Reimbursement.

(3) Other scum physicians "shamelessly stealing our revenue"

(4) Admin type losers "shamelssly stealing our revenue".

(5) Other physicians playing "histopathologist" without undergoing an "AP" residency. Ask yourself why can't a dermatopathologist practice clinical dermatology while a dermatologist can practice dermatopathology after only a derm residency.

Be assertive and think independently (the field is crowded with people of low IQ and atrophic b-lls).

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[yaah]

It's all about clout. TC is where the $ is. Big labs want more for TC.

 

[purplecolor]

Be assertive and think independently (the field is crowded with people of low IQ and atrophic b-lls).

you r right. absolutely.

what to do to survive ?

In american healthcare the one who controls patient controls dollars.
Learn from radiologists ( they started interventional )

we need to add one year clinical exposure after 4 years so we can do history physical, refil DM and hypertension and lipid medications on out patient basis along with seeing slides.

The problem with low IQ and atrophic b-lls is that we are allergic to patients and it is the patients where the money is and eventually pathology job security.

I was surprised to see the impotent CAP go to middle east and click pictures with towel heads. Oh comeon --- before doing anything overseas....first improve the pathology market in USA.

http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=news_service%2F1103%2F1103_signs_agreement.html&_state=maximized&_pageLabel=cntvwr

 

[Euchromatin]

we need to add one year clinical exposure after 4 years so we can do history physical, refil DM and hypertension and lipid medications on out patient basis along with seeing slides.

The problem with low IQ and atrophic b-lls is that we are allergic to patients and it is the patients where the money is and eventually pathology job security.
http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=news_service%2F1103%2F1103_signs_agreement.html&_state=maximized&_pageLabel=cntvwr

I know I shouldn't feed the troll, but...

Number 1 - One of the reasons I went into path was so that I would never have to do another H&P or refill another DM or HTN medication. Yuck! Also, although I don't know how often this actually happens, I believe that anyone with an MD, regardless of their residency training (or even lack thereof), is legally permitted to open up a general medicine outpatient clinic. If you're really keen on reaping all that outpatient visit/pt. counseling reimbursement (which, from what I've heard, the family practice/g.p. docs barely break even or sometimes lose money on) - have at it.

Number 2 - My I.Q. is not low and my, let's call it gumption, boldness, or backbone (I don't think that these characteristics are limited to men or need to be equated with only their genitalia), is neither lacking nor atrophic.

Number 3 - I find the phrase "towelhead" offensive and racist. Knock it off.

 

[raider]

Pathologists already do "interventional stuff" e.g. bone marrow biopsies, FNAs etc.

All we need to do is to introduce a fellowship with imaging based procedures because someone who will later on read the specimen out is better at judging what constitutes an adequate specimen .

Besides this has nothing to do with decreased reimbursement for stuff we already do. Pathology reports have got more complicated and the diagnosis has to be more accurate and then there is this thing called inflation. In other professions people retaliate if there is no "inflation adjusted increase". Here we are talking about a "massive" decrease, yet our organizations seem to think this is a non-issue and keep talking about other nonsense stuff in their absurd publications like CAP today or whatever.

I keep on hearing all these BS things like those who control patients control the money and other bull****. First off these days patients usually go to see a doc at lets say MD Anderson only becuase the said doc is working at MD anderson not because he/she is so and so. Take away MD anderson and lets see how many patients come. Pathologists are no different than lets say surgeons who get patients referred through other docs e.g. oncologists etc and vice versa. These are BS excuses made by weak individuals to ascribe their "own" shortcomings to envoirnmental factors. We are "consultants" and we should be recognized for our extreme value to both the patient and other clinicians. If this is not the case, then there is a serious error somewhere in the system and it needs to be rectified pronto (unfortunately do not wait for CAP to take action , they like to live in a fantasy world where in-vivo imaging will become the diagnostic modality of choice in ten years and where pathologists should be wasting their time "rounding").

The term "atrophic b-lls" was, of course slang for "a person lacking assertiveness" and had nothing to do with gender. A lot of women I know are way more b-llsy (in a good way) and intelligent than men.

 

[Thrombus]

You don't think the CAP Today's push for "rounding for free" is a good use of our time?

I will round for free when I see radiologists "round for free". Come to think of it, I wil round for free when I see anyone "round for free".

Agreed that the CAP and other organizations of pathology "leadership" are complete failures, deflating our reimbursement at an embarassing rate.

 

[Unty]

You don't think the CAP Today's push for "rounding for free" is a good use of our time?

I will round for free when I see radiologists "round for free". Come to think of it, I wil round for free when I see anyone "round for free".

Agreed that the CAP and other organizations of pathology "leadership" are complete failures, deflating our reimbursement at an embarassing rate.

Aren't reimbursement rates lower across most if not all specialties?

 

[futuredoc15]

Pathology is a dead field anyway.

In the future you will have three primary groups of pathologists:

1. The pathologists who work for cutrate reimbursement at the inhouse labs of GI docs, urologists, dermatologists, and multispecialty groups.
2. Those who work as employees of large corporate mills like Quest/AmeriPath. Labcorp, Caris, etc.
3. Hospital pathologists who are begging for crumbs from the new ACOs under Obamacare.

 

[2121115]

This thread rules.

 

[KCShaw]

And we could inject the argument that it has nothing to do with controlling patients, but with herding the clinicians who send specimens. If we want to be paid more like proactive consultants than as interchangeable tools to be manipulated then we have to play the part, with unity. The problem isn't that pathology isn't a critical part of patient care, it's that the perception is our jobs are machinistic, purely objective, not prone to incompleteness or interpretive error/bias, and has no particular need for good training, good resources, and experience. We are "The Lab", often thought of as simply another machine to be plugged in, moved around, and treated as a tool.

 

[gschl1234]

And we could inject the argument that it has nothing to do with controlling patients, but with herding the clinicians who send specimens. If we want to be paid more like proactive consultants than as interchangeable tools to be manipulated then we have to play the part, with unity. The problem isn't that pathology isn't a critical part of patient care, it's that the perception is our jobs are machinistic, purely objective, not prone to incompleteness or interpretive error/bias, and has no particular need for good training, good resources, and experience. We are "The Lab", often thought of as simply another machine to be plugged in, moved around, and treated as a tool.

Well said.

 

[rockit]

Why not hire some Physician Assistants to do scopes, bill for those, then read the biopsies?

 

[Substance]

Why not hire some Physician Assistants to do scopes, bill for those, then read the biopsies?

Because that would require aggression, and nobody in pathology wants to piss off the surgeons and internists.

Pathologists on the whole don't think they deserve anything. They're too humble, made up of people with average to below average board scores, scramblers, and foreign medical graduates: all of which don't believe they can do any better.

 

[2121115]

because that would require aggression, and nobody in pathology wants to piss off the surgeons and internists.

Pathologists on the whole don't think they deserve anything. They're too humble, made up of people with average to below average board scores, scramblers, and foreign medical graduates: All of which don't believe they can do any better.

lol.

 

[Johnny Sunshine]

My hospital recently conducted an intensive economic review of operations, and the pathology department was solemnly informed that we are slightly in the red on the balance sheet.

While in principle it would be nice for our department to be bringing in more reimbursement than it has expenses, I feel the hospital is missing a major point of perspective: Many, if not a majority of their high-reimbursement procedures would likely not be well reimbursed (or possibly not reimbursable at all) without pathology analysis. Simply, path allows the hospital to make its money elsewhere.

I'm wondering, for example: Unless the patient has current symptoms clearly related to a mass, how difficult would it be convincing insurance companies to reimburse for a surgical resection without biopsy-proven malignancy? Even screening procedures such as endoscopy, skin exams, DRE or mammograms will be of much reduced value if the clinicians couldn't take biopsies and make major treatment decisions based on the pathology interpretation.

About 10 years ago, I worked at Wal-Mart. Like most large retail stores, Wal-Mart has loss leaders - items that they take a loss on, knowing if they get people in the door they will more than make up for those losses with everything else the customer might buy while they're in the store. One of Wal-Mart's biggest loss leaders, for example, is meat. On practically every meat product the store lost big money. But no one gave the manager of the deli a stern lecture, because those reasonably priced meats brought in a ton of customers who spent a whole lot of money on other things too.

I'm not saying path shouldn't work to be economically efficient and profitable, of course. But it might benefit us for the world of medicine (and the public) to see us as...I don't know, maybe "expert gatekeepers"? As others have said, pathology is undervalued. Possibly because it is so strikingly different from other specialties, there is not enough overlap for our practice to be relatable to the clinicians and therefore they have little idea of what our job entails? Well, we need to make them understand. We need more balls, yes.

Perhaps, as I've overheard an attending once suggest, pathology could use a good old fashioned strike.

 

[LADoc00]

It's all about clout. TC is where the $ is. Big labs want more for TC.

wonk wonk wonk...I predict TC on 88305 which in my area will now be LESS than the PC (TC now around 35-37 bucks, PC 42) per this most recent breaking news(YAY!!!), will nosedive all the way to sub-20 bucks in the next decade as government contracts.