AMA and IHC

[pathstudent]

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I have been more focused on the fact that we will have to try to collect TC for pathology from the surgery centers rather than the Medicare, so I didn't pick up on the following until yesterday.

I knew with the G codes that you can only bill one particular IHC per container rather than per block. In otherwords if you have a very undifferentiated tumor that you want to attempt SMAs and CAM5.2s on four blocks, you can only bill for one (i.e. only one G0461and one G0462 and next year only one 88342, 88341). You just have to eat the cost for the other 6 IHC. I understand Medicare giving them themselves this discount as their agenda is about reducing payments to specialists and reducing economic inequality.

However, I just learned that starting in 2015 the AMA adopted the policy so now private insurance will have to be billed the same way. It is an absurd policy. There are cases that requite the same immuno on multiple blocks from the same specimen. We should be reimbursed. Moreover, the insurers are for profit companies not a government run entitlement. So the AMA has made a policy that is bad for patients and helps increase profits of insurance companies.

How come the AMA never adopted the stark laws that would have prevented doctors from profiting of pathology services on the non-medicare patients! AMA is corrupt.

 

[WEBB PINKERTON]

So I guess we can put nails in the coffin of "Personalized Medicine"?

 

[Thrombus]

Instead of being able to negotiate with insurers, we now will be told what we are going to get thanks to Obamacare. Meanwhile, instead of creating more access to healthcare, this Obamination has reduced the number of biopsies nationwide according to my sources. The good news for pathology: 88309's will increase.

 

[turtle1966]

I knew with the G codes that you can only bill one particular IHC per container rather than per block. In otherwords if you have a very undifferentiated tumor that you want to attempt SMAs and CAM5.2s on four blocks, you can only bill for one (i.e. only one G0461and one G0462 and next year only one 88342, 88341). You just have to eat the cost for the other 6 IHC.

ONLY If you are bearing the cost of the IHC-TC, you may try the following recommendations. It will not work for all cases.

1-punch area(s) of interest(s) from block(s), re-block them and stain them as a single block.
2-place no more than 1 or 2 sections per slide, depending on the block size.
3-try to punch several cases and re-block them as a single block.
4-control area of slide being stained. Usually there are 3 zones per slides, try to do with only one or two.
5-optimize amount and dilutions of primary and detection system reagents
6-go over your IHC procedure at your lab. Often there is waste in the procedure(s), either from manufacturer's over-recommendations or from histotech's idiosyncrasies.

This may be time-intensive, however, if your skin is in the game, you may have to.

Necessity is mother of invention.

 

[2121115]

ONLY If you are bearing the cost of the IHC-TC, you may try the following recommendations. It will not work for all cases.

1-punch area(s) of interest(s) from block(s), re-block them and stain them as a single block.
2-place no more than 1 or 2 sections per slide, depending on the block size.
3-try to punch several cases and re-block them as a single block.
4-control area of slide being stained. Usually there are 3 zones per slides, try to do with only one or two.
5-optimize amount and dilutions of primary and detection system reagents
6-go over your IHC procedure at your lab. Often there is waste in the procedure(s), either from manufacturer's over-recommendations or from histotech's idiosyncrasies.

This may be time-intensive, however, if your skin is in the game, you may have to.

Necessity is mother of invention.

LOL

 

[yaah]

Personally, I think you all need to stop blaming "Obamacare." Obamacare made a lot of changes to the health care industry but it merely perpetuated existing trends (if not stabilized them) that were driving reimbursement lower. It's not Obamacare making the changes, it's CMS and congress. Obamacare was passed without fixing the SGR issue (because to do so would have cost "too much money."). Blaming Obamacare just makes you look silly and uninformed. Blame Obamacare (in part) for higher insurance payments, medicaid expansion, things like that. Not for declining medicare payment. Obamacare does do some stuff with payment bundling and all that, but again, those were existing trends and not anything new to the law.

 

[cmz]

ONLY If you are bearing the cost of the IHC-TC, you may try the following recommendations. It will not work for all cases.

1-punch area(s) of interest(s) from block(s), re-block them and stain them as a single block.
2-place no more than 1 or 2 sections per slide, depending on the block size.
3-try to punch several cases and re-block them as a single block.
4-control area of slide being stained. Usually there are 3 zones per slides, try to do with only one or two.
5-optimize amount and dilutions of primary and detection system reagents
6-go over your IHC procedure at your lab. Often there is waste in the procedure(s), either from manufacturer's over-recommendations or from histotech's idiosyncrasies.

This may be time-intensive, however, if your skin is in the game, you may have to.

Necessity is mother of invention.

I can barely get a freaking proper H&E and you want me to do what?

 

[Pingu]

I can barely get a freaking proper H&E and you want me to do what?

No kidding. You would need a fairly experienced and skilled histotech to do any of this. When we were interviewing for histotechs back a few months ago, the talent pool did not appear to be deep enough for something like this.

 

[LADoc00]

Yaah,

Correct me if Im wrong, but didnt the CAP leadership directly say that as a result of the ACA/Obamacare, the CMS created a series of "Overvalued Code Initiatives" secret Washington speak for "we gonna cut joos!" during the 2013 teleconference?

I think that is where most people are getting this. The ACA did FAR more than merely tweak insurance systems hence why many Democrats are finally coming out and saying it was a disaster.

 

[Crossed Path]

This is my understanding as well, based on the CAP webinars. Before the ACA, payment by CMS was determined using the RUC's recommendation, which was determined largely by the cost to perform a test (reagents, tech time, etc.). Now, CMS is using the ACA to justify its authority to ignore the evidence/fact-based recommendations by the RUC and claimthat they can set their own payment levels and methods. This is what they did for the cuts to 88305, ipox, FISH, etc. While it may not be good politics or PR to blame Obamacare, it's hard to argue that Obamacare did not directly cause declining Medicare payments.

 

[pathstudent]

Agree with above.

And i still am baffled by their logic. There are cases where it is essential to perform the same antibody on multiple blocks from the same specimen, yet they must contend that it is not because they won't reimburse for it. So either I pay for it out of my own pocket or I do less than what is essential.

 

[Thrombus]

The AMA defenders like poster "Yaah" are part of a team (the democrats) who must defeat the other team (the Republicans) no matter the evidence or irrationality. The inverse also applies somewhat but not nearly as much as how the D's view the R's as their bitter enemy (more so than the Ruskies, ISIS, NK, ChiComms -- you name the villain).

Hence, we get stuck with this abomination of a bill that reduces patient access, transfers money from people who produce (doc's, tech's RN's etc) to those who don't (admin, insurance, regulators), makes everything more expensive and time consuming, treats the guy without insurance who refuses to be productive and who uses the ER for his primary care as the same as the productive guy who pays for his insurance and others and rarely has any issues. It rewards irresponsibility and nonproductivity and penalizes responsibility and productivity.

 

[WEBB PINKERTON]

Remember when both democrats and republicans ended competitive bidding for medicare.....

http://www.saveourlabs.com/CBid history.htm

 

[yaah]

Yaah,

Correct me if Im wrong, but didnt the CAP leadership directly say that as a result of the ACA/Obamacare, the CMS created a series of "Overvalued Code Initiatives" secret Washington speak for "we gonna cut joos!" during the 2013 teleconference?

I think that is where most people are getting this. The ACA did FAR more than merely tweak insurance systems hence why many Democrats are finally coming out and saying it was a disaster.

That may be true, but my point is that the CMS was going to do this anyway, almost certainly. Whether it was called obamacare or not called anything at all. I seem to remember hearing about stuff like this before Obamacare. And reimbursement was certainly falling and being recategorized well before the ACA took shape.

 

[yaah]

The AMA defenders like poster "Yaah" are part of a team (the democrats) who must defeat the other team (the Republicans) no matter the evidence or irrationality. The inverse also applies somewhat but not nearly as much as how the D's view the R's as their bitter enemy (more so than the Ruskies, ISIS, NK, ChiComms -- you name the villain).

Hence, we get stuck with this abomination of a bill that reduces patient access, transfers money from people who produce (doc's, tech's RN's etc) to those who don't (admin, insurance, regulators), makes everything more expensive and time consuming, treats the guy without insurance who refuses to be productive and who uses the ER for his primary care as the same as the productive guy who pays for his insurance and others and rarely has any issues. It rewards irresponsibility and nonproductivity and penalizes responsibility and productivity.

Will you please stop this nonsense? I have absolutely ZERO relationship with the AMA. I do not pay dues and I never have. I have never gone to a meeting. I have essentially zero respect and zero use for the AMA. Just because someone disagrees with PART OF your obviously well thought out and 100% correct position does not mean they are a paid shill. Get a grip. I am so sick of these types of arguments. And I love how you can tell how I vote. What a total joke of an argument.

I mean, honestly, reading everything you guys post you would think that before the ACA existed everything was wonderful and beautiful, efficient, and rewarded hard work and didn't penalize good practice. Do you have any common sense? Were you alive 10 years ago? The ACA does a lot of things, yes. That is quite obviously indisputable. What is also indisputable is that the ACA does some good things. Whether these good things outweigh the bad things is open to your (mostly) political viewpoints and (partially but FAR less common) actual knowledge of the bill. Personally I don't even like the ACA either. But I mostly don't like it because it was a huge wasted opportunity. It codified and created a bunch of stuff that is wasteful or doesn't help. The democrats rammed it through instead of figuring out a way to make it politically palatable to both sides. You could argue, quite successfully, that there was no way the republican party was going to support anything at all, and that is part of the problem with politics. It's now a game instead of being anything close to constructive. And what happens as a result? Otherwise rational people get taken up by it and start parroting all the political nonsense in the non-political world.

 

[LADoc00]

That may be true, but my point is that the CMS was going to do this anyway, almost certainly. Whether it was called obamacare or not called anything at all. I seem to remember hearing about stuff like this before Obamacare. And reimbursement was certainly falling and being recategorized well before the ACA took shape.

Dunno and no one can really say if the RUC process abandonment was going to happen with or without the ACA. But a direct result of the ACA was the now commonplace ignoring of RUC recommendations by CMS. But I would talk to the CAP guys if you want granularity on the issue.

We have the potential for total disaster now as they seem to be using Obamacare to remove the normal checks and balances on Medi/Medi reimbursements.