Bloody Friday

[Easton Ghost]

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Today, my group received news from a major insurer that our reimbursement rates were going to be drastically cut, to a fraction of Medicare. Since Medicare will not pay more than what we accept from other places, we will soon have to cut their rates I am sure. Our profit margins, for those of you in business who would know, will take a greater cut, since our costs only rise and do not get cut in a similar fashion.

Our group will have to reduce our workforce, and do more work to keep the lights on. I think flipping cheeseburgers will soon be more profitable.

 

[AZpath]

Anthem and subsidiary in 13 states Is cutting payments to about 40-60% of MC.
Consider going out of Network if possible

 

[y2k_free_radical]

Today, my group received news from a major insurer that our reimbursement rates were going to be drastically cut, to a fraction of Medicare. Since Medicare will not pay more than what we accept from other places, we will soon have to cut their rates I am sure. Our profit margins, for those of you in business who would know, will take a greater cut, since our costs only rise and do not get cut in a similar fashion.

Our group will have to reduce our workforce, and do more work to keep the lights on. I think flipping cheeseburgers will soon be more profitable.

Don't worry.We are groovy so the CAP will defend us.

 

[Spikebd]

Well maybe forensics will start to get more competitive.

 

[Torsed]

It is a death blow to small groups. I really don't know what you can do except go out of network or retire. Locums looking a lot better, walk away from the headaches. If it is a 70 percent cut to 88305's that Medicare pays say 38 bucks on, you are literally doing diagnostic biopsies for about 12 bucks if in network with this insurer? And can be sued within the terms of your malpractice for the 12 dollar reimbursement (1:3 mil)? Not sure what alternative universe this is.

Wonder what the profit margins for Anthem were last year? That would be interesting to follow.

 

[AZpath]

Locums pay is about 700-900 a day and you are likely to live out of a suit case. No benefits.
They pay malpractice but that is it.
I don't think they pay the time is takes to travel if it is out of your area. I would work for Quest or LC before that unless your going part time.
Looks like Anthem is a large % in IN, KY, OH, ME and NH

 

[Torsed]

What about CA and NY for Anthem. We looking at the mega parts of the population.

 

[Dave CX]

Going non-par is really hard for pathologists. We considered it in the past, but our referring docs, who were very supportive with outpatient business told us that they definitely did not want their patients calling and complaining about bills. Administration was unsupportive for the same reasons.

 

[AZpath]

I missed the high % in those states. Sucks.
If they are successful expect other insurance co to do the same.

 

[AZpath]

Going non-par is really hard for pathologists. We considered it in the past, but our referring docs, who were very supportive with outpatient business told us that they definitely did not want their patients calling and complaining about bills. Administration was unsupportive for the same reasons.

Push back is a problem for sure. So is collecting cash OON from patients.
My experience has been that physician lay off when they find out that the ins is paying 50% MC.

It gains a certain level of sympathy among our peers and even administrations when they see this happen.
I told our doctors to have patients call my biller and they will settle the charges for MC rates or bit below.
I did not send anyone to collections.

I was able to have the insurance co give me a good contract but it took a while.
I doubt I collected that much from patients during this period.

They are also cutting TC to the bone.
Dave, Your GI lab might decide that it is not worth doing that insurer cases and send them out.

 

[PhillyMed777]

This sounds ridiculous.
You guys need to fight this.
Good luck.

 

[Torsed]

Going non-par is really hard for pathologists. We considered it in the past, but our referring docs, who were very supportive with outpatient business told us that they definitely did not want their patients calling and complaining about bills. Administration was unsupportive for the same reasons.

Funny. Those docs and hospital admin don't listen when whopper bills from clinic and the hospital come.

 

[Dave CX]

Push back is a problem for sure. So is collecting cash OON from patients.
My experience has been that physician lay off when they find out that the ins is paying 50% MC.

It gains a certain level of sympathy among our peers and even administrations when they see this happen.
I told our doctors to have patients call my biller and they will settle the charges for MC rates or bit below.
I did not send anyone to collections.

I was able to have the insurance co give me a good contract but it took a while.
I doubt I collected that much from patients during this period.

They are also cutting TC to the bone.
Dave, Your GI lab might decide that it is not worth doing that insurer cases and send them out.

That's funny. I guess you missed the point. The in-office labs will not be ones to get screwed. Medical specialists negotiate better contracts because can and will WALK.

 

[AZpath]

I hope so for your sake Dave.
The insurance company does not care if the GI group has ancillary path or not.
They know that Path can be sent out without impact to rest of the care.

I don't see any safe turf

 

[path24]

Path mills set the price. Insurance will only talk with huge labs. Become employed and hope the hospital offers a decent salary.

Oversupply. This is a proud moment for academia and pathology professional organizations.

It will only get worse. We will all be working in a mill. Just hospital, academic or corporate owned.

 

[Alteran]

Pathology in general is going to have to start doing what other specialties have done for sometime now. Other specialty practices (oncology, surgery, fam med, etc.) have banded together to create supergroups under one corporate entity to control a significant fraction of that specialty's care (>70%) in their respective states. They're not messed with in any way by an insurer. As soon as an insurer tries to do something like this, they're immediately told that they'll be out of network and essentially locked out of the state. Antitrust doesn't apply because all the groups are linked as one corporate supergroup...there's no collusion if you're all the same "entity".

 

[AZpath]

Good idea.

 

[Dave CX]

Path mills set the price. Insurance will only talk with huge labs. Become employed and hope the hospital offers a decent salary.

Where the heck do you get this? I've seen it from both sides. Large specialty groups have the Insurance companies by the curlies. They go non-par frequently and within 6 m onths the insurance companies are begging to negotiate. The path mills don't have that leverage.

 

[WEBB PINKERTON]

Go out of network. We have done it in the past with these people. Looks like we will be again.

Only other options are employment or retire.

Large entities fighting with each other is what the US system has become. Everyone trying to get the upper hand with no efforts to control costs.

 

[path24]

Where the heck do you get this? I've seen it from both sides. Large specialty groups have the Insurance companies by the curlies. They go non-par frequently and within 6 m onths the insurance companies are begging to negotiate. The path mills don't have that leverage.

Contacted insurance companies and tried to negotiate. Wouldn't come to the table. They don't care about our pathology group. Out of network. Ticks of the patients, docs, and admin. (let me know if you have a work around) Large specialty groups would be different (why they would give path a seat at the table is beyond me, gi docs would be like we already own them no need to make them equals). Other docs have power/leverage, with path I don't see it.

The hospital systems are just going to get bigger and bigger. Corporate vs corporate.

 

[Dave CX]

Contacted insurance companies and tried to negotiate. Wouldn't come to the table. They don't care about our pathology group. Out of network. Ticks of the patients, docs, and admin. (let me know if you have a work around) Large specialty groups would be different (why they would give path a seat at the table is beyond me, gi docs would be like we already own them no need to make them equals). Other docs have power/leverage, with path I don't see it.

The hospital systems are just going to get bigger and bigger. Corporate vs corporate.

I don't dispute any of this, my point refers to the persistently envious AZpath who seems to thing that the clinical specialty groups have the same lack of leverage as pathologists, and I explained in an earlier reply why that is not accurate. There is nothing more powerful in medicine than a clinical group that has 70 or 80% market share in their region, and this is very common in small cities (eg Charleston SC, Portland ME, Duluth MN etc)

 

[Alteran]

I don't dispute any of this, my point refers to the persistently envious AZpath who seems to thing that the clinical specialty groups have the same lack of leverage as pathologists, and I explained in an earlier reply why that is not accurate. There is nothing more powerful in medicine than a clinical group that has 70 or 80% market share in their region, and this is very common in small cities (eg Charleston SC, Portland ME, Duluth MN etc)

I’ve been told of a group of ENTs in a southern city that have 100% market share...including the academic hospital there. Anytime an ENT comes to town to set up shop, they show up like Don Corleone and say “have I got a deal for you”. Next thing you know, they join the group and start making serious bank.

 

[deleted314957]

I’ve been told of a group of ENTs in a southern city that have 100% market share...including the academic hospital there. Anytime an ENT comes to town to set up shop, they show up like Don Corleone and say “have I got a deal for you”. Next thing you know, they join the group and start making serious bank.

Wonder how many of the ENT’s are academically lower tier, wallflowers and have a less-than-stellar command of the English language.
As I have said before, an employment model ( gov’t or private) awaits essentially all pathologists. A comfortable 20 years in the military followed by 10-15 years in a senior non-military capacity ain’t such a bad working life and retirement. Unfortunately the military does not need all that many pathologists. Too, too many of us and we have about zero bargaining power.
To the kids reading this-do not go $200,000 + in debt and enter pathology (or just about any other specialty. Everybody’s gonna get hit eventually.)

 

[jupiterianvibe]

Wonder how many of the ENT’s are academically lower tier, wallflowers and have a less-than-stellar command of the English language.
As I have said before, an employment model ( gov’t or private) awaits essentially all pathologists. A comfortable 20 years in the military followed by 10-15 years in a senior non-military capacity ain’t such a bad working life and retirement. Unfortunately the military does not need all that many pathologists. Too, too many of us and we have about zero bargaining power.
To the kids reading this-do not go $200,000 + in debt and enter pathology (or just about any other specialty. Everybody’s gonna get hit eventually.)

This is sick. As someone who destroyed the steps and was interested in pathology but stayed at a mid-tier place because of family obligations, i regret my choice regularly. its not right that our specialty is open to anyone that applies regardless of skill, motivation, or qualifications, and i think this is the biggest problem that is destroying the leverage the field once had moons ago. when i see pds recruit swaths of poorly trained doctors from foreign and offshore schools into their residency programs, i wonder what kind of respect they have for the specialty or if they see they are the architects of their own demise, since academics are paid terribly.

 

[Unty]

Not all foreign peeps are crap but I agree pathology opens its gates to whoever wants to take a spot. If you are crap (doesn’t matter who you are), you will have issues in practice anyways or no one will be willing to hire you.

Some programs wet their pants when they get their few positions filled in the match after ranking most of the candidates they interview.

 

[y2k_free_radical]

Go out of network. We have done it in the past with these people. Looks like we will be again.

Only other options are employment or retire.

Large entities fighting with each other is what the US system has become. Everyone trying to get the upper hand with no efforts to control costs.

I agree for the short term,but this has to be coupled with reduction of residency positions to best affect the long term

 

[y2k_free_radical]

I don't dispute any of this, my point refers to the persistently envious AZpath who seems to thing that the clinical specialty groups have the same lack of leverage as pathologists, and I explained in an earlier reply why that is not accurate. There is nothing more powerful in medicine than a clinical group that has 70 or 80% market share in their region, and this is very common in small cities (eg Charleston SC, Portland ME, Duluth MN etc)

Do they have control over PALMETTO HEALTH who is the worst MEDICARE payor in the US ?

 

[WEBB PINKERTON]

Last time we were out of network it was difficult to get paid since the patients were sent a check by the insurance company, which of course many would spend. Still, we got paid better than being in-network despite the problems.

 

[Dave CX]

Do they have control over PALMETTO HEALTH who is the worst MEDICARE payor in the US ?

Ha!!! Definitely not. And you are right they are horrible. And their top administrator is apparently a pathologist.

 

[y2k_free_radical]

I can not believe the paucity of replies and reactions to an action which might represent one of the most egregious attacks on our livelihood in some time.I conclude that most are still in shock.Where is LA DOC in this moment of crisis ??

 

[PhillyMed777]

I can not believe the paucity of replies and reactions to an action which might represent one of the most egregious attacks on our livelihood in some time.I conclude that most are still in shock.Where is LA DOC in this moment of crisis ??

Seriously...

 

[Dave CX]

I can not believe the paucity of replies and reactions to an action which might represent one of the most egregious attacks on our livelihood in some time.I conclude that most are still in shock.Where is LA DOC in this moment of crisis ??

Hopefully banging strippers

 

[Med Director New England]

GI biopsies are headed toward a G-code or similar (I.e what happened to extended core prostrate biopsies). Derms the same.

There are large academic groups contracting to do AP pro work below Medicare. And the word is getting out - if I worked for a third party payer I would lob low ball sub-Medicare offers too. Guess what folks there are so many pathologists out there needing work someone will bite. 25 bucks /305 became the status quo sometime ago, once that happened it was a slippery slope...

No take backs kiddos

 

[Dro133]

So uhh... should I not go into pathology?

 

[Dave CX]

GI biopsies are headed toward a G-code or similar (I.e what happened to extended core prostrate biopsies). Derms the same.

There are large academic groups contracting to do AP pro work below Medicare. And the word is getting out - if I worked for a third party payer I would lob low ball sub-Medicare offers too. Guess what folks there are so many pathologists out there needing work someone will bite. 25 bucks /305 became the status quo sometime ago, once that happened it was a slippery slope...

No take backs kiddos

Unfortunately you are probably correct regarding the G codes. This is why I am working 6 days per week, 52 weeks per year while the getting is good.