Bostwick

[musom]

So, there is a local (very) busy urology practice which sends part of their specimens to me (medicare/medicaid) and part of their specimens out to Bostwick (private insurance and self payers). In trying to swoon them for all of their business I have learned some, and probably more than I ever wanted to know, about their business relationship with Bostwick. Here is my understanding:

The Urology group bills the patient both TC and PC and sends the specimen(s) out to Bostwick. Bostwick performs the TC and PC and charges the Urology group a "price/CPT". Seems to be around $25 for an 88305. I actually obtained their negotiated price sheet.

Is this everyone else's understanding? LADOC, I'm sure you know more?

My question, how in the he** am I suppose to compete with this?

It's nice to know that the Urology group retains about 80% of work they don't do....Thanks guys.

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[icpshootyz]

Yep, this is what the rest of us are up against. It truly is other pathologists that are killing the field, it's just our clinical colleagues that can take advantage of it. We've been trying to woo the local dermatologists away from the big labs and they basically all told us there's no way we can beat the deals they're getting. Integrity is in short supply these days.

 

[WEBB PINKERTON]

Sounds like you are in a state that needs to end client billing. Better be fighting for some legislation. We wouldn't be in business without the law since the prices had gotten so low from the competing sweat shops in the area. We had a skins/pap test lab nearby that was doing paps for 16 and skins for even less than that on the TC.

Anyone that thinks we don't have an oversupply problem has their head in the sand. These arrangements wouldn't exist otherwise.

 

[jupiterianvibe]

Sounds like you are in a state that needs to end client billing. Better be fighting for some legislation. We wouldn't be in business without the law since the prices had gotten so low from the competing sweat shops in the area. We had a skins/pap test lab nearby that was doing paps for 16 and skins for even less than that on the TC.

Anyone that thinks we don't have an oversupply problem has their head in the sand. These arrangements wouldn't exist otherwise.

agreed. The program I came from had almost 30 residents total. That's over six per year graduated and out in a glutted market.

 

[mlw03]

Excuse my ignorance, but I want to understand these issues better. I'm a forensic guy who never did surg path in any form post residency. My question is whether the quality of diagnoses coming out of these mega-labs for cytology, GU, derm, etc are inferior in any way? Are they diagnostically correct? Are they using ancillary studies reasonably (or bilking insurance companies for IHC that isn't warranted)? Are they simply able to outbid on efficiency of scale, because clearly these labs are profitable too, right?

For what it's worth, I don't know if such a business model even exists in western Canada... I've not heard of it if it does.

 

[coroner]

My question, how in the he** am I suppose to compete with this?

You don't in the short run. Maybe in the long run as said before if the laws change or when there's no longer an oversupply. Be happy you even get the few scraps of CMS pts. because it's better than nothing. Look at the bright side, overall you're probably faring better than the scope monkeys at Bostwick (not the top dogs).

My question is whether the quality of diagnoses coming out of these mega-labs for cytology, GU, derm, etc are inferior in any way? Are they diagnostically correct? Are they using ancillary studies reasonably (or bilking insurance companies for IHC that isn't warranted)? Are they simply able to outbid on efficiency of scale, because clearly these labs are profitable too, right?

Many times the reference labs hire their own subspecialty pathologists so, their quality is no better/worse than the average hospital based pathology group. They get the business because they are willing to undercut the average pathology group because they can do so by scale of efficiency as you mentioned and maintain revenue by high volume, and low overhead by paying their pathologists underwhelming wages.

 

[musom]

You don't in the short run. Maybe in the long run as said before if the laws change or when there's no longer an oversupply. Be happy you even get the few scraps of CMS pts. because it's better than nothing. Look at the bright side, overall you're probably faring better than the scope monkeys at Bostwick (not the top dogs).



Many times the reference labs hire their own subspecialty pathologists so, their quality is no better/worse than the average hospital based pathology group. They get the business because they are willing to undercut the average pathology group because they can do so by scale of efficiency as you mentioned and maintain revenue by high volume, and low overhead by paying their pathologists underwhelming wages.

And not only underpaying their pathologists, but also having a significantly reduction of their TC costs, by placing a large number of biopsies (? 12 i think) on a single slide, all being inked a different color. Nothing more than a pyramid sweatshop, squashing our financial existence. Sleep well at night Bostwick, sleep well.

 

[WEBB PINKERTON]

Here is how Bostwick is able to give those "great deals". Defraud medicare/medicaid, create a fake market .

Notice that the whistleblower got 2.5 million dollars. I am ready to take a job at one of these shady labs and turn them in for one last pay day.

https://www.justice.gov/opa/pr/form...y-375-million-resolve-allegations-unnecessary

He doesnt even work for the lab bearing his name. I guess you should be on the look out for his new ventures-Granger Diagnostics

http://www.grangerdiagnostics.com/

 

[LADoc00]

So, there is a local (very) busy urology practice which sends part of their specimens to me (medicare/medicaid) and part of their specimens out to Bostwick (private insurance and self payers). In trying to swoon them for all of their business I have learned some, and probably more than I ever wanted to know, about their business relationship with Bostwick. Here is my understanding:

The Urology group bills the patient both TC and PC and sends the specimen(s) out to Bostwick. Bostwick performs the TC and PC and charges the Urology group a "price/CPT". Seems to be around $25 for an 88305. I actually obtained their negotiated price sheet.

Is this everyone else's understanding? LADOC, I'm sure you know more?

My question, how in the he** am I suppose to compete with this?

It's nice to know that the Urology group retains about 80% of work they don't do....Thanks guys.

Yah it's called a 'Client Bill' arrangement. It is illegal where I roam but I am quite familiar with how it works. Is there is anything else about this group we could use to pressure them, such as are you in a ACO arrangement with them or do you do work for them in a hospital setting or are some of their Urologists employed by the hospital you have an exclusive contract with? Can you exert soft power on their flanks?

Then there is Black Ops: do any of the Urology partners have a drug, hooker or gambling problem? You could go after the weak link.

 

[jupiterianvibe]

Yah it's called a 'Client Bill' arrangement. It is illegal where I roam but I am quite familiar with how it works. Is there is anything else about this group we could use to pressure them, such as are you in a ACO arrangement with them or do you do work for them in a hospital setting or are some of their Urologists employed by the hospital you have an exclusive contract with? Can you exert soft power on their flanks?

Then there is Black Ops: do any of the Urology partners have a drug, hooker or gambling problem? You could go after the weak link.

LADoc, I always pay attention to your messages. Consider me a fan.

But I am curious: have you, or anyone you know of, used "Black Ops" to secure better business? How'd it happen?

 

[Nilf]

Yah it's called a 'Client Bill' arrangement.

Can anyone provide a list of states which outlaw client billing? I am admittedly too lazy to research each state laws. Thank you in advance.

 

[mlw03]

You don't in the short run. Maybe in the long run as said before if the laws change or when there's no longer an oversupply. Be happy you even get the few scraps of CMS pts. because it's better than nothing. Look at the bright side, overall you're probably faring better than the scope monkeys at Bostwick (not the top dogs).



Many times the reference labs hire their own subspecialty pathologists so, their quality is no better/worse than the average hospital based pathology group. They get the business because they are willing to undercut the average pathology group because they can do so by scale of efficiency as you mentioned and maintain revenue by high volume, and low overhead by paying their pathologists underwhelming wages.

Thanks for those explanations. The economics are quite interesting. I can see how this does come down to the oversupply of pathologists issue that folks often return to. Without a lot of pathologists in need of work, the mega-lab economic model doesn't work. I'd be curious to hear from a pathologist employed by a Bostwick or similar type of company/lab. Perhaps some of them like their situation as a moderately well-pain technician. There are worse things in the world obviously. No admin, no politics... I can see the appeal to some folks.

 

[yaah]

The quality from these labs is usually fine. Part of the problem is that it's often better than a lot of smaller community groups. And of course they have pretty reports with color and images and diagrams. But quality is also often not great. Have seen a few mistakes. The bigger problem for quality is not the massive reference labs but the small labs (in office labs and the like). Of course, for them, quality is only really lip service. Have seen some major doozies from those types of labs (Gleason score 2 + 4 = 6, for example). Big reference labs tend to do more ancillary studies (which often impress dubious clinicians) like molecular studies and patient identity testing on every sample. And of course ubiquitous IPOX and special stains. 3-4 stains on every gastric biopsy and duodenal biopsy and bladder biopsy. "confirmatory" melanocytic markers on every melanocitic lesion.

Personally, I don't know how it can possibly be legal for a urologist office to bill the TC and PC even though they don't do any of the work.

 

[Torsed]

Yah it's called a 'Client Bill' arrangement. It is illegal where I roam but I am quite familiar with how it works. Is there is anything else about this group we could use to pressure them, such as are you in a ACO arrangement with them or do you do work for them in a hospital setting or are some of their Urologists employed by the hospital you have an exclusive contract with? Can you exert soft power on their flanks?

Then there is Black Ops: do any of the Urology partners have a drug, hooker or gambling problem? You could go after the weak link.

I like that black ops approach LADoc00. At least there is one other person on the planet like myself.

 

[LADoc00]

LADoc, I always pay attention to your messages. Consider me a fan.

But I am curious: have you, or anyone you know of, used "Black Ops" to secure better business? How'd it happen?

Yes I have. I didn't toss that out merely because I thought of it while downing 1800 Teq and limes

There was a guy who specialty was arranging trips to Vegas for Urologists and then getting them in compromising situations that were quite effectively used as leverage in getting business. Some would call this blackmail, others perhaps whitemail? Its usually the white ex-Frat dude who cooks up such plans.