Why current breast pathology practices must be evaluated. A Susan G. Komen for the Cure white paper: June 2006.
Pathologists, radiologists, and surgeons generally agree that pathologists are not adequately compensated for performing breast pathology. A pathologist who is thorough is likely to lose money, yet a thorough review is needed for diagnostic accuracy. The average stereotactic vacuum-assisted biopsy specimen requires review of slidesfrom approximately 2 to 3 paraffin blocks, whereas a wire-localized surgical breast specimen averages 15 to 20blocks; however, reimbursement is generally not based on the type of specimen reviewed or the complexity of the case.[personal communication, Dr. Ibarra] For example, a breast core biopsy, which requires multiple levels (often 3 to 6) and needs correlation with imaging, is reimbursed at the same rate as seborrheic keratosis, a non-cancerous
skin growth that can be diagnosed with the review of only one slide. This clearly demonstrates the lack of connection between workload and reimbursement and should be particularly concerning given that one condition is potentially fatal while the other is relatively benign. Low rates of reimbursement may also lead to suboptimal review of ductal
carcinoma in situ (DCIS) resections. A DCIS resection may require up to 40 paraffin blocks, and a pathologist needs to examine 100% of the specimen to determine the size and margin status and confirm the absence of occult invasive disease, information crucial to the subsequent treatment decision. This thorough review is time-consuming,
and current reimbursement is not commensurate with the work or materials used. Since the incidence of DCIS is rising, the low reimbursement rate is a major issue.
Pathologists, radiologists, and surgeons generally agree that pathologists are not adequately compensated for performing breast pathology. A pathologist who is thorough is likely to lose money, yet a thorough review is needed for diagnostic accuracy. The average stereotactic vacuum-assisted biopsy specimen requires review of slidesfrom approximately 2 to 3 paraffin blocks, whereas a wire-localized surgical breast specimen averages 15 to 20blocks; however, reimbursement is generally not based on the type of specimen reviewed or the complexity of the case.[personal communication, Dr. Ibarra] For example, a breast core biopsy, which requires multiple levels (often 3 to 6) and needs correlation with imaging, is reimbursed at the same rate as seborrheic keratosis, a non-cancerous
skin growth that can be diagnosed with the review of only one slide. This clearly demonstrates the lack of connection between workload and reimbursement and should be particularly concerning given that one condition is potentially fatal while the other is relatively benign. Low rates of reimbursement may also lead to suboptimal review of ductal
carcinoma in situ (DCIS) resections. A DCIS resection may require up to 40 paraffin blocks, and a pathologist needs to examine 100% of the specimen to determine the size and margin status and confirm the absence of occult invasive disease, information crucial to the subsequent treatment decision. This thorough review is time-consuming,
and current reimbursement is not commensurate with the work or materials used. Since the incidence of DCIS is rising, the low reimbursement rate is a major issue.
Oops! This is not important, instead lets talk about transformation and "rounding with clinicians", while other specialities address real issues.
