California SB 1215

[LADoc00]

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California SB 1215 brought into play this week is CRAZY. Total ban on essentially all ancillary in office medical services including Adv. Imaging, Pathology, Rad Onc and Phys. Therapy.

Consequences:
1.) All Dermatologists reading slides would be banned from doing so..not just prevented from billing CMS, this would literally be a crime.
2.) All Pathologists working for multispec or single spec physician groups with less than 10 different specialties represented would be banned from in office lab work
3.) All Heme Onc groups who invested millions into office Rads/Rad Onc, would be banned from using these tools.

California Democrats have completely left the planet. This is after the asshat Leland Yee, the biggest anti-gun politician perhaps in the entire US, is arrested for trying to import heavy machine guns and RPGs from radical Abu Sayyaf rebels in the Philippines!!

This is total f'ing insanity.

 

[BlondeDocteur]

Wasn't this killed in committee two days ago?

http://openstates.org/ca/bills/20132014/SB1215/

 

[2021Doctor]

California SB 1215 brought into play this week is CRAZY. Total ban on essentially all ancillary in office medical services including Adv. Imaging, Pathology, Rad Onc and Phys. Therapy.

Consequences:
1.) All Dermatologists reading slides would be banned from doing so..not just prevented from billing CMS, this would literally be a crime.
2.) All Pathologists working for multispec or single spec physician groups with less than 10 different specialties represented would be banned from in office lab work
3.) All Heme Onc groups who invested millions into office Rads/Rad Onc, would be banned from using these tools.

California Democrats have completely left the planet. This is after the asshat Leland Yee, the biggest anti-gun politician perhaps in the entire US, is arrested for trying to import heavy machine guns and RPGs from radical Abu Sayyaf rebels in the Philippines!!

This is total f'ing insanity.

What will this do to MOHS surgery?

 

[LADoc00]

MOHS would technically be illegal IF they billed any frozen section codes..ie any Anatomic pathology. I dont understand MOHS enough to know how it is billed.

It hasnt been killed so far, it was edited and resubmitted. Hopefully someone strangles this GD turd.

 

[turtle1966]

Consequences:
1.) All Dermatologists reading slides would be banned from doing so..not just prevented from billing CMS, this would literally be a crime.
2.) All Pathologists working for multispec or single spec physician groups with less than 10 different specialties represented would be banned from in office lab work

Isn't this banning of POLs? Should we not welcome it?

 

[vistaril]

Isn't this banning of POLs? Should we not welcome it?

POLs give local pathologists work. It keeps things local. POLs are a big improvement on corporate megalabs from the standpoint of most pathologists

 

[turtle1966]

POLs give local pathologists work. It keeps things local. POLs are a big improvement on corporate megalabs from the standpoint of most pathologists

My decreasing order of preference:

1st, specimens in my lab
2nd, specimens in any other lab run by a pathologist
3rd, a POL that does not exploit their pathologist too badly
4th, a POL that exploits their pathologist less than a commercial lab
dead last, a national lab.​

 

[pathstudent]

California SB 1215 brought into play this week is CRAZY. Total ban on essentially all ancillary in office medical services including Adv. Imaging, Pathology, Rad Onc and Phys. Therapy.

Consequences:
1.) All Dermatologists reading slides would be banned from doing so..not just prevented from billing CMS, this would literally be a crime.
2.) All Pathologists working for multispec or single spec physician groups with less than 10 different specialties represented would be banned from in office lab work
3.) All Heme Onc groups who invested millions into office Rads/Rad Onc, would be banned from using these tools.

California Democrats have completely left the planet. This is after the asshat Leland Yee, the biggest anti-gun politician perhaps in the entire US, is arrested for trying to import heavy machine guns and RPGs from radical Abu Sayyaf rebels in the Philippines!!

This is total f'ing insanity.

It sounds like a good thing and will prevent docs for making money of professional services that they don't provide and will also prevent them from making money of self referrAl for TC services.

It sounds like specimens will be coming back to small group hospital based pathologists in Cali!

 

[vistaril]

It sounds like a good thing and will prevent docs for making money of professional services that they don't provide and will also prevent them from making money of self referrAl for TC services.

It sounds like specimens will be coming back to small group hospital based pathologists in Cali!

this bill prevents the physicians from sending them out to megalabs?

 

[LADoc00]

In what possible country other than North Korea and maybe Cuba, should a physician be NOT allowed to make $ off a technical service he/she capitalized and provides support for?

This is literally the government act of strangling free commerce and handing DIRECTLY over to large publicly traded meg labs OUTSIDE the GD community bro. You need to see this for what it is. Specimens are NOT coming back anywhere near you Pathstudent.

 

[Substance]

In what possible country other than North Korea and maybe Cuba, should a physician be NOT allowed to make $ off a technical service he/she capitalized and provides support for?

This is literally the government act of strangling free commerce and handing DIRECTLY over to large publicly traded meg labs OUTSIDE the GD community bro. You need to see this for what it is. Specimens are NOT coming back anywhere near you Pathstudent.

I agree. Having other docs skim your PC is improper, but TC is fair game since it is basically just setting up and managing an infrastructure for technical workers to work in, like any factory or McDonald's.

 

[pongo]

GI group uses local pathologists in non-client billing state. GI group opens in-office lab for a few years, which gets legislated out of business. GI group returns to local pathologist, who also happens to see all of the resections, and sits on hospital committees with GI docs. Pathology group has solid contracts with all major third party payors in the area. What am I missing? Why is this the end of days, with everything now going to Labcorp?

 

[2121115]

GI group uses local pathologists in non-client billing state. GI group opens in-office lab for a few years, which gets legislated out of business. GI group returns to local pathologist, who also happens to see all of the resections, and sits on hospital committees with GI docs. Pathology group has solid contracts with all major third party payors in the area. What am I missing? Why is this the end of days, with everything now going to Labcorp?

Surely you aren't naive enough to believe that.

 

[vistaril]

GI group uses local pathologists in non-client billing state. GI group opens in-office lab for a few years, which gets legislated out of business. GI group returns to local pathologist, who also happens to see all of the resections, and sits on hospital committees with GI docs. Pathology group has solid contracts with all major third party payors in the area. What am I missing? Why is this the end of days, with everything now going to Labcorp?

hahahahahahaha....damn that was good.

the tissue is never coming back. That ship sailed a long long long time ago.

 

[pongo]

Naive? It has already happened in our market. Still waiting to hear the logic. The clinicians who have tried the corporate labs here over the years have always come back. Sorry this doesn't fit the paranoid narrative of this forum.

 

[vistaril]

Naive? It has already happened in our market. Still waiting to hear the logic. The clinicians who have tried the corporate labs here over the years have always come back. Sorry this doesn't fit the paranoid narrative of this forum.

if it has looked for a switch soon imo....I'm not a pathologist btw but have a bit of knowledge about the mindsets of GI practices on this issue. The ones I'm familar have absolutely no interest in giving the tissue to local path groups and giving up everything.

 

[pongo]

So to put it as simply as possible, if the GI doc can no longer profit from the TC (or PC), what is the incentive for sending to Labcorp? As I said before, client billing is not an issue.

 

[icpshootyz]

So to put it as simply as possible, if the GI doc can no longer profit from the TC (or PC), what is the incentive for sending to Labcorp? As I said before, client billing is not an issue.

Unfortunately there's more than just client billing in many cases. There's many, many quasi-legal arrangements that get made, including the mega-labs supplying support staff to label specimens and prepare them for send-out (ie an employee paid for by Mega-Lab that works in the clinician's office, and likely does other non-path things even though that's technically illegal). I work in a client bill state and when we've approached some clinicians about using us we were told "You can't beat the deal I'm getting from X lab" and "What's in it for me?" Never underestimate human greed. Regulation for a lot of this stuff is in name only, no one's actually watching.

 

[pongo]

Fair enough, but we've prevailed for decades despite these mega lab strategies. The only thing we couldn't stop was a single IOP lab. When it didn't live up to Bernie Ness' promises, the work came right back.

 

[BlondeDocteur]

It seems to me like this is primarily designed to prevent perverse incentives and abuse of government health care dollars. When an ortho group buys an MRI machine, the frequency with which they order $5000 MRIs suddenly rockets up. When a dermatologist has a dermpath with a small lab in-house, suddenly the number of lesions they want to biopsy (thus collecting the office visit, procedure, & pathology fees) increases. With such a high percentage of Medi-Cal subscribers in the state (around 25% of Californians IIRC) it seems like the state would have a vested interest in regulating these abuses.

It is interesting how very different the Senate bill is from last year's Assembly Bill 1215, which was all about who exactly can be a clinical lab director (seemed favorable to pathologists to me).

I think you're discounting the opinion of clinicians a little too much, too. I never left the sheltering arms of academic medicine, but I know in surgery residency we immediately looked to the *name* on the pathology report before we looked at the diagnosis. No one, and I mean no one, would send out to a corporate megalab. N of 1, I know, but clinicians do respect pathologists as colleagues and don't just think of them as interchangeable black box Diagnosis Machines.

For those who are in the know, what kind of price structure do the big labs offer small clinical groups? How does it compare to a small pathology group with a negotiated contract, or an academic hospital?

 

[turtle1966]

California SB 1215 brought into play this week is CRAZY. Total ban on essentially all ancillary in office medical services including Adv. Imaging, Pathology, Rad Onc and Phys. Therapy.

I know that in CA some pathologists, as dermatologists, outsource TC on client bill basis. Will this prevent them from doing so?

 

[vistaril]

So to put it as simply as possible, if the GI doc can no longer profit from the TC (or PC), what is the incentive for sending to Labcorp? As I said before, client billing is not an issue.

hahahahaha....this keeps getting better and better.

 

[pongo]

So you aren't going to answer the question? Previous posters have claimed that if the in office ancillary exception is closed, those clinicians will send everything to corporate labs. I ask, how are you so sure? I have seen these labs close and clinicians return to local pathology labs. Vistaril, what is your interest in this forum if you are not in the field? Not sure why you keep making inane comments to my posts. Don't you have anything better to do?

 

[vistaril]

So you aren't going to answer the question? Previous posters have claimed that if the in office ancillary exception is closed, those clinicians will send everything to corporate labs. I ask, how are you so sure? I have seen these labs close and clinicians return to local pathology labs. Vistaril, what is your interest in this forum if you are not in the field? Not sure why you keep making inane comments to my posts. Don't you have anything better to do?

even in cases where cb is not an issue(a big if), my answer would mirror icp's....good gi/uro/derm groups can find ways. My interest is not for me but a partner and knowing a bit about how large gi groups work because of that

 

[pongo]

At least so far, every time one of our clients has made a switch to get a free EMR or get a "phlebotomist" put in their office, they've quickly tired of dealing with corporate pathology and come back. Not to mention how the shine of a few kickbacks pales after a lawsuit or two due to lower quality pathology services.

 

[pathstudent]

It sounds like a good thing and will prevent docs for making money of professional services that they don't provide and will also prevent them from making money of self referrAl for TC services.

It sounds like specimens will be coming back to small group hospital based pathologists in Cali!

G

In what possible country other than North Korea and maybe Cuba, should a physician be NOT allowed to make $ off a technical service he/she capitalized and provides support for?
.

Because medicine is heavily subsidized by the tax payers. And unnecessarily testing and treating patients because you are incentivized by the pet scanner or Histo lab you own is un-****ing-ethical.

 

[Pathwrath]

It seems to me like this is primarily designed to prevent perverse incentives and abuse of government health care dollars.

I can't speak to the motivation behind this particular bill, but the point you raise is valid. There is a difference between blocking good capitalism and curbing self-referral abuse.

And don't kid yourself that these in-office labs don't come at a price beyond the lost tech and professional fees that go to their loathsome, avaricious, quack owners. You think the now-yearly rounds of CMS cuts and soaring in-office biopsy volumes are somehow unrelated?

On an unrelated, more pleasant note, BlondeDocteur, I find your avatar beguiling.

 

[BlondeDocteur]

Thank you. That was my ERAS photograph.

 

[LADoc00]

Update:
1.) I strangled this turd in its crib. The chance of passage is near zero and if it remotely rears its head again at the state level, I have the team in place to "Christmas Tree" this bill with so many amendments it couldnt pass even if the Dems in CA werent embroiled in a massive scandal crisis.
2.) CMA is coming out against, strongly against. Good night.
3.) To imply ALL people are getting unnecessarily biopsied merely to make money for a lab is ludicrous and has NO basis in fact. Yes, there are outliers and groups with absolutely no moral compass. Yes there are people who skew the mean and order crazy amounts of imaging when they have in house MRI. But government needs to deal with THOSE groups and not impose blanket collective guilt.

Collective guilt is a bad thing. Collective guilt would see every urban minority youth in jail or deported. Collective guilt is responsible for some of the worst atrocities in human history.

Attack abusers with facts and data. Look at their negative rates. If a urology group has a 80% negative biopsy there needs to be some investigation. Establish criteria for testing but do not impose collective guilt on a community or a marketplace.

That GAO report people often referred to by CAP et al. is idiotic. Anyone with a 4 unit course in basic statistics can rip all sorts of holes in it. Classic government propaganda, big on conclusions, light on methods!

And do not be part of the sheeple.

That is all.

 

[turtle1966]

Update:
1.) I strangled this turd in its crib. The chance of passage is near zero and if it remotely rears its head again at the state level, I have the team in place to "Christmas Tree" this bill with so many amendments it couldnt pass even if the Dems in CA werent embroiled in a massive scandal crisis.
2.) CMA is coming out against, strongly against. Good night.
3.) To imply ALL people are getting unnecessarily biopsied merely to make money for a lab is ludicrous and has NO basis in fact. Yes, there are outliers and groups with absolutely no moral compass. Yes there are people who skew the mean and order crazy amounts of imaging when they have in house MRI. But government needs to deal with THOSE groups and not impose blanket collective guilt.

Collective guilt is a bad thing. Collective guilt would see every urban minority youth in jail or deported. Collective guilt is responsible for some of the worst atrocities in human history.

Attack abusers with facts and data. Look at their negative rates. If a urology group has a 80% negative biopsy there needs to be some investigation. Establish criteria for testing but do not impose collective guilt on a community or a marketplace.

That GAO report people often referred to by CAP et al. is idiotic. Anyone with a 4 unit course in basic statistics can rip all sorts of holes in it. Classic government propaganda, big on conclusions, light on methods!

And do not be part of the sheeple.

That is all.

You must be one of the very very rare pathologists in favor of POL/IOLs.

 

[LADoc00]

Im in favor of ANYTHING that keeps Pathology local. 50% of X is better than 0% of X.

In the end this may not matter as most of Pathology will likely be off shored to India etc in the coming decades to reduce cost. Which why I would NEVER EVER EVER recommend Path to a med student.
But in the meantime, Im doing all I can to salvage the situation from the academics and politicos who drove us collectively off the cliff!!

Unfortunately most pathologists practicing are:
1.) employees who will see their incomes drop steadily over time
OR
2.) sheeple who have stumbled into running groups by fate and will soon be put up for slaughter

So yes, I am quite rare indeed.

 

[turtle1966]

Im in favor of ANYTHING that keeps Pathology local. 50% of X is better than 0% of X.

In the end this may not matter as most of Pathology will likely be off shored to India etc in the coming decades to reduce cost. Which why I would NEVER EVER EVER recommend Path to a med student.
But in the meantime, Im doing all I can to salvage the situation from the academics and politicos who drove us collectively off the cliff!!

Unfortunately most pathologists practicing are:
1.) employees who will see their incomes drop steadily over time
OR
2.) sheeple who have stumbled into running groups by fate and will soon be put up for slaughter

So yes, I am quite rare indeed.

I like your guts and your far farsighted vision. I agree with most of current facts stated above (in deep sorrow, may I add).

 

[WEBB PINKERTON]

I remember when LADoc told us that fossil fuel costs would keep stuff local....LOL. What happened LADoc? Now you are saying specimens will be heading to India!


Love this posting from LADoc back in 2012:

the big elephant in the room for bx companies is their shipping charges, which are out of control. that will be the biggest cost driver for TC labs going forward given that smaller practices might send out 1-2 specimens max a day at least $40 for an overnight ship out to the "cheap place" read Tenn. or Georgia.

No, stuff will begin falling back to the locale where the biopsy is done if only due to shipping expenses eating all the profit and then some! Ive been shouting this from the roof tops for 5 years to all the national lab types who will listen and only now are they realizing they need to start regionalizing resources rather than super consolidating at large national level facilities if they want to stay competitive.

Basically its counter intuitive to standard scale up economics, but the driver here will be fossil fuels especially as the TC drops likely another 20% in next 5 years (and 88342 goes with it).

My guess is the TC ends up 1/2 of the PC fee rather than the other way around. That would make it spot on the $18 for the 88305TC analysts have been saying. Also realize that since CMS rates the reimbursement on the geographic area, my region gets 30% more than the lowest "cheap place" rates.

Meaning your profit is going to get completely wiped out: first on transporting it to the cheap place and then on the fact the cheap place is getting you only a fraction of the expensive place's reimbursement!!
LADoc00,Nov 21, 2012

 

[WEBB PINKERTON]

Future of pathology is labcorp/quest, some large hospital chain AP labs and a few speciality labs here and there. You WILL be an employee and you will be pushing a LOT of glass.

Seriously get a coag panel to make sure you dont have a blood disorder. You're going to be on your butt A LOT and high risk for embolism. Consider taking Warfarin now..

 

[BlondeDocteur]

@Webb we've moved on to Arixtra now.

 

[2121115]

IOL/POL are not what is vexing the pathology community right now. It is a side issue. The immuno cuts are crippling, and that is what is changing the landscape right now. We're talking paradigm shift type of stuff.

 

[turtle1966]

Which why I would NEVER EVER EVER recommend Path to a med student.

Any pithy advice to 1st and 2nd year path residents?

 

[Pathwrath]

Over the years I've had the dubious opportunity to work in a number of large and small, single and multiple-specialty in-office gigs, with owners running the gamut from the openly venal to vaguely concerned about the ethics of their enterprise. All of them, ALL OF THEM, have resorted to unneccessary biopsies. The TC cuts, for example, saw the proliferation of multiple gastric biopsies, the bogus micro-polypectomies of benign "hyperplastic" mucosa, all in separate containers, of course; the HP IHC's on normal gastric biopsies, on and on and on. I've seen it all. I do not need a GAO study to convince me, not when I'm sitting down to thirty trays of pointless gastric biopsies where there were five ten years ago, in a metropolitan area that is losing population.

And to be honest, it is not the ethics alone that bothers me about this. Medicine is so corrupt across the board that this really is a drop in the bucket. The problem is that this unnecessary biopsy volume is getting noticed. It is dragging down pathology fees across the board. And the more fee cuts, the more biopsies, triggering still more fee cuts in a vicious circle.

I would love to live in a free land where only the bad guys are regulated, but regulation doesn't work that way. Never has, never will. Not everyone who prescribes narcotics for family members is engaging in questionable activity; not every investor with insider knowledge is corrupt; not every in-office lab is a scam. But there's enough of a conflict of interest in all of these to say, No, there's too much potential for abuse here. You can't do this anymore.

To my mind, ending these arrangements IS the targeted solution. The alternative is letting CMS (and ultimately other payers) continue to take a sledgehammer to pathology.

 

[pathstudent]

Any pithy advice to 1st and 2nd year path residents?

Marry a subspecialty surgeon.

 

[BlondeDocteur]

Exactly, pathwrath. I've always anecdotally heard that the abuses are greater with in-house imaging versus pathology. Another enormous problem is hospitalists consulting all of their buddies on every single patient they manage-- you scratch my back, I'll scratch yours-- so that post/op TKA with stable afib, well-controlled DMII and GERD is suddenly being managed by a cardiologist, endocrinologist and GI. There is literally no incentive for a hospitalist not to do this.

 

[Crossed Path]

Im in favor of ANYTHING that keeps Pathology local. 50% of X is better than 0% of X.

In the end this may not matter as most of Pathology will likely be off shored to India etc in the coming decades to reduce cost. Which why I would NEVER EVER EVER recommend Path to a med student.
But in the meantime, Im doing all I can to salvage the situation from the academics and politicos who drove us collectively off the cliff!!

Unfortunately most pathologists practicing are:
1.) employees who will see their incomes drop steadily over time
OR
2.) sheeple who have stumbled into running groups by fate and will soon be put up for slaughter

So yes, I am quite rare indeed.

In my experience, in-office labs result in loss of business to local path groups, unless you're in an area where you are the only pathology group. With an in-office lab, the business is closed to all local groups except their one competitor who was willing to sell out the specialty to get the contract. If the clinician were to instead send specimens to a national lab, the local groups could still compete for business (tough, but it can be done). Sure - I can see your point that if I want to make a contract under certain terms that's my business. But, don't try to cloak it in the guise of keeping the work local.

I think we can safely conclude that LADoc receives some part of his income from an in-office lab - either by himself doing the work or his group doing it, or a group he owns doing it. I can't really think of any other explanation for the claims that this is an issue of personal liberty or his vitriolic reaction to what seems like a sensible bill to limit over-utilization of healthcare resources and would open doors to new business for many local pathology groups. Do all in-office labs result in increased tests ordered? Of course not. But it seems like on balance they do, and the practice overall harms local pathology groups and makes us seem more like a commodity to clinicians, rather than as colleagues.

OK... go ahead, call me sheeple if that makes you feel better about yourself - but, I'm pretty sure you've got cards you ain't showin'. Of course, who doesn't, on an anonymous internet forum?

 

[icpshootyz]

I'm guessing LADoc does all sorts of things that are terrible for the field of pathology overall. But great for his bank accounts.

 

[turtle1966]

I'm guessing LADoc does all sorts of things that are terrible for the field of pathology overall. But great for his bank accounts.

I do not know the facts for sure, but, in addition, I suspect that LADoc farms out TC to an outside lab, on client bill basis, and marks it up, and the proposed law would forbid it. This practice, in my opinion, is a dishonest way of making money off TC. It is rampant in CA; almost all CA derms and many pathologists do it. And as a result, the quality of farmed out slides generally stinks very very badly, at times it borders criminal. I have seen punches missing tumors because a 4 mm punch was not bisected and only very superficial cuts made; and faint staining too boot to save a few bucks.

California Society of Pathologists could not even argue for "direct billing" for TC because many pathologists were farming it out themselves. Although CA is a direct billing state on "paper", it does not cover TC, rather as a simple classified as a "purchased service".

It is totally contrary to common sense and my experience that if IOP/POL were forbidden, the specimens will all flow to national labs. No, most of them will come back to local labs, especially ones that are more proactive and client friendly. The national labs have an awful awful record of specimen flow control, inflexible billing practice, lousy turn around time, etc. I am not criticizing our colleagues in national labs, who are in my opinion as qualified as any of us; they are simply victims of this sham perpetrated by our leadership.

 

[turtle1966]

Any pithy advice to 1st and 2nd year path residents?

Marry a subspecialty surgeon.

Would you advice divorce for some? Ha ha ha!

 

[2121115]

Would you advice divorce for some? Ha ha ha!

No. But if you have a stay-at-home spouse, pathology will be a tough road. Med students should know that.

 

[WEBB PINKERTON]

Stay at home spouse what pathologists should want. Most will be moving around a lot, going where the jobs are. You dont want a spouse who can't find work in your new locale.

 

[vistaril]

In my experience, in-office labs result in loss of business to local path groups, unless you're in an area where you are the only pathology group. With an in-office lab, the business is closed to all local groups except their one competitor who was willing to sell out the specialty to get the contract. If the clinician were to instead send specimens to a national lab, the local groups could still compete for business (tough, but it can be done). Sure - I can see your point that if I want to make a contract under certain terms that's my business. But, don't try to cloak it in the guise of keeping the work local.

I think we can safely conclude that LADoc receives some part of his income from an in-office lab - either by himself doing the work or his group doing it, or a group he owns doing it.

from what I've seen from someone close to me who is a member in a group that profits from an in office lab, there is a definite pecking order in this world. At the top is the large uro group(or gi or derm) who has the in office lab. below them is the pathologist who has the contract with the practice. And finally, at the bottom is the pathologist who works for the pathologist who has the contract.

You want to be at the top, but in path that's not possible. So better to be in the middle than at the bottom.

 

[Crossed Path]

from what I've seen from someone close to me who is a member in a group that profits from an in office lab, there is a definite pecking order in this world. At the top is the large uro group(or gi or derm) who has the in office lab. below them is the pathologist who has the contract with the practice. And finally, at the bottom is the pathologist who works for the pathologist who has the contract.

You want to be at the top, but in path that's not possible. So better to be in the middle than at the bottom.

I guess that's true if you're one of the lucky few pathologists granted access to such an arrangement, but how about we get rid of the pecking order? Without in-office labs and the closed market with perverse incentives they create, the guys at the top (urologists, gastros) would send their specimens to outside labs, and more local pathologists could compete for the business. It seems like that would be one effect of outlawing in-office labs, in addition to reducing overall healthcare expenditures.

 

[turtle1966]

from what I've seen from someone close to me who is a member in a group that profits from an in office lab, there is a definite pecking order in this world. At the top is the large uro group(or gi or derm) who has the in office lab. below them is the pathologist who has the contract with the practice. And finally, at the bottom is the pathologist who works for the pathologist who has the contract.

You want to be at the top, but in path that's not possible. So better to be in the middle than at the bottom.

So do you see pecking order in the your fiance's GI group? I presume not.

It is another sign of oversupply in pathology.

We are faced with an existential question: do we remedy the symptom or cause? Our leaders are blind incapable of seeing either. It is a very lamentable situation.

 

[turtle1966]

I do not know the facts for sure, but, in addition, I suspect that LADoc farms out TC to an outside lab, on client bill basis, and marks it up, and the proposed law would forbid it. This practice, in my opinion, is a dishonest way of making money off TC. It is rampant in CA; almost all CA derms and many pathologists do it. And as a result, the quality of farmed out slides generally stinks very very badly, at times it borders criminal. I have seen punches missing tumors because a 4 mm punch was not bisected and only very superficial cuts made; and faint staining too boot to save a few bucks.

California Society of Pathologists could not even argue for "direct billing" for TC because many pathologists were farming it out themselves. Although CA is a direct billing state on "paper", it does not cover TC, rather as a simple classified as a "purchased service".

It is totally contrary to common sense and my experience that if IOP/POL were forbidden, the specimens will all flow to national labs. No, most of them will come back to local labs, especially ones that are more proactive and client friendly. The national labs have an awful awful record of specimen flow control, inflexible billing practice, lousy turn around time, etc. I am not criticizing our colleagues in national labs, who are in my opinion as qualified as any of us; they are simply victims of this sham perpetrated by our leadership.

Sweatshops competing for POL business on price, not on quality, would lose out. Ergo, sweatshop owners would tremble.