CAP council of Gov and Public affairs calls path self referral "small problem"

[WEBB PINKERTON]

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Recent discussions with the CMS have not been promising either, Dr. Friedberg says. “We’ve suggested a time-based approach, where only those services that benefit patients and inform treatment or diagnosis during the same visit may warrant exception under the Stark laws. CMS wasn’t willing to move forward on that. But we’re a relatively small group of people with a relatively small problem. And we’re probably more likely to get some solutions by piggybacking onto imaging as a bigger problem.”



Ever hear of client billing Dr Friedberg? There is more to self referral than just in-office labs. It's a huge problem!

 

[2121115]

http://www.cap.org/apps/cap.portal?...c_gao.html&_state=maximized&_pageLabel=cntvwr

Recent discussions with the CMS have not been promising either, Dr. Friedberg says. “We’ve suggested a time-based approach, where only those services that benefit patients and inform treatment or diagnosis during the same visit may warrant exception under the Stark laws. CMS wasn’t willing to move forward on that. But we’re a relatively small group of people with a relatively small problem. And we’re probably more likely to get some solutions by piggybacking onto imaging as a bigger problem.”



Ever hear of client billing Dr Friedberg? There is more to self referral than just in-office labs. It's a huge problem!

Did you read the quote? He didn't say it was a small problem for pathologists. Of course it isn't. He said in the grand scheme of CMS funding, pathology is small potatoes. That is what I've been trying to say every time people say CAP isn't doing anything. It isn't that no one is trying, but we don't have natural allies, and we have to be strategic in partnering with others to advance our agenda. I guarantee you that as soon as we got in CMS's ear about this, derm, GI, and Uro got in their ear too. And guess who has a bigger voice/lobbying power? Not pathology. Every other specialty organization is pressing them to do the exact opposite of what we are wanting them to do. It is no wonder they just ignore it then and take it off the table.

 

[pathstudent]

Did you read the quote? He didn't say it was a small problem for pathologists. Of course it isn't. He said in the grand scheme of CMS funding, pathology is small potatoes. That is what I've been trying to say every time people say CAP isn't doing anything. It isn't that no one is trying, but we don't have natural allies, and we have to be strategic in partnering with others to advance our agenda. I guarantee you that as soon as we got in CMS's ear about this, derm, GI, and Uro got in their ear too. And guess who has a bigger voice/lobbying power? Not pathology. Every other specialty organization is pressing them to do the exact opposite of what we are wanting them to do. It is no wonder they just ignore it then and take it off the table.

But I don't think we can get expect help from CAP regarding client billing and POD labs/self referal. A lot of CAP pathologists are involved in these activities and some have a lot of money to give CAP. THis stuff has been going on for over a decade and they haven't done that much and basically made zero progress on the national level.

 

[LADoc00]

Podlab income is yummy in my tummy. Of course, Im careful to ensure it is outside my own practice's draw area. But damn it is yummy in my tummy. Im almost embarrassed to say what I earned yesterday.


That is all.

 

[pathstudent]

Podlab income is yummy in my tummy. Of course, Im careful to ensure it is outside my own practice's draw area. But damn it is yummy in my tummy. Im almost embarrassed to say what I earned yesterday.


That is all.

Just imagine how much you would earn if you got to bill the global and not fee split or client bill or whatever.

 

[LADoc00]

Just imagine how much you would earn if you got to bill the global and not fee split or client bill or whatever.

If I got a global fee for what I did YESTERDAY (like a complete TC/PC, not counting expenses or anything), dude I could have bought a Maserati in cash.

I dont want to be too greedy. But damn, it is yummy in my tummy.

Full Bore Podlab'ing (Im talking 200,000+ CPT codes/yr) is like a entrepreneur's dreamland, like fluffy clouds of dead presidents with Victoria Secret models lounging all over them. I literally couldnt believe it when I added it all up. I actually couldnt sleep last night as a result.

Im late to the game, so I cant even begin to imagine what it is was like for some guys in the very early days doing 2K+ per day just in the FISH urine field. Heck, it wouldnt surprise me that some very early podlab path types hit 4m in annual income with ease. On expenses of less than 50K.

I *think* I could move 1200+ CPT codes in a day of the right mix of specimens. I shudder at even seeing that stack of glass but folks I have seen the promised land now.

 

[pathstudent]

If you are earning full pc, that's cool.

If I got a global fee for what I did YESTERDAY (like a complete TC/PC, not counting expenses or anything), dude I could have bought a Maserati in cash.

I dont want to be too greedy. But damn, it is yummy in my tummy.

Full Bore Podlab'ing (Im talking 200,000+ CPT codes/yr) is like a entrepreneur's dreamland, like fluffy clouds of dead presidents with Victoria Secret models lounging all over them. I literally couldnt believe it when I added it all up. I actually couldnt sleep last night as a result.

Im late to the game, so I cant even begin to imagine what it is was like for some guys in the very early days doing 2K+ per day just in the FISH urine field. Heck, it wouldnt surprise me that some very early podlab path types hit 4m in annual income with ease. On expenses of less than 50K.

I *think* I could move 1200+ CPT codes in a day of the right mix of specimens. I shudder at even seeing that stack of glass but folks I have seen the promised land now.

 

[Substance]

If you are earning full pc, that's cool.

I'm curious: if a pathologist is working at a pod lab and billing professional, would you consider that fair? If the pod lab is being run by a urologist and they are running the technical, shouldn't they bill for the technical?

I do understand the hullabaloo about taking a small percentage of the professional. That's unprofessional.

 

[2121115]

I'm curious: if a pathologist is working at a pod lab and billing professional, would you consider that fair? If the pod lab is being run by a urologist and they are running the technical, shouldn't they bill for the technical?

I do understand the hullabaloo about taking a small percentage of the professional. That's unprofessional.

Yes it is fair for the physicians if the pathologist gets the full PC and the person/group running the lab gets the full TC. No where is it written that you must be a pathologist to manage/run a lab. As long as the pathologist isn't being paid a fraction of the PC, then it is "fair". This is how many hospital groups operate in fact, with the hospital getting the TC and pathologists getting the PC.

However, the bad thing about this arrangement (with regard to a urology/GI/etc group owning the lab) is that it drives overutilization of services - particularly biopsy rates go up. This is why the 88305 has been in so much trouble. Recently it became one of the most billed codes in all of medicine, and CMS flagged it as being potentially overvalued for that reason, which triggered the recent TC cuts. Basically, when a physician who owns the lab and profits from the volume (88305-TC) also is the physician who controls the volume (doing the biopsies) there is a perverse financial incentive to do more biopsies (obviously). The result is that healthcare costs go up (this has been proved by studies with hard data), and patients get needless biopsies.

 

[Arctic Char]

So LA, are you saying that you are working as pathologist at a POD Lab in partnership with clinicians, or have you invested in one? did you set one up for someone? What was the move??