Curious what pro-'Bama path thinks about Bundling?

[LADoc00]

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2013- All payments will begin to be bundled for Medicare patients.

This would include all lab tests, all biopsies, all in office follow up biopsies etc.

After the hospital and unions scrap it out for the big chunks, you would have to plead with the surgeons and oncologists for some scrap of the leftovers directly.

Totally awesome. Im soooo glad this bill passed. I was getting far too used to actually eating food and need to lose a few pounds. 2013 the big diet begins!
For all of us.

Dont worry though, the student loans you took out to get you here will still be due every month.

LADOC's FAQs:
Well, how exactly will this work LADOC? I mean if they make the big cuts for Medicare they are planning wont Surgeons and hospitals with fixed overhead still want level reimbursement??
Of course! But dont worry, CAP is distributing knee pads to all pathologists in late 2012. Just find a dark corner of the hospital and ask the surgeons and admin "nicely" for a piece of bread.

LADOC what about all the people now with shiney new Pelosi health insurance, isnt it all about the people and not how much sperm we need to choke down to get paid?
Good point! The interesting thing is the bill leaves all this new insurance to be paid for by the states, which quite frankly are broke. Basically the new 30 million people on the Pelosi plan will end up getting a lump of coal.

LADOC what about all the pathologists who voted for Pelosi, do you think they might get their money?
Great question. Unlikely though. Usually many of the initial adjunct elements of a People's revolution are the first to get liquidated after the new government is stabilized. It's called the People Power Struggle and there can be only one. For Nancy, its all about the Nursing and service unions, so they will win.

LADOC then what the heck can we do??
I would say head to Petco and get a dog collar. Seems these types of people really like small dogs. Perhaps if we appear to be actual dogs, they might feed us.

 

[2121115]

How were pathologists able to negotiate their current RVU's for the surgical pathology CPT codes? All of that has to be wrangled out at the AMA with other specialties. I assume bundling will get worked out in a similar way.

 

[path24]

We better pray for the fantasy "pathologist shortage" to happen. Good luck with negotiating services that aren't even remotely in demand. (Pathology is essential but the oversupply kills any power we bring to the table.)

 

[LADoc00]

How were pathologists able to negotiate their current RVU's for the surgical pathology CPT codes? All of that has to be wrangled out at the AMA with other specialties. I assume bundling will get worked out in a similar way.

When Pathologists negotiated charges for CPT codes they WERENT negotiating against other specialities. Now we will be.

Pelosi has turned hospital against surgeon, surgeon against oncologist, oncologist against pathology/radiology. Her evil little heart will cry with joy as we bloody each other fighting for her scraps.

She will be cheering when pathologists go on strike against surgeons. Hospitals go without call coverage. Patients go without doctors.

She will lap up the tears of our profession like the 3 headed dog that guards the gates of Hell lapping up the souls of the damned.

 

[pathstudent]

It looks like in 2013 the mass-retirement you community practice types have been dreaming of when finally come to fruition.

I can't believe the AMA endorsed this bill. What a bunch of numb-nuts. They got totally worked over.

I wonder if the insurance companies will follow suit and bundle their payments. Their profits would sky rocket and it would be very good for the shareholders.

I keep thinking back to that WSJ article I read back in the late 90s that was titled "Mama don't let you babies grow up to be doctors".

I have a friend that works at twitter and he said he is just waiting to figure out when to sell his personal stock in the company and he will never have to work again. What a different perspective he must have versus numb-nut doctors. Smart people don't go into medicine.

 

[Entgegen]

From what I understand, the bundling program is a pilot program, meaning that they'll be "trying it out". So if it doesn't work out, then the bundling program is axed, or so it seems.

No one wants to fight each other over payment, so it seems like it'll be more than just the pathologists who will be pissed about bundling...like the surgeons, radiologists, anesthesiologists, ER docs, hospitalists, and anyone else who does a lot of work out of the hospital. So seeing as how the bundling program is not something set in stone but a pilot program, is there not the possibility that it would cause enough of an uproar to get it thrown out? Or will it benefit the influential parties to an extent that it would be left in, even if everyone else is upset about it?

 

[LADoc00]

From what I understand, the bundling program is a pilot program, meaning that they'll be "trying it out". So if it doesn't work out, then the bundling program is axed, or so it seems.

No one wants to fight each other over payment, so it seems like it'll be more than just the pathologists who will be pissed about bundling...like the surgeons, radiologists, anesthesiologists, ER docs, hospitalists, and anyone else who does a lot of work out of the hospital. So seeing as how the bundling program is not something set in stone but a pilot program, is there not the possibility that it would cause enough of an uproar to get it thrown out? Or will it benefit the influential parties to an extent that it would be left in, even if everyone else is upset about it?

Wow, shucks wouldnt that be great? For politicians to realize that in free society, those that study hard and become pathologists after much debt and sacrifice should be rewarded rather than treated as slaves of the proletariat?

Maybe before 2013 OUR Emancipation Proclamation will come. Maybe we will spared this. I can only imagine the sorry less fortunate of my brothers and sisters (because thats what I consider you all), with no personality for the coming conflict with surgeons and hospital execs, settling for nothing. Working for free, I thought we called those people slaves? People who are forced to work for free? Right? Or has it been reclassified as for the better of society. Those sad souls without insurance cant be held accountable, not with all the money they need to spend on iphones and new sneakers. Hell my cleaning lady has a BMW! One cant expect her to pay for health care AND a BMW!

We must sacrifice.

 

[BU Pathology]

Medicare and medicaid have bundling, and pathology laboratories have not been placed at a disadvantage. All safety net hospitals have a substantial portion of their budget negotiated with the hospitals to cover pathology's costs. Since Medicare and Medicaid have been in place since the 1960s, pathology has worked with bundled payments for more than 40 years. At most institutions these are called part A transfers from Medicare. Bundled payments have worked fine for pathology throughout that time. There is no need to fear. There is substantial reason to allow 32 million Americans to the ranks of the insured. Pathology has other issues to focus on, bundled payments are not a concern.

 

[DrBloodmoney]

I can't believe the AMA endorsed this bill. What a bunch of numb-nuts. They got totally worked over.

AMA is mostly looking out for the primary care folks who are going to be getting (at least a short term) pay increase through bonus payments starting in 2011.

 

[LADoc00]

Medicare and medicaid have bundling, and pathology laboratories have not been placed at a disadvantage. All safety net hospitals have a substantial portion of their budget negotiated with the hospitals to cover pathology's costs. Since Medicare and Medicaid have been in place since the 1960s, pathology has worked with bundled payments for more than 40 years. At most institutions these are called part A transfers from Medicare. Bundled payments have worked fine for pathology throughout that time. There is no need to fear. There is substantial reason to allow 32 million Americans to the ranks of the insured. Pathology has other issues to focus on, bundled payments are not a concern.

Part A compensation to pathology for CP work has been a flipping DISASTER. Are you serious, did you just make this argument?? Am I imagining things.

Im going bonkers, its Sunday morning before church and my blood pressure is going crazy.

You know many pathology groups get NOTHING for medical directorship of the lab? Nothing, its considered pro bono for being able to bill for AP as a fee-for-service.

Tell the truth BUpath, please. If all pathologists recieve payment through part A, then they are effectively employees. Private practive pathology will be dead or even worse we will be subcontractors making nothing with no benefits (as in California hospitals cannot under law directly employ physicians).

Do you know much the average Pathologist even gets for Part A Medicare from hospitals in California? If they are lucky, 60-80,000/year per person for 24-7 lab coverage. If they are LUCKY. A first year sheriff deputy with overtime makes more.

Wow, that really pissed me off. Your attitude is one of "well Im a employee of a big medical center and everyone else can go to hell." Nice.

Damn Im really pissed now. Im so glad I dont go to national Pathology meetings. It would be an all out riot.

Residents, fellows and practicing pathologists should read about part A and what effect bundling will have for themselves:
Many hospitals use Part A reimbursement data from "selected" hospitals to justify compensation amounts that the pathology practices consider inadequate. Oftentimes, the data is skewed, and the services provided by the pathology practices in the survey are not representative of the types and volume of services that another pathology practice provides

http://www.g2reports.com/issues/advisory/advisory/jane_wood/179-1.html

I cannot believe a practicing pathologist just posted bundled payments are not a concern. Wow. just wow.

 

[SkinPath]

Pathology has other issues to focus on, bundled payments are not a concern.

Like what other issues? The oversupply of pathologists and horrible job market that you academicians like to make us think are not real problems?

There is no more pressing issue facing us today than the attack on the security of our profession and our future.

I hate very much that this health care reform is upon us, but this happened partly because we doctors did not do anything to protect ourselves from it. With the AMA behind this, and doctors like BU Pathology, it is very hard to get organized as one to fight this monstrosity.

 

[Thrombus]

Medicare and medicaid have bundling, and pathology laboratories have not been placed at a disadvantage. All safety net hospitals have a substantial portion of their budget negotiated with the hospitals to cover pathology's costs. Since Medicare and Medicaid have been in place since the 1960s, pathology has worked with bundled payments for more than 40 years. At most institutions these are called part A transfers from Medicare. Bundled payments have worked fine for pathology throughout that time. There is no need to fear. There is substantial reason to allow 32 million Americans to the ranks of the insured. Pathology has other issues to focus on, bundled payments are not a concern.

This Dan Remick character is COMPLETELY out of touch with the practice of pathology and words such as this make him lose nearly all credibility.

 

[Nilf]

Part A compensation to pathology for CP work has been a flipping DISASTER. Are you serious, did you just make this argument?? Am I imagining things.

Im going bonkers, its Sunday morning before church and my blood pressure is going crazy.

You know many pathology groups get NOTHING for medical directorship of the lab? Nothing, its considered pro bono for being able to bill for AP as a fee-for-service.

Tell the truth BUpath, please. If all pathologists recieve payment through part A, then they are effectively employees. Private practive pathology will be dead or even worse we will be subcontractors making nothing with no benefits (as in California hospitals cannot under law directly employ physicians).

Do you know much the average Pathologist even gets for Part A Medicare from hospitals in California? If they are lucky, 60-80,000/year per person for 24-7 lab coverage. If they are LUCKY. A first year sheriff deputy with overtime makes more.

Wow, that really pissed me off. Your attitude is one of "well Im a employee of a big medical center and everyone else can go to hell." Nice.

Damn Im really pissed now. Im so glad I dont go to national Pathology meetings. It would be an all out riot.

Residents, fellows and practicing pathologists should read about part A and what effect bundling will have for themselves:
Many hospitals use Part A reimbursement data from “selected” hospitals to justify compensation amounts that the pathology practices consider inadequate. Oftentimes, the data is skewed, and the services provided by the pathology practices in the survey are not representative of the types and volume of services that another pathology practice provides

http://www.g2reports.com/issues/advisory/advisory/jane_wood/179-1.html

I cannot believe a practicing pathologist just posted bundled payments are not a concern. Wow. just wow.

BU pathology... please come up with a good response that will cheer me up and give me a reason to study hard and excel. I am getting so depressed reading these doom and gloom prediction. Explain why you think it won't be that bad... just don't mention the joy of treating 32 milions of newly insured.

 

[Kid Icarus]

I am a pathology resident from Canada and I'm concerned about everything thats happening in the USA. Your new bill is not good at all.

Should I bail on this field, even though your bill doesnt directly affect me? I can see longterm effects that might cripple my ability to practice where i want and get paid what im worth. I did not go to school for more than a decade to be told where i can and cannot work and to be paid less than im worth.

 

[path24]

LADoc is right (again)...In a lot of private groups you are the pro bono medical director so you can charge for AP (otherwise those specimens would be in the mail)...now we won't make jack off AP either....great.

Academics and private practice are worlds apart.

 

[MOHS_01]

BU Pathology,

tick tock tick tock...


*crickets*

 

[BU Pathology]

Part A negotiations

This is what academics love, the opportunity to educate. This information is provided so that those considering a career in pathology will not be frightened by unfounded rumors of the coming disaster in pathology reimbursement. It is possible that physicians will be reimbursed less with healthcare reform, but it will not be due to bundled payments and pathology will probably not be singled out.

Some history will help those new to the field of pathology understand the current predicament for some pathology groups. Many years ago, pathologists made substantial amounts of money from reading biopsies since the reimbursement rate for this work was excellent. Consequently, pathologists would deeply discount the professional component of running the laboratories in order to secure the biopsy business. Groups that adopted this business practice did quite well from a financial perspective. However, much like the dinosaurs, those that failed to adapt to changing times probably have had part A transfers become a disaster.

Here is how to obtain adequate reimbursement for providing pathology services. The rules from the Centers for Medicare and Medicaid Sciences (CMS) state that pathologists must be paid fair market value for their professional services to manage laboratories. The math is very simple. If the fair market value (the pathologist salary) is $300,000 annually, and 50% of the pathologist’s time is actually devoted to managing the lab, then the pathologist is due $150,000 plus fringe benefits (typically 28 to 30% of salary). The total reimbursement to run a clinical laboratory would be about $192,000 per year. To obtain this salary, you need to determine only 2 things 1) what a pathologist earns in your market place and 2) what is the actual percent time spent running the lab.

It is important to stay in legal compliance with the CMS rules, which means that you cannot deeply discount your services for running the laboratory. The Office of Inspector General ruled in 1991 that failure to charge fair market value for the pathology services falls under the anti-kickback rules. These rules apply to this situation, because discounting the lab management services in order secure the biopsy business amounts to a kickback to the hospital. This means that another group cannot undercut your price in order to get the biopsy service, because that constitutes a kickback. Kickbacks are illegal.

It is possible to fail in this situation if you have allowed your business practices to ossify to practice pathology similar to the 1960s, or you fail to do due diligence to determine the fair market value of your services. Hospitals will try and take advantage of your naiveté, and tell you that the fair market value is less than it actually represents. In some ways this is similar to buying a car. If you have not done your homework, the dealer will explain to you that the sticker price on the car is the fair market value, that is what everyone pays. Just go to any showroom in the region and they will all have the same sticker price. With a little bit a preparation, you will pay for less than the sticker price for your car. With a little bit of preparation, you will obtain fair market value for your professional services.

All the pathology groups that I know receive appropriate reimbursement for managing the labs. Perhaps they are just lucky but it is more likely that they have kept track of the changes in medicine and do their homework before starting negotiations with the hospital.

Bundled payment should not be a problem for pathology, for the reasons listed above. Medicare payments are currently bundled, and even a modicum of business savvy will ensure that you are reimbursed appropriately. This is also another excellent reason why healthcare reform is a positive thing. Everyone should be playing by the same set of Medicare rules which are simple to understand and generally fair. Although I do wish that Medicare paid better for an 88305.

 

[Pathwrath]

It is possible to fail in this situation if you have allowed your business practices to ossify to practice pathology similar to the 1960s, or you fail to do due diligence to determine the fair market value of your services. Hospitals will try and take advantage of your naiveté, and tell you that the fair market value is less than it actually represents. In some ways this is similar to buying a car. If you have not done your homework, the dealer will explain to you that the sticker price on the car is the fair market value, that is what everyone pays. Just go to any showroom in the region and they will all have the same sticker price. With a little bit a preparation, you will pay for less than the sticker price for your car. With a little bit of preparation, you will obtain fair market value for your professional services.

Wow. Just wow.

I would encourage all pathology trainees reading this to visit planet Earth from time to time and ask community docs about their Part A reimbursement for lab management.

Oh, and for laughs, mention that bit about naivete and the car dealer.

 

[TypicalTuesday]

Part A negotiations


Here is how to obtain adequate reimbursement for providing pathology services. The rules from the Centers for Medicare and Medicaid Sciences (CMS) state that pathologists must be paid fair market value for their professional services to manage laboratories. The math is very simple. If the fair market value (the pathologist salary) is $300,000 annually, and 50% of the pathologist’s time is actually devoted to managing the lab, then the pathologist is due $150,000 plus fringe benefits (typically 28 to 30% of salary). The total reimbursement to run a clinical laboratory would be about $192,000 per year. To obtain this salary, you need to determine only 2 things 1) what a pathologist earns in your market place and 2) what is the actual percent time spent running the lab.

QUOTE]


And what happens now if the "fair market value" suddenly plummets?
.....hmmm what is 50% of next to nothing?