Do you do bone marrows?

[pathstudent]

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i just found out that my group is the last group that does bone marrow biopsies in my city. At the other hospitals the radiologists do it with CT guided imaging. Should we quit doIng it?

 

[Sulfinator]

We still do about 50% of the ones we read, just as a value added service, of course, and not because it is really worth our time monetarily.


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[deleted314957]

i just found out that my group is the last group that does bone marrow biopsies in my city. At the other hospitals the radiologists do it with CT guided imaging. Should we quit doIng it?

I stopped doing them about 20 years ago. In my experience the orthopedist have no idea what constitutes a "normal" needle core box and aspiration with a jams hide. Educate them or have a tech in the OR or you may get crap.

 

[AZpath]

Could you teach a PA and still bill it?

 

[Torsed]

Oncology does them not us.

 

[Path or bust]

We do them. Radiologist wanted more procedures so we gladly handed them over. They are picky about NPO (due to sedation) and late/weekend marrows, so I get requests now and then from Oncs and other docs for same day biopsies. Straightforward, but time consuming. They do CT guided biopsies which is the trend but needless if you know your anatomy.

 

[deleted314957]

We do them. Radiologist wanted more procedures so we gladly handed them over. They are picky about NPO (due to sedation) and late/weekend marrows, so I get requests now and then from Oncs and other docs for same day biopsies. Straightforward, but time consuming. They do CT guided biopsies which is the trend but needless if you know your anatomy.

The ultimate in waste is a CT to identify the palpable posterior superior iliac crest.

 

[stickyshift]

i just found out that my group is the last group that does bone marrow biopsies in my city. At the other hospitals the radiologists do it with CT guided imaging. Should we quit doIng it?

I perform about 70 of these a year. The radiologists do the really big patients or the ones that need sedation. I might be the last of the pathologists in my area doing a lot of them; everywhere else it's all radiology. Seems to be a rather expensive way to do a half-hour procedure that should routinely be done in the office.

 

[WEBB PINKERTON]

We still do them as does oncology. Radiology plays no role here.

 

[pathstudent]

The ultimate in waste is a CT to identify the palpable posterior superior iliac crest.

They are radiologists. When your only tool is a hammer.....

 

[medgator]

Didn't realize pathologists did bone marrow biopsies, in my experience, it's always been heme onc. I know many are handing it over to IR to make their clinic run more efficiently.

Although I do know a few who own a heme path setup where it's worth their while to continue to do them

 

[coroner]

We don't perform them and the senior members in my current and former groups stopped doing so 20+ years ago. Once it's ordered, the patient would require a heme-onc consult anyway, so they just do it themselves. It is certainly a dying breed for pathologists. I don't know if the reimbursement for doing the procedure would justify continuing them in your practice. But if your hospital has always expected the pathologists to perform them, it may be difficult to pawn off to heme-onc or rads. Again, this is probably reimbursement dependent. I think this statement about doing them sums it up pretty well..

I learned within weeks of my first job procedures were the bane of any high efficiency pathologist. Autopsies, bone marrow procedures and FNA (either attending them in interventional rads or doing them solo) are EPIC time sinks. I was able to jettison this dark triad after a year or so of concerted effort.

 

[deleted314957]

We don't perform them and the senior members in my current and former groups stopped doing so 20+ years ago. Once it's ordered, the patient would require a heme-onc consult anyway, so they just do it themselves. It is certainly a dying breed for pathologists. I don't know if the reimbursement for doing the procedure would justify continuing them in your practice. But if your hospital has always expected the pathologists to perform them, it may be difficult to pawn off to heme-onc or rads. Again, this is probably reimbursement dependent. I think this statement about doing them sums it up pretty well..

When I stopped doing them I would just tell clinicians that I wasn't credentialed to do marrows. That stopped any questions and also forestalled any gripe about not being accommodating and the requests quickly ceased.

 

[stickyshift]

I think I'm stuck doing bone marrow biopsies: I've done them for 17 years and the heme-oncs and rads don't want to do them.

 

[coroner]

I think I'm stuck doing bone marrow biopsies: I've done them for 17 years and the heme-oncs and rads don't want to do them.

Sounds like you'd like to shuttle them off if you could. Is that because the procedure is too much of a time suck or because the reimbursement isn't worth it? If it's reimbursement, how much of a decline has it taken compared to years past? Not flow or interpretation, I'm just talking about the technical/procedural component.

 

[stickyshift]

The procedure still pays OK, and it generates spinoff revenue for us (flow, ipox), but it's the time suck, really. I'm also the only pathologist at my hospital, so when I'm doing a bone marrow, I'm stuck for 30-45 minutes and unavailable for other things, e.g. frozen sections, FNA adequacies.

 

[pathstudent]

The procedure still pays OK, and it generates spinoff revenue for us (flow, ipox), but it's the time suck, really. I'm also the only pathologist at my hospital, so when I'm doing a bone marrow, I'm stuck for 30-45 minutes and unavailable for other things, e.g. frozen sections, FNA adequacies.

Stickyshaft,

That's justification not to do them right there. A surgeon can't wait for you to finish a bone marrow for a frozen section. Take a look at having an onc PA doing them. You would still get all the billing from interpretation. Heme oncs quit doing them because the reimbursement isn't worth their time.

 

[Ishie1013]

We don't do them, but I did a couple in residency, and wouldn't really object to them. They heme onc crew is just better at not turning the specimens into powder.

 

[yaah]

We do not do them. They are done either by heme-onc MDs or radiology (image-guided)

 

[Adrian Cocot]

Resurrecting an old thread rather than starting a new one.

For those of you who still perform BMBx's, what do you get reimbursed?

I recently became aware of a hospital system in a formerly rural area (now overrun with California transplants), where the biopsies are done by radiology. In the hospital. With CT guidance. Under conscious sedation. At a cost of $16,000 if you're paying cash, or around $6300 if you go through insurance. Oh, and it's an all-day affair, thanks to the anesthesia.

This seems an outright scam to me, if not an opportunity. During my days as a real pathologist, we'd do these with local anesthesia and a lot of encouragement for the pt. Had them in and out in about an hour. What's stopping someone from setting up a bone marrow clinic and charging 2500-3000 in cash for the procedure? Is the collusion between insurers and hospitals that bad?

 

[HemeOncHopeful19]

Resurrecting an old thread rather than starting a new one.

For those of you who still perform BMBx's, what do you get reimbursed?

I recently became aware of a hospital system in a formerly rural area (now overrun with California transplants), where the biopsies are done by radiology. In the hospital. With CT guidance. Under conscious sedation. At a cost of $16,000 if you're paying cash, or around $6300 if you go through insurance. Oh, and it's an all-day affair, thanks to the anesthesia.

This seems an outright scam to me, if not an opportunity. During my days as a real pathologist, we'd do these with local anesthesia and a lot of encouragement for the pt. Had them in and out in about an hour. What's stopping someone from setting up a bone marrow clinic and charging 2500-3000 in cash for the procedure? Is the collusion between insurers and hospitals that bad?

I can’t even convince my patients to get a BM Bx for free sometimes, who the hell is paying $16k cash for it

 

[Adrian Cocot]

That's the point, isn't it. Nobody should be. And charging that much is straight up fraud IMO.

 

[coroner]

At a cost of $16,000 if you're paying cash, or around $6300 if you go through insurance.

That $6300 is what is charged, not collected by physicians. And, I would think the vast majority of patients go through insurance vs paying $16K out-of-pocket. If the patient is still paying $6300 thru insurance, that's one heckuva cut by the insurance companies.

This article below is 2 years old and did a survey on collections for performing BMBx's. On average, IR groups charge $5254 per biopsy; but collect only $1392. Heme-Onc groups collect $1109 per biopsy. What do you think insurance companies are going to pay pathologists...? hint: not more than IR or heme-onc. So, even at the low end of collections ($1100 - 1400) for performing BMBx's, a pathologist can easily be on par with that revenue-wise from staying at their desk and pushing glass.

Bone marrow biopsy and aspiration: a departmental financial comparison in a rural hospital

But, let's break down the numbers. Doing some rough math: In 45min-1hr, most pathologists could sign out 3-5 trays of biopsies, let's use the lower end at 3 trays. Let's use GI as that is a lot of bread & butter for most practices. On the average tray, depending if a gap is put in between different patients or all 20 slots are filled with slides, and how many levels/slides per specimen, that is could be anywhere from 6 specimens up to 20 (1 slide per specimen filling up all slots). This varies depending how your department organizes them; so again, using an average of 10 biopsy specimens/88305s per tray (without stains). So, the professional component only reimbursement at the Medicare rate per tray (without stains) would be roughly $39. At (10 bxs per tray) ($39 per bx) (3 trays) = $1170. On the high end, if you bumped up your pace to sign out 5 trays, add a "normal" amount of IHC ordered, and higher reimbursement at a hospital with a better payor mix, maybe you could pull in $2500-$3000 (this is really higher end) in that 45min- 1hr from pushing glass on 88305s.

In other words, in the 45min- 1hr it would take for you to do a bone marrow, you could sign out enough slides that would equally or more profitable. Hence, the general consensus from Pathologists' revenue standpoint is that the procedural cost does not justify the means.

 

[DoctorInQuotations]

All inpatient bone marrows at my hospital are done by IR, with sedation and CT guidance. The heme oncs here seem like they just want to get in and out ASAP when seeing consults and don't want to bother with performing them bedside.

A good chunk of the outpatient BMBxs are also done by IR too.