Does this make sense?

[pathstudent]

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The current consensus of healthcare in the United States is that we spend way too much money without a measurable benefit due to the overutilzation of specialists who make too much money. Pathologists are grouped in with the specialists.

The current goal will be to reduce compensation for specialists in order to give money to primary care. And there will be an emphasis on less utilization of specialists.

Yet our leadership claims we need to expand the number of pathologists which goes directly against the model that governement wants to move to.

So in the near future it is likely there will be more specialists (pathologists) with less work to do (as the US attempts to move away from specialists) which will be reimbursed at a lower rate.

What the hell path are we following?

 

[rollwithit]

I don't think there is a push for less work to be done by specialists. It's more directed to have their reimbursements lowered to incent desired behavior. The intent is to artificially create a demand for more and better qualified medical graduates to purse primary care versus specialties. Decreasing the income gap would help make that happen, in theory. With better primary care, the idea is that we would see a healthier population and there would be a natural reduction of the use of specialists as a result since healthy folks won't require is as much specialized care.

Of course, all that is theory and based on many assumptions. You and I know that, in reality, demand for all medical services is going to increase due to an aging population and one that isn't likely going to make better health-related life decisions regardless of how great our primary care system may become. Our primary care physicians are already lecturing us on poor life decisions (poor diet, no exercise, smokers, etc.) and it's not really helping.

 

[yaah]

The current consensus of healthcare in the United States is that we spend way too much money without a measurable benefit due to the overutilzation of specialists who make too much money. Pathologists are grouped in with the specialists.

The current goal will be to reduce compensation for specialists in order to give money to primary care. And there will be an emphasis on less utilization of specialists.

Yet our leadership claims we need to expand the number of pathologists which goes directly against the model that governement wants to move to.

So in the near future it is likely there will be more specialists (pathologists) with less work to do (as the US attempts to move away from specialists) which will be reimbursed at a lower rate.

What the hell path are we following?

Actually, the argument I have seen more is that with healthcare reform there will be an increasing demand for laboratory tests and interpretation, and also there will be increasing need for pathologist participation in ways to reduce healthcare expenditures and provide for judicious ordering of tests (that is, more direct pathologist consultation and participation in patient care). I don't know if that is going to end up true or not, but if true it would be more work, not less.

 

[pathstudent]

Actually, the argument I have seen more is that with healthcare reform there will be an increasing demand for laboratory tests and interpretation, and also there will be increasing need for pathologist participation in ways to reduce healthcare expenditures and provide for judicious ordering of tests (that is, more direct pathologist consultation and participation in patient care). I don't know if that is going to end up true or not, but if true it would be more work, not less.

Totally disagree that it implies more work. One lab director could come up with criteria for when what tests are appropriate and it will be a collaborative process with input from ICU, ED and other physicians. And it will only involve a few meetings (not more work for additional pathologists to get hired at hospitals.) So all this extra work you anticipate isn't all that much and moreover there is no defined reimbursement for it at this time. And what laboratory tests are interpreted by pathologists other than anatomic anyway? Flow, SPEPs, maybe a little coag? Oncologists know how to interpret their own molecular tests.

 

[deleted314957]

It is all going to get more expensive, with more technology and necessity for specialists. The system will go bankrupt unless it is socialized and rationed. In way of example-when I was in med school the cost of an arthritic hip was 8 ASA per day and a cane. Now it is a total hip. We cannot continue to spend 80% of medicare expenditures on the last 6 months of life of the elderly. (generalized figures)

 

[pathstudent]

It is all going to get more expensive, with more technology and necessity for specialists. The system will go bankrupt unless it is socialized and rationed. In way of example-when I was in med school the cost of an arthritic hip was 8 ASA per day and a cane. Now it is a total hip. We cannot continue to spend 80% of medicare expenditures on the last 6 months of life of the elderly. (generalized figures)

Totally agree. I am pro "death panel" for lack of a better word.

Pneumonia used to be an old man's best friend. Now it is a power failure in the unit.

Cut the majority of that last 6 months of life and spend it on hospice/comfort for the stricken elderly, preventative medicine in the young, and increasing reimbursement ot pathologists.

I can't tell you how many tumor boards I have sat in on where we are discussing treatment for 92 year-olds with metastatic "something horrible" or being asked to do a bone marrow on demented 88 year-old with platelet count of 105.

 

[WEBB PINKERTON]

We dont need to be increasing reimbursement for pathologists. Its fair now (well maybe not with Wellpoint) except we are forced to share a good deal of it with others. That is what needs addressed. We have to get out of this model that uses the government as our "pull through" business. Fewer specimens with the lab getting the full reimbursement is what is needed.


Speaking of the elderly. Ed Whitlock, who is 81 year old, just ran a half marathon in 1:38. No "death panel" for him anytime soon.

http://blogs.montrealgazette.com/2012/09/17/ed-whitlock-earns-another-world-record/

 

[lipomas]

The current consensus of healthcare in the United States is that we spend way too much money without a measurable benefit due to the overutilzation of specialists who make too much money. Pathologists are grouped in with the specialists.

The current goal will be to reduce compensation for specialists in order to give money to primary care. And there will be an emphasis on less utilization of specialists.

Yet our leadership claims we need to expand the number of pathologists which goes directly against the model that governement wants to move to.

So in the near future it is likely there will be more specialists (pathologists) with less work to do (as the US attempts to move away from specialists) which will be reimbursed at a lower rate.

What the hell path are we following?

Yeah well what patients do you know who are going to be the ones who agree to give up their specialist care or give up their extra tests or whatever? I didn't think so. Everybody wants everything. I don't think people are going to spend less on healthcare. Death panels are not a solution. Pathologists and radiologists can play a role by helping to decide who needs what test and when. That could potentially be compensated for, and yes, it could require more pathologist effort and time. It's not as simplistic as an algorithm to follow. Of course, it also could not do much.

Either way I am waiting to see what happens but not really making any bets other than that reimbursement is going to go down. Because that is an easy fix for politicians to sign off on, unless it gets so low that doctors really do stop seeing medicare patients. But I think they'll keep testing to see what the real floor is.

 

[KCShaw]

What the patient wants isn't always relevant, unless that equals enough real political pressure for something to be acted on. Most of the time patients don't pay for very much, and if they're told insurance/medicare ain't gonna pay for it, how many say "oh do it anyway, I got it covered"? On the whole, physicians fail at making sound decisions when it comes to cost effectiveness for a population. I suspect this is because physician training tends to focus on the individual patient and a lot of academic fluff. Since physicians have been unable to manage this, other pressures are coming to bear in an attempt to do so. This is entirely expected.

 

[scienceguy19]

pathologists can branch out to new career paths by adapting to expected changes in health care...

maybe pathologists are well positioned to lead death panels... 😛

 

[TMZ2007]

On the whole, physicians fail at making sound decisions when it comes to cost effectiveness for a population.

In defense of physicians, this topic hasn't really been a focus of our training...

 

[KCShaw]

More or less true, beyond some lip service. There's a lot of talk about making efficient decisions in terms of diagnosis and treatment, and utilizing evidenced based medicine as part of that, but only occasionally does it appear to be followed on a large scale. In my biased experience, it's been pathologists who tend to pee in the porridge as far as calling folks out or putting a halt to dumbness, but that applies mainly to laboratory testing which tends to lead to clinicians outsourcing instead, although applies to some procedures too. Even as a resident I heard other clinicians laugh about how silly we were to suggest that doing X, Y, or Z was a waste of money, instead claiming they were income generators because the system could bill for it and would get a good return. The difference in point of view was pretty stark at times (not universally though), but perhaps that was influenced by certain clinicians also having a private practice and thinking in terms of personal or institutional income rather than cost to the taxpayer. At any rate, the boat has probably sailed on that as more medical decisions are handed over to non-physicians behind a desk in a cubicle somewhere.

 

[Kunu]

The CDC is advocating worthless flu shots in all people, their pets, and if they are not stopped will likely soon expand this inanamit objects. They expect to poison 170-200 million people with this trash this year @ $30 a pop so that CDC "advisory panel" members and ACIP patent holders can get filthy rich bullying vaccine they hold stock and patent in. How many billions are wasted just on that?

 

[member0007]

imo, the healthcare industry cannot afford to pay pathologist for special consulting and to hold everyone's hand at every decision making point, as that has been proposed in some vein. however, it might be worthwhile to invent some new codes that actually define this type of work. like the rest of medicine, doctors are not being paid for their expertise or actual medical work, but for herding 1000s of patients and patient sitting. this is total garbage. why become an expert and professional, only to be forced to do rushed and poor work because utilizing your knowledge and expertise doesn't pay the bills. anyway, if people want to cut down the work pathologists do or bill, then look at where the work comes from. try reasoning with those 'type a' personalities to utilize their tools wisely.

 

[lipomas]

The CDC is advocating worthless flu shots in all people, their pets, and if they are not stopped will likely soon expand this inanamit objects. They expect to poison 170-200 million people with this trash this year @ $30 a pop so that CDC "advisory panel" members and ACIP patent holders can get filthy rich bullying vaccine they hold stock and patent in. How many billions are wasted just on that?

take off the tinfoil hat. Flu shots are well researched and proven to reduce health care spending by reducing hospitalizations and severe illness. Get a clue. Anyone who calls themselves a physician who is anti vaccine is a poor physician.

 

[Euchromatin]

The CDC is advocating worthless flu shots in all people, their pets, and if they are not stopped will likely soon expand this inanamit objects. They expect to poison 170-200 million people with this trash this year @ $30 a pop so that CDC "advisory panel" members and ACIP patent holders can get filthy rich bullying vaccine they hold stock and patent in. How many billions are wasted just on that?

I could not agree any more thoroughly with the comment lipomas made to you. Do you think vaccines cause autism too? According to my calculations, your stance on this issue as well as your use "inanamit" gives you a combined credibility score of approximately 0.0001.

 

[deleted314957]

The CDC is advocating worthless flu shots in all people, their pets, and if they are not stopped will likely soon expand this inanamit objects. They expect to poison 170-200 million people with this trash this year @ $30 a pop so that CDC "advisory panel" members and ACIP patent holders can get filthy rich bullying vaccine they hold stock and patent in. How many billions are wasted just on that?

I think you are lost. This board is for folks with an extensive background of scientific education with a particular interest in pathology; not an adherent of Jenny McCarthy's nonsensical campaign. You should re-direct to her site.

 

[thebouque]

I think you guys are talking to a spambot

 

[Euchromatin]

I think you guys are talking to a spambot

I fed the troll...

*hangs head in shame*