Higher Use of Anatomic Pathology Services by Providers Who Self-Refer

[DrBloodmoney]

---

Members do not see this ad.

http://www.gao.gov/products/GAO-13-445

GAO Hammer

 

[2121115]

http://www.gao.gov/products/GAO-13-445

GAO Hammer

No one in any specialty really disputes this with a straight face. However, the trick is to curb self-referral without harming ourselves in the process. Easier said than done.

 

[jp123ok]

Good, hopefully this will mean that we can add POD labs to the endangered species list.

 

[Path or bust]

No one in any specialty really disputes this with a straight face. However, the trick is to curb self-referral without harming ourselves in the process. Easier said than done.

I believe that is their intention. When making AP billing claims to CMS they would have you check whether it is a self referral. Otherwise we will be bystanders again, akin to the urology cuts they made a while ago. Did that end up going through?

 

[MOHS_01]

Q - what all are they calling "self referral"? I'm assuming that if I were to hire a dermpath trained dermatologist to my practice I would then be labeled a "switcher", huh. Given that I am 95% surgery, and this new hire would presumably be doing more general derm (i.e., generating more biopsies from my previous baseline)... and, according to this metric, it would give the appearance of something nefarious going on -- when that is not necessarily the case.

Sounds curiously protectionistic to an outsider without a dog in the fight, I have to say.

 

[icpshootyz]

Q - what all are they calling "self referral"? I'm assuming that if I were to hire a dermpath trained dermatologist to my practice I would then be labeled a "switcher", huh. Given that I am 95% surgery, and this new hire would presumably be doing more general derm (i.e., generating more biopsies from my previous baseline)... and, according to this metric, it would give the appearance of something nefarious going on -- when that is not necessarily the case.

Sounds curiously protectionistic to an outsider without a dog in the fight, I have to say.

If your practice grew and the rate of biopsies to patients did not increase by adding a dermpath to your practice I don't think there would be much fuss. But since the data continues to show that practices that add laboratory services overutilize those services purely for profit, who's to say that you might not do a few more biopsies here and there to recoup costs? Maybe add a few more IHC's and special stains to pad the bottom line? Each study that comes out shows that when clinicians make money off their own labs, they use the lab far more than those that simply send out to labs with no monetary ties.

 

[2121115]

Sounds curiously protectionistic to an outsider without a dog in the fight, I have to say.

The issue isn't whether it is protectionistic, of course there is an element of that.

The issue is that self referral costs CMS $$$$, and now they know this. Their goal is to curb health care expenditures, no matter who gets cut, and this is a prime target. They can reduce healthcare $$ spent without harming patient care - win/win.

 

[MOHS_01]

If your practice grew and the rate of biopsies to patients did not increase by adding a dermpath to your practice I don't think there would be much fuss. But since the data continues to show that practices that add laboratory services overutilize those services purely for profit, who's to say that you might not do a few more biopsies here and there to recoup costs? Maybe add a few more IHC's and special stains to pad the bottom line? Each study that comes out shows that when clinicians make money off their own labs, they use the lab far more than those that simply send out to labs with no monetary ties.

I'm vaguely familiar with this argument as it turns out. So, when followed to its logical end, death to FFS and independence. Raise the sails on the ship SS Employed Bitch and all will be well.

I'm not sure that these changes will be all that beneficial to the pathologist, btw. If we are operating under the assumption that there are too many of you now... and that there is gross overutilization by some number of them, an overutilization that will be curtailed via these changes... does that not worsen the supply problem?

The issue isn't whether it is protectionistic, of course there is an element of that.

The issue is that self referral costs CMS $$$$, and now they know this. Their goal is to curb health care expenditures, no matter who gets cut, and this is a prime target. They can reduce healthcare $$ spent without harming patient care - win/win.

I believe there to be a mountain's worth of assumption in that last part... assumptions that likely will not prove to be as true as predicted.

 

[2121115]

I believe there to be a mountain's worth of assumption in that last part... assumptions that likely will not prove to be as true as predicted.

Well, I would somewhat agree in that they think they can reduce expenditures in this area. But the fact that self referral increases cost to CMS over non-self referring providers has been published with prostate biopsies, which is what got this whole ball rolling.

 

[WEBB PINKERTON]

Jobs will be lost when overutilization is stopped. The true pathology market will be revealed and the supply problem should be even worse.

What is going to happen to the in-office labs if they are legislated out? Some are much more than just an ex-broom closet. There are two huge urology ones in my area. Will path groups or labcorp/quest just line up to overpay for them to get control of the specimens?

 

[2121115]

Will path groups or labcorp/quest just line up to overpay for them to get control of the specimens?

Yes, absolutely.

 

[WEBB PINKERTON]

Yes, absolutely.

Lovely, guess the large in-office labs will now be owned by labcorp/quest and large catholic or university "networks". Labcorp/quest have a lot of cash and love to overspend. Can't win a bidding war with them. The urologists/gi/derms are gonna make out like bandits. You watch.

Shutting down all the in-office labs probably isnt going to help our profession much. It will just get rid of overutilization and cause more out of work pathologists.

 

[icpshootyz]

It may depend on how the in-office labs are set up and whether large companies just want the business (i.e. specimens) or are actually willing to buy the lab and staff it. I doubt Labcorp or Quest are looking to place a full-time pathologist in a Urology pod lab or the like. And if the TC billing and lab upkeep is not worth it for the urologist or whoever, would they bother keeping the lab, or just go back to sending out their specimens? At some point the hassle of running the lab, keeping lab staff employed, and doing the billing may not be worth it and they may bail on the whole TC/PC thing. Who knows. But I don't think they'll find it that easy to just sell their "labs" to the big guys. Those guys just want the volume, not the physical space.

 

[LADoc00]

There is NO way in HELL that the GAO can clamp down on self-referrals on one hand and then have politicians like Obama push ACOs on the other side. Those are 2 total opposite sets of goals.

Self referral has just began but it wont be called self referral in an ACO, it will be called "Internal Consultation."

This study was a total waste of government money, which is of course is ironic given it claims to be able to realize savings...another typical government B.S. attempt to snow the tax payer into believing they actually care about how their money is spent...they dont of course!

Here's a Hammer: Hammer the GAO, between them and the IRS they probably spend 69m a year on CUPCAKES and DONUTS at their bleeping conferences!

 

[WEBB PINKERTON]

There is NO way in HELL that the GAO can clamp down on self-referrals on one hand and then have politicians like Obama push ACOs on the other side. Those are 2 total opposite sets of goals.

Self referral has just began but it wont be called self referral in an ACO, it will be called "Internal Consultation."

This study was a total waste of government money, which is of course is ironic given it claims to be able to realize savings...another typical government B.S. attempt to snow the tax payer into believing they actually care about how their money is spent...they dont of course!

Here's a Hammer: Hammer the GAO, between them and the IRS they probably spend 69m a year on CUPCAKES and DONUTS at their bleeping conferences!

I wonder what Clarient's budget is for treats. They send us some pretty darn good Panera bread goodies.

You are right about ACOs. The ultimate in self referral. CMS did give ACOs waivers to the anti-kickback laws.

Referrals are always going to be within the ACO even if the procedure can be done cheaper and better somewhere else. It wont save anyone anything.

It's all part of the big hospital takeover of healthcare. Get ready to work for the two or three surviving "systems" in your state. I will be working my fields farming, glad I left this cesspool behind.

 

[MOHS_01]

I wonder what Clarient's budget is for treats. They send us some pretty darn good Panera bread goodies.

You are right about ACOs. The ultimate in self referral. CMS did give ACOs waivers to the anti-kickback laws.

Referrals are always going to be within the ACO even if the procedure can be done cheaper and better somewhere else. It wont save anyone anything.

It's all part of the big hospital takeover of healthcare. Get ready to work for the two or three surviving "systems" in your state. I will be working my fields farming, glad I left this cesspool behind.

They'll nationalize (or otherwise redistribute to corporate overlords) your fields, too... just have to work their way down the list.

 

[Doormat]

There is NO way in HELL that the GAO can clamp down on self-referrals on one hand and then have politicians like Obama push ACOs on the other side. Those are 2 total opposite sets of goals.

Self referral has just began but it wont be called self referral in an ACO, it will be called "Internal Consultation."

This study was a total waste of government money, which is of course is ironic given it claims to be able to realize savings...another typical government B.S. attempt to snow the tax payer into believing they actually care about how their money is spent...they dont of course!

Here's a Hammer: Hammer the GAO, between them and the IRS they probably spend 69m a year on CUPCAKES and DONUTS at their bleeping conferences!

Disagree. ACO has no financial incentive to self-refer. ACO has a hospital overlord dividing up a bundled payment regardless of units of service provided. Self-referral labroatories provide direct financial incentive to perform addition fee for service biopsies. ACOs exist in a world with no fee-for-service compensation model. Self-referral labs thrive only in a fee-for-service compensation model. Kaiser Northern California, Group Health Seattle, and Mayo Clinic's pathology labs could all be considered self-referral labs, but they morally corrupt? No they are not. The pathologists are salaried.

 

[2121115]

but they morally corrupt? No they are not. The pathologists are salaried.

And so are the other physicians involved. It isn't pathologists who benefit from self referral.