Immediate Change of Course

[LADoc00]

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Members don't see this ad.

Its becoming more apparent than Pathology is digging itself into an even deeper black hole than during the 90s.

first familiarize yourself with these scumbags: http://www.iopathology.com/news.php
these are turds that either enslave or encourage enslavement of pathologists at the hands of other subspecialists like GI, GU or Derm.

I would suggest the profession immediately change course via the following:
1.) closure of 50% of all Pathology training programs beginning in 2013-14.
2.) a 50% reduction in training slots in remaining academic programs phased in over 2 years.
3.) a 75% across the board cut in the remaining fellowship slots phased in over 5 years.
4.) a sharp reduction in the number of passing ABP certificates issued each year to precisely match the number of graduating trainees minus 10-15%.
5.) implementation of state laws prohibiting the transport of specimens for state Medicaid cases across state lines.
6.) long term goal of prohibition of self referral to physician owned labs completely

I dont not believe step 6 can be accomplished without 1-5. You need to attack and weaken the powerbase that these degenerates feed off before you lop the head off the beast.

As you can read, they openly mock the CAP and ABP and these organizations would be well advised to fire broadsides in response.

 

[rollwithit]

Serious question. What are you going to do in real life to help make this happen or are you just going to post about it here and let the LADoc00 fan club fawn over your perceived awesomeness?

 

[LADoc00]

Serious question. What are you going to do in real life to help make this happen or are you just going to post about it here and let the LADoc00 fan club fawn over your perceived awesomeness?

Im in the CAP webinar right now to discuss this. GET IN THIS WEBINAR if you are available. It is critical.

http://www.cap.org/apps/cap.portal

will put the summary points of the active CAP discussion below:
1.) CMS is actively redistributing $ from specialists to primary care
2.) the power to redistribute comes directly from ACA aka Obamacare
3.) the RUC process for Pathology is now being analyzed in a very unfavorable light
4.) PC reimbursement was last evaluated in 2010 and is unlikely to be re-reviewed again soon
5.) 88342 or IHC is next up on the blocks, likely a huge cut to this as well BOTH PC and TC. ruling out Nov 1st, 2013
6.) CAP is only trying to mitigate PC reduction, not TC
7.) G code Sat Bx for Prostate Biopsies will NOT be implemented, YAY!!
8.) RUC process results in a dramatic reduction in 88305 TC reduction but an increase in PC for 88305, TC and PC for 88307-9 due to internal rebalancing
9.) decreases in 88305 automatically results in increases in other codes due to reallocation through RUC
10.) overall decrease in Pathology is 6% due to 88305 TC, BUT if you do NO TC work your reimbursement will increase
11.) CMS placement of molpath codes onto the Clin Lab scheduled has basically doomed Pathologists in molpath
12.) hmm now he is saying the RUC evaluates each code separately and independently meaning a decrease in 88305 TC does NOT neccesarily indicate an increase elsewhere...now Im confused, he seems to be contradicting the internal rebalancing concept he put forth earlier or these are 2 different redistribution processes??
13.) November 1st of each year is SUPER IMPORTANT: RUC valuations are officially released by CMS

 

[coomasie blue]

I am listening too........ supposedly the most attended webinar EVER

 

[LADoc00]

I doubt they will get to my questions or answer them. They are being bombarded with questions. Yikes.

okay I should have typed my ?s at the first possible moment I could have because its apparent now this could go on for hours and not get to them all....

 

[coomasie blue]

so we can change the outcome for 2014?

 

[LADoc00]

so we can change the outcome for 2014?

RUC movement is conducted in secret, how do we even know what to fight for?

Its the equivalent of entering into a battle with no clue who the combatants are, who is on our side or what our mission goals are.

I dont see how you do that, do you??

they bumbled the one question I asked: is grossing considered reimbursed under the TC or PC, given the survey is thrown out there with NO differentiation between groups which have a grossing asst. and those that dont, we really have no answer on this...argh.

they got to another one of my ?s: will the PC only Pathology groups get a raise for 2013? Answer: IF they fix the SGR, then PC only groups will get a 2% increase for 2013..

DOWNLOAD THIS WEBINAR at CAP entitled "How will changes for 2013 affect Pathology", lots of good stuff in there.

 

[lipomas]

Are people asking unrelated questions? This is the kind of thing where people jump in with questions like, "How will this effect the job market for FMGs" and "Does CK20 stain mesothelioma" and "anyone need a study partner for boards"

Does it really matter how grossing is reimbursed? It only matters how it is reimbursed if the hospital employs the grosser. Most groups that I know of that have a PA or other assistant pay them from the group, if all that person does is gross. If they have other duties like morgue attendant or accessioning or histotech the hospital might pay though. If the hospital needs to make cuts because of the TC they will throw it back at you anyway.

 

[LADoc00]

Does it really matter how grossing is reimbursed? It only matters how it is reimbursed if the hospital employs the grosser. Most groups that I know of that have a PA or other assistant pay them from the group, if all that person does is gross. If they have other duties like morgue attendant or accessioning or histotech the hospital might pay though. If the hospital needs to make cuts because of the TC they will throw it back at you anyway.

It matters hugely.

If grossing is part of the TC, which I believe it is, then hospitals who get the income for this will need to take that cost into account and not "throw it back" at Pathology groups staffing hospitals.

In my opinion, Pathologists who employ grossing personnel but dont see a dime of the TC component are idiots. They are absorbing cost with no revenue.

By and large, since a vast majority of hospital based stuff is DRG reimbursed anyway, I dont think we will see much reaction from hospital admin on this cut.

PS- morgue attendant?? who the hell is still doing autopsies?! I dont think CMS has ever even recognized/mentioned that as even a function of Pathologists.

Considering all new hospitals since what? the late 90s have been built without any morgue facilities on site. I think we can all say autopsy Pathology is completely obsolete. This is in addition to the obvious point that no one pays for it.

 

[Silent Cool]

Well, hey, given that the ****storm seems to be heading towards Path, anybody look back and wish they had done something else?

 

[univlad]

Will the webcast be posted on the CAP website for later viewing?

 

[WEBB PINKERTON]

Will the webcast be posted on the CAP website for later viewing?

It should be posted here at some point.

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

 

[deleted113029]

Its becoming more apparent than Pathology is digging itself into an even deeper black hole than during the 90s.

first familiarize yourself with these scumbags: http://www.iopathology.com/news.php
these are turds that either enslave or encourage enslavement of pathologists at the hands of other subspecialists like GI, GU or Derm.

I would suggest the profession immediately change course via the following:
1.) closure of 50% of all Pathology training programs beginning in 2013-14.
2.) a 50% reduction in training slots in remaining academic programs phased in over 2 years.
3.) a 75% across the board cut in the remaining fellowship slots phased in over 5 years.
4.) a sharp reduction in the number of passing ABP certificates issued each year to precisely match the number of graduating trainees minus 10-15%.
5.) implementation of state laws prohibiting the transport of specimens for state Medicaid cases across state lines.
6.) long term goal of prohibition of self referral to physician owned labs completely

I dont not believe step 6 can be accomplished without 1-5. You need to attack and weaken the powerbase that these degenerates feed off before you lop the head off the beast.

As you can read, they openly mock the CAP and ABP and these organizations would be well advised to fire broadsides in response.

redistribution is becoming a euphemism for getting f'd in the ass.

WTF do primary care physicians do in the world anyway? Manage chronic problems and admit those who are acutely ill to a hospital. It is then the specialists that take over whenever things are going awry. Taking money away from specialists to give to PCPs is disgusting.

I cannot wait until Obama gets older and has no specialists to take care of whatever may be ailing him. I'm not sure if he's still smoking, but it'll take a pathologist to diagnose whatever lung masses he may develop.

on a side:
with over $200K in school debt, where in the f is Obama to help me out? Instead he wants to help all the college students who haven't proven themselves yet and f the people who already have.

i'll stop here as I can just talk about this **** for a long time. sorry for ranting.

 

[DIce3]

WTF do primary care physicians do in the world anyway? Manage chronic problems and admit those who are acutely ill to a hospital. It is then the specialists that take over whenever things are going awry.
.

Just as a quick note: a solid general internist can manage most acute and chronic medical problems competently without specialty referral. As an example, a patient with DM, HTM, COPD, and chronic stable angina may only see his/her internist and not see any specialists. This is highly cost efficient to the system and better for the care of the patient.

 

[deleted113029]

that's completely true...but you used the qualifier "solid" which doesn't apply to a good portion of general internists. i admit that there are many pathologists that are not "solid" as well.

i just wish quality would get rewarded...i believe healthcare providers are no different than teachers in the educational system. those that care and are good WILL be an asset and not a drain on the system.

 

[pathstudent]

This all has to do with a far left u economist from Columbia who was an adviser to Obama. She wrote an article about how specialists in the us make too much money relative to the rest of the workd. Plus Obama's goal is to end wealth discrepancy. In his world doctors would earn no more than teachers. Even though once his presidency is done he will be making 500k per speaking appearance. Not unlike Clinton who left the white house in debt but is now worth 200 million with out working a real job. Those guys are ok with them being worth millions upon millions but they are not ok with you earning 300k a year.

 

[deleted113029]

This all has to do with a far left u economist from Columbia who was an adviser to Obama. She wrote an article about how specialists in the us make too much money relative to the rest of the workd. Plus Obama's goal is to end wealth discrepancy. In his world doctors would earn no more than teachers. Even though once his presidency is done he will be making 500k per speaking appearance. Not unlike Clinton who left the white house in debt but is now worth 200 million with out working a real job. Those guys are ok with them being worth millions upon millions but they are not ok with you earning 300k a year.

Ha! you're so right about the above statements.

president of the US: select cabinet members "posse" to do your work. what's his education? 4 yrs college. 3 yrs of law school. (7 yrs total)

pathologist such as myself and most others: do all work by ourselves in terms of diagnosing disease. 4 yrs college. 4 yrs medical school (+4/5 yrs for those with PhD). 4 yrs of AP/CP training (or 3 yrs of AP or CP only). 1 yr of fellowship. (>=12 yrs total)

pathologists salary < president? ...selective redistribution

always very nice to elect a president who is a lawyer at heart...anything to f us harder working physicians. seriously the last yr of his first term was just campaigning...how is that working?

 

[Enkidu]

what's his education? 4 yrs college. 3 yrs of law school. (7 yrs total)

pathologist such as myself and most others: do all work by ourselves in terms of diagnosing disease. 4 yrs college. 4 yrs medical school (+4/5 yrs for those with PhD). 4 yrs of AP/CP training (or 3 yrs of AP or CP only). 1 yr of fellowship. (>=12 yrs total)

pathologists salary < president? ...selective redistribution

Pretty lame analysis. Pathologists provide a critical service, but equal to leading the free world? Not remotely.

In any case, I think the president makes ~400K from being president and millions of dollars from book sales. Maybe you're suggesting that his books are overpriced relative to his meager Harvard legal education.

 

[handwriting]

In any case, I think the president makes ~400K from being president and millions of dollars from book sales. Maybe you're suggesting that his books are overpriced relative to his meager Harvard legal education.

If you think he's making money only from his salary and book sales, you're hugely mistaken, sir.

 

[deleted113029]

Pretty lame analysis. Pathologists provide a critical service, but equal to leading the free world? Not remotely.

In any case, I think the president makes ~400K from being president and millions of dollars from book sales. Maybe you're suggesting that his books are overpriced relative to his meager Harvard legal education.

'leading the free world?' 🙄

 

[Enkidu]

If you think he's making money only from his salary and book sales, you're hugely mistaken, sir.

Well I guess I'll take your word for it, since you didn't feel it was necessary to back that vague conspiracy claim with any explanation.

 

[Enkidu]

'leading the free world?' 🙄

You've never heard that phrase before? It's been around for some time. But if you are saying that you no longer think the US has the leading role in the world, you'd be wrong. Even so, he is chief executive of the entire federal apparatus and the commander of all of our armed forces.

I understand that you don't like Obama, but it's a little ridiculous to say that he is less important than a community pathologist.

 

[handwriting]

Well I guess I'll take your word for it, since you didn't feel it was necessary to back that vague conspiracy claim with any explanation.

I don't have all of my sources in front of me, but first off, his job has plenty of perks. He and his family are flying all over the place in separate jets--taking baller vacations--and staying at fancy hotels. This stuff costs a lot of money. These perks are given in addition to his salary. Every president uses these benefits to a different extent.

Also, what politicians tend to do sometimes is put contracts and, essentially, "money" into the hands of their families and close friends. Also, the upper class (read note at bottom) and the government are in bed with each other. It's a huge circle of lobbying and favors and stashing/losing money in green energy ventures and what not.

Also, presidents, historically, have also invested in oil, gold, whatever it is.

I highly doubt the president is getting his salary and book royalties and then sitting there with a checkbook deciding how he can use his money wisely on all of the things, both tangible and intangible, that he and his family desire. I think citizen tax money gets used for some of that.

Note: I don't consider anyone making any big money as upperclass. In college, my politics professor (a very smart man), said that you can make $200,000; or a million dollars, or even several millions...and you'd still be considered upper middle class. To be upper class you MUST have craploads of employees (people working under you) and/or some political/societal power in addition to the big sums of money you make.

 

[WEBB PINKERTON]

Dont forget us taxpayers also pay for perks after they are out of office. Remember last year when that story broke about how we paid George Bush's massive telephone bill and apartment rent in NY for Bill Clinton? Even though they are worth millions, we are on the hook for perks THEY should pay for. If you wanna get angry, look up how much taxpayers paid last year to former presidents. Both republican and democrat presidents took plenty of money.

I love how we engage in "client billing" with family practice physicians for lab specimens. Now they wanna take more money from pathologist. We are getting screwed TWICE. If someone recommends pathology as a career, I wanna hook them up to a polygraph...

 

[Johnny Sunshine]

Well, hey, given that the ****storm seems to be heading towards Path, anybody look back and wish they had done something else?

I should have followed my childhood dream of being a stage magician. I suppose that always remains an option, should I wish to default on my loans. 😀

 

[moonraker]

redistribution is becoming a euphemism for getting f'd in the ass.

WTF do primary care physicians do in the world anyway? Manage chronic problems and admit those who are acutely ill to a hospital. It is then the specialists that take over whenever things are going awry. Taking money away from specialists to give to PCPs is disgusting.

I cannot wait until Obama gets older and has no specialists to take care of whatever may be ailing him. I'm not sure if he's still smoking, but it'll take a pathologist to diagnose whatever lung masses he may develop.

on a side:
with over $200K in school debt, where in the f is Obama to help me out? Instead he wants to help all the college students who haven't proven themselves yet and f the people who already have.

i'll stop here as I can just talk about this **** for a long time. sorry for ranting.

Oh don't stop now...this is entertaining. It's much better than all the usual "I can't find a job and so my pu$$y hurts" talk on this forum.

 

[lipomas]

It matters hugely.

If grossing is part of the TC, which I believe it is, then hospitals who get the income for this will need to take that cost into account and not "throw it back" at Pathology groups staffing hospitals.

In my opinion, Pathologists who employ grossing personnel but dont see a dime of the TC component are idiots. They are absorbing cost with no revenue.

By and large, since a vast majority of hospital based stuff is DRG reimbursed anyway, I dont think we will see much reaction from hospital admin on this cut.

PS- morgue attendant?? who the hell is still doing autopsies?! I dont think CMS has ever even recognized/mentioned that as even a function of Pathologists.

Considering all new hospitals since what? the late 90s have been built without any morgue facilities on site. I think we can all say autopsy Pathology is completely obsolete. This is in addition to the obvious point that no one pays for it.

Yeah, but see I am saying that grossing is something that can be done by pathologists, PAs free up time for pathologists to do other things - to me it's more of a professional fee issue. Grossing is part of the professional diagnostic interpretation. Theoretically you could sign out a lot of specimens with gross exam only (but not realistically, obviously). So it really doesn't matter how it's reimbursed. Hospitals don't want to pay for this anyway, they wouldn't want to pay for it if it's reimbursed and they wouldn't want to pay for it if it isn't. So ultimately it's up to the pathologists who take a salary hit to employ the PA. It's all fungible money anyway, depends on how your contract is written more than where the reimbursement comes from. In our group the PAs are employed by the group. The hospital pays for all the rest of the histo lab staff including some who gross smaller specimens as part of their duties.