Just informed-BC BS ANTHEM reduced my payments 40 %

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y2k_free_radical

y2k_free_radical

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40 % less than medicare and no official notice to me about reduction-i am leaving network on DEC 1
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So, so wrong. I am sorry this crap is happening to you good people who have worked their asses off to play by the rules and excel. Everyone views doctors as low hanging fruit, and it seems the “pathology fruit” must grow on the ground.
 
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mikesheree said:
So, so wrong. I am sorry this crap is happening to you good people who have worked their asses off to play by the rules and excel. Everyone views doctors as low hanging fruit, and it seems the “pathology fruit” must grow on the ground.
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Yes,we are lowest on the scrotum pole
 
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Anthem BCBS Cuts. Grim for several states.

From my watchdog group Vachette: Vachette has come across an issue some states are facing with Anthem BCBS. At this time it will not affect you because it is not in your state but we wanted you to be aware just in case other Blue plans decide to do the same thing. For pathology groups listed...
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I hope non par goes ok for you.
This will not help the job market for new fellows
 
AZpath said:
I hope non par goes ok for you.
This will not help the job market for new fellows
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I foresee many problems ,especially with hospital administrators when patients complain.Any suggestions would be appreciated.How do the ACADEMICS and CAP align this with a shortage? How does one PLAN FOR THIS AS RIRRIRI SUGGESTED?They are willfully in denial of the reality of the work place.
 
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I need a serious exit strategy. This will be nationwide and every carrier.
 
path24 said:
I need a serious exit strategy. This will be nationwide and every carrier.
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Yes, other insurance companies,MEDICARE and MEDICAID will follow.This is fore running the prohibition of "surprise billing" which will pass soon.
 
In my state, most of the cuts are greater than 40%. We've gotten into negotiations and debates with high level executives at BC/BS. When asked for an explanation of how they determined appropriate reimbursement, the executive cited the payment levels commonly accepted by those who staff in-office laboratories for other physicians. He said "why should I pay $45 for the PC when the pathologist will do it for $15? Why should the GI doc get $30 for doing nothing?"

This is not going away. And we can thank our colleagues who have been willing to drive around to in-office labs and accept less than the full PC. Anthem isn't devaluing us, they are just acknowledging how we've devalued ourselves. Who can really blame them? I guess the in-office labs will also be big losers, though I suppose those that work for a fraction of the current fee schedule will probably go lower.
 
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pongo said:
In my state, most of the cuts are greater than 40%. We've gotten into negotiations and debates with high level executives at BC/BS. When asked for an explanation of how they determined appropriate reimbursement, the executive cited the payment levels commonly accepted by those who staff in-office laboratories for other physicians. He said "why should I pay $45 for the PC when the pathologist will do it for $15? Why should the GI doc get $30 for doing nothing?"

This is not going away. And we can thank our colleagues who have been willing to drive around to in-office labs and accept less than the full PC. Anthem isn't devaluing us, they are just acknowledging how we've devalued ourselves. Who can really blame them? I guess the in-office labs will also be big losers, though I suppose those that work for a fraction of the current fee schedule will probably go lower.
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Which state ??????????????
 
pongo said:
In my state, most of the cuts are greater than 40%. We've gotten into negotiations and debates with high level executives at BC/BS. When asked for an explanation of how they determined appropriate reimbursement, the executive cited the payment levels commonly accepted by those who staff in-office laboratories for other physicians. He said "why should I pay $45 for the PC when the pathologist will do it for $15? Why should the GI doc get $30 for doing nothing?"

This is not going away. And we can thank our colleagues who have been willing to drive around to in-office labs and accept less than the full PC. Anthem isn't devaluing us, they are just acknowledging how we've devalued ourselves. Who can really blame them? I guess the in-office labs will also be big losers, though I suppose those that work for a fraction of the current fee schedule will probably go lower.
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In this discussion did BC/BS happen to mention anything about a contract in Rhode Island for 88305s for sub Medicare rate going back to the mid 2000s? I ask because this is what happened at a larger hospital in the state - I think it started ~ 2006. The entire path dept knew about this, voiced objections and complained to everyone up here at state path society meetings so this was pretty commonly known.

The hospital leadership took the rate for path essentially for concessions in other codes in different fields. The employed path group was supposedly made whole by the hospital but I wonder if this was the start of the slippery slope down....
 
pongo said:
In my state, most of the cuts are greater than 40%. We've gotten into negotiations and debates with high level executives at BC/BS. When asked for an explanation of how they determined appropriate reimbursement, the executive cited the payment levels commonly accepted by those who staff in-office laboratories for other physicians. He said "why should I pay $45 for the PC when the pathologist will do it for $15? Why should the GI doc get $30 for doing nothing?"

This is not going away. And we can thank our colleagues who have been willing to drive around to in-office labs and accept less than the full PC. Anthem isn't devaluing us, they are just acknowledging how we've devalued ourselves. Who can really blame them? I guess the in-office labs will also be big losers, though I suppose those that work for a fraction of the current fee schedule will probably go lower.
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If true this is exactly what I always feared about in-office pathology. We know it devalues our overall field in exchange for the short-term gain of those who engage in it. Unfortunately our powers that be never saw fit to truly push to ban allowing other physicians to bill for our services and enforce Stark law. Instead they did nothing and allowed us to cutthroat each other into powerlessness. CAP, where are you???
 
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Simply supply-and-demand. No one could do this to ER orthopods and neurosurgeons.

The formula is simple, go find out who is willing to work for the least and make it the bottom line. Why not? Try it out in a piecemeal fashion till it sticks. Those who are smug in their job beware.
 
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Client billing is far worse than in-office labs. It is hard to blame the insurance companies for being asked to make up the difference for the bad deals we enter into to steal business from each other.
 
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pongo said:
In my state, most of the cuts are greater than 40%. We've gotten into negotiations and debates with high level executives at BC/BS. When asked for an explanation of how they determined appropriate reimbursement, the executive cited the payment levels commonly accepted by those who staff in-office laboratories for other physicians. He said "why should I pay $45 for the PC when the pathologist will do it for $15? Why should the GI doc get $30 for doing nothing?"

This is not going away. And we can thank our colleagues who have been willing to drive around to in-office labs and accept less than the full PC. Anthem isn't devaluing us, they are just acknowledging how we've devalued ourselves. Who can really blame them? I guess the in-office labs will also be big losers, though I suppose those that work for a fraction of the current fee schedule will probably go lower.
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This is like skipping the pimp and directly paying the hooker.
 
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It is dog eat dog and my butt is looking like a bowel of Alpo...
 
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Med Director New England said:
In this discussion did BC/BS happen to mention anything about a contract in Rhode Island for 88305s for sub Medicare rate going back to the mid 2000s? I ask because this is what happened at a larger hospital in the state - I think it started ~ 2006. The entire path dept knew about this, voiced objections and complained to everyone up here at state path society meetings so this was pretty commonly known.

The hospital leadership took the rate for path essentially for concessions in other codes in different fields. The employed path group was supposedly made whole by the hospital but I wonder if this was the start of the slippery slope down....
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This also illustrate the job insecurity of those working in IO labs. Today IOLs are taking business away with lower cost, however, with an appropriate debasement of fees, payers may ban IOLs or Path Groups will get into the business. Then, it will be hard for the pathologists so long out of hospital practice to come back.

It is interesting to see how the law of supply-demand works.

Similarly, in the old days when the TC was only about 2/3 of global, the hospital pathologists did not care for the cost of TC. Thus allowing hospitals to come back with cummulative data to invert the TC-PC ratio, and later Medicare to cut TC in 50%.
 
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The march toward hospital employment continues.
 
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I enjoy the job security and not having to go to multiple places/hospitals of hospital employment. While private practice can be far more lucrative, the stress and uncertainty is not worth it for me in today’s time. Roughly 40-45 hrs/week, 395k (increases a bit each year) salary, 6 weeks vacation, family life and free weekends-I’ll take it any day. Path is great if you can learn to embrace being a hospital employee.
 
y2k_free_radical said:
With the lowering of payment for surgicals,will not this be under pressure also.
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I doubt it. In my experience hospital administrations don't seem to know or care if they are losing money because of lower payments on AP. They seem much more concerned with the cost side rather than the revenue end. They are not really into accounting.
 
There is lots of blame being directed at IO labs for Anthems cuts. You all have to remember that it is the big clinical labs that have been giving away AP as a hook to get clinical lab work. This started in the 80's when quest and LabCorp started basically doing pap smears for free. LabCorp has long had arrangements with Anthem HMO products to do the 88305's at steep bargains. They are now applying those rates to hospital work.
 
Dave CX said:
There is lots of blame being directed at IO labs for Anthems cuts. You all have to remember that it is the big clinical labs that have been giving away AP as a hook to get clinical lab work. This started in the 80's when quest and LabCorp started basically doing pap smears for free. LabCorp has long had arrangements with Anthem HMO products to do the 88305's at steep bargains. They are now applying those rates to hospital work.
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The difference is that in case of IOLs, payers get no benefit, rather, they are hurt because there is an apparent unethical skimming on the back of pathologists and payers, via over-utilization. Big labs truly lowered the cost for the payers.
 
Big labs have their own share of overutilization. WE ALL DO IT. That is the game to quote David Percifield from Atomic Blonde.

Bundled payments are coming sooner than later. Good luck getting any pie. You won't be hearing of anyone bragging about making 395,000 as a hospital employee much longer. The competition for surgeons and other specialists will be intense and the money they throw at them will be coming out of your pocket.
 
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turtle1966 said:
Simply supply-and-demand. No one could do this to ER orthopods and neurosurgeons.

The formula is simple, go find out who is willing to work for the least and make it the bottom line. Why not? Try it out in a piecemeal fashion till it sticks. Those who are smug in their job beware.
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CAP,BIG LABS,and ACADEMIA are treating community pathologists similarly to those third rate LAW SCHOOLS who produced such an excess of attorneys who couldn't get a decent job in the field just to keep collecting the tuition=government grant money
 
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turtle1966 said:
The difference is that in case of IOLs, payers get no benefit, rather, they are hurt because there is an apparent unethical skimming on the back of pathologists and payers, via over-utilization. Big labs truly lowered the cost for the payers.
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The big labs are doing WAAY more stains than I do.
 
One thing I have noticed on reports is that a competing "big" lab in my territory orders dual p16/ki-67 on virtually every cervical biopsy they do. This is one way you get away with doing the 88305s so cheap.

You can see why we are heading to bundled payments. Enjoy playing the game while you can. Get yours and get out.
 
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WEBB PINKERTON said:
One thing I have noticed on reports is that a competing "big" lab in my territory orders dual p16/ki-67 on virtually every cervical biopsy they do. This is one way you get away with doing the 88305s so cheap.

You can see why we are heading to bundled payments. Enjoy playing the game while you can. Get yours and get out.
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Or CD 3 on every colon biopsy or H PYLORI on every gastric
 
Torsed said:
forums.studentdoctor.net

Anthem BCBS Cuts. Grim for several states.

From my watchdog group Vachette: Vachette has come across an issue some states are facing with Anthem BCBS. At this time it will not affect you because it is not in your state but we wanted you to be aware just in case other Blue plans decide to do the same thing. For pathology groups listed...
forums.studentdoctor.net forums.studentdoctor.net
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Did they cut the TC or only the PC
 
WEBB PINKERTON said:
One thing I have noticed on reports is that a competing "big" lab in my territory orders dual p16/ki-67 on virtually every cervical biopsy they do. This is one way you get away with doing the 88305s so cheap.

You can see why we are heading to bundled payments. Enjoy playing the game while you can. Get yours and get out.
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I don't fault anyone for ordering p16 and Ki-67 on cervical biopsy specimens considering its one of the pillars of pathology litigation. Its just defensive medicine, that's all.
 
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Alteran said:
I don't fault anyone for ordering p16 and Ki-67 on cervical biopsy specimens considering its one of the pillars of pathology litigation. Its just defensive medicine, that's all.
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It definitely has a role but it is yet another crutch/prognostic test with a false market due to overutilization.
 
If it is considered to be “ the standard of care “ then you have to do it or be open to liability. Sadly, it seems that the attys elucidate that standard by choosing expert witnesses who are friendly to the “standard” which helps their case. And I absolutely, 100% guarantee you that there is a charismatic “expert” who will assure the jury that p16/Ki-67 is indeed “required” and anything less is a breach of that standard.
 
Torsed said:
forums.studentdoctor.net

Anthem BCBS Cuts. Grim for several states.

From my watchdog group Vachette: Vachette has come across an issue some states are facing with Anthem BCBS. At this time it will not affect you because it is not in your state but we wanted you to be aware just in case other Blue plans decide to do the same thing. For pathology groups listed...
forums.studentdoctor.net forums.studentdoctor.net
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I have been amazed at how alone i feel in trying to fight this.Pathology is so divided with ACADEMIA and community pathologists having differing and often competing agendas.Furthermore,we community pathologists are divided into hospital ,big lab, government or self employed with changes affecting us in different ways and degrees. Most of us are not true alphas or can't really afford to act as one.An increasing number of us are also female or FMGs who tend to be more compliant with the status quo_Our union, the CAP, is impotent or disinterested.Finally,laboratories and pathology have never been appreciated as much as some specialties..
 
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All, CAP is a complete joke in case you haven’t noticed.
 
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I kinda feel you only got hit by this if you were totally asleep, like a party where people write on your face with sharpie while you are passed out on the carpet in puddle of Natty Light.
 
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LADoc00 said:
I kinda feel you only got hit by this if you were totally asleep, like a party where people write on your face with sharpie while you are passed out on the carpet in puddle of Natty Light.
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I fail to follow your reasoning or humor.Yes I knew it was coming and tried to rally other pathologists in my state to fight this, but it was an exercise in futility as in has been in MISSOURI and other states.This event is affecting hundreds of pathologists who so far have not been able to reverse it.The income loss is real.Going NON PARTICIPATING has a myriad of its' own problems as those who are doing it have experienced.Mainly unhappy referring doctors and hospital administrators when the patients complain. Almost all patients believe the insurance companies version of reality,not ours.The CAP has done a poor job of propaganda.
 
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y2k_free_radical said:
I fail to follow your reasoning or humor.Yes I knew it was coming and tried to rally other pathologists in my state to fight this, but it was an exercise in futility as in has been in MISSOURI and other states.This event is affecting hundreds of pathologists who so far have not been able to reverse it.The income loss is real.Going NON PARTICIPATING has a myriad of its' own problems as those who are doing it have experienced.Mainly unhappy referring doctors and hospital administrators when the patients complain. Almost all patients believe the insurance companies version of reality,not ours.The CAP has done a poor job of propaganda.
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Sorry didnt mean to offend, only that we had tons of other posts on THIS site about it and everyone should just remain calm and send in the letter saying they are terminating.

Having talked to people at Anthem, it appears this was more a test...if you follow me.
 
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LADoc00 said:
Sorry didnt mean to offend, only that we had tons of other posts on THIS site about it and everyone should just remain calm and send in the letter saying they are terminating.

Having talked to people at Anthem, it appears this was more a test...if you follow me.
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My feedback is that ANTHEM is not negotiating.If you know better please inform me.If you are aware where they have rescinded this because of PATHOLOGIST PUSH BACK direct me.The other pathologists i contacted in my area are just accepting this as a fait accompli.Those who have tried non participating have met with surgeon and hospital administrator unhappiness.
 
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y2k_free_radical said:
My feedback is that ANTHEM is not negotiating.If you know better please inform me.If you are aware where they have rescinded this because of PATHOLOGIST PUSH BACK direct me.The other pathologist i contacted in my area are just accepting this as a fait accompli. Those who have tried non participating have met with surgeon and hospital administrator unhappiness.
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I would tell those surgeons and administrators to express their unhappiness to the insurance company. Also, would love to hear how said surgeon(s) would respond to THEIR reimbursements being cut to sub-medicare rates.
 
acurax said:
I would tell those surgeons and administrators to express their unhappiness to the insurance company. Also, would love to hear how said surgeon(s) would respond to THEIR reimbursements being cut to sub-medicare rates.
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They express their sympathy but only are really concerned about how it affects their business
 
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