Looming cuts in 88305 TC reimbursement

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Nilf

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I received a CAP newsletter that basically said that CMS will cut the technical component reimbursement of 88305.

This cuts will take effect in 2013. This will affect every pathology practice in the country.

The end is near, ladies and gents. Make your money now and start planning exit strategy from pathology. Maybe clinical medicine is not that bad after all.
 

2121115

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I received a CAP newsletter that basically said that CMS will cut the technical component reimbursement of 88305.

This cuts will take effect in 2013. This will affect every pathology practice in the country.

The end is near, ladies and gents. Make your money now and start planning exit strategy from pathology. Maybe clinical medicine is not that bad after all.

Only just less than half of pathologists bill for TC of surgical pathology services anyway. Many practices won't be affected at all. In office labs, however, will take a huge hit since that is their primary revenue. Many have said for a long time that this is what it would take to keep greedy hands out of the pathology pie.

And honestly, the TC is WAY overvalued anyway. It was only a matter of time before CMS figured that out.
 

Nilf

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True, it is overvalued. But this is only a beginning. PC will be getting a review in a few years, too. It was last reviewed in 2009 according to the newsletter.
 

2121115

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True, it is overvalued. But this is only a beginning. PC will be getting a review in a few years, too. It was last reviewed in 2009 according to the newsletter.

Yes it was reviewed recently and held value. Don't worry about the PC component. CMS has other bigger fish to fry before they come back around to that.
 

pathstudent

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Only just less than half of pathologists bill for TC of surgical pathology services anyway. Many practices won't be affected at all. In office labs, however, will take a huge hit since that is their primary revenue. Many have said for a long time that this is what it would take to keep greedy hands out of the pathology pie.

And honestly, the TC is WAY overvalued anyway. It was only a matter of time before CMS figured that out.

Are you serious. Every pathology group with any outpatient component to their business bills for tc.

Let's hope cap can intervene and prevent this. At worst let's hope the cut is just a small percent.

Even if you are in academics your department raises revenue by billing tc on outreach/outpatient cases.
 
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pathstudent

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True, it is overvalued. But this is only a beginning. PC will be getting a review in a few years, too. It was last reviewed in 2009 according to the newsletter.

They can't devalue the work of pathologists any further. We only get 35 to evaluate a breast biopsy for cancer, only 60 for a lumpectomy or a brain biopsy. I don't see how they could go any lower. To get your flat tire changed, lawn mowed, toilet unplugged will soon cost more than what a pathologist gets for spending 30 minutes producing a report in a complex lumpectomy case.

If they do, then just put me on salary and I'll sit around trying to do as little work as possible like all salaried employees.
 

KeratinPearls

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Are you serious. Every pathology group with any outpatient component to their business bills for tc.

Let's hope cap can intervene and prevent this. At worst let's hope the cut is just a small percent.

Even if you are in academics your department raises revenue by billing tc on outreach/outpatient cases.

I would have to agrees with pathstudent. How can less than half pathologists not be affected by this. Sure specimens are being kept in house by in office labs but you can't tell me path groups and academic centers dont charge TC for biopsies aka 88305? There are still biopsies being processed in house by pathologists. The well has not been milked that dry.
 

pathstudent

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I would have to agrees with pathstudent. How can less than half pathologists not be affected by this. Sure specimens are being kept in house by in office labs but you can't tell me path groups and academic centers dont charge TC for biopsies aka 88305? There are still biopsies being processed in house by pathologists. The well has not been milked that dry.

Totally. I bet most private pathologists have contracts with outpatient surgery centers and bill global for everything coming out of there.

And some gi groups still only send the Medicare/medicaid cases to pathologists as stark laws prevent them from biling for them. So those gi groups won't be effected depending o their insurance contracts while whoever is getting their Medicare cases will.
 

Pathwrath

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In office labs, however, will take a huge hit since that is their primary revenue. Many have said for a long time that this is what it would take to keep greedy hands out of the pathology pie.

LOL, the clinician owners will just screw their pathologists and cut their PC reimbursement. A smaller TC revenue is still revenue. It's free money for in-office owners.
 

KeratinPearls

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LOL, the clinician owners will just screw their pathologists and cut their PC reimbursement. A smaller TC revenue is still revenue. It's free money for in-office owners.

Yes lets say TC gets cut in half. That is still easy money for the clinicians. They do nothing. They just need to biopsy more.
 

2121115

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Are you serious. Every pathology group with any outpatient component to their business bills for tc.

Actually no. Around here anyway there is no way to get outpatient business unless you put the TC on the table as an incentive. Many (most?) hospital-based groups bill PC only.

They can't devalue the work of pathologists any further. We only get 35 to evaluate a breast biopsy for cancer, only 60 for a lumpectomy or a brain biopsy.

That $35 or $60 is PC only though. It doesn't include the TC which is much more.

And yes this will hurt academic revenues since academic departments rely heavily on the TC (and the PC) to fund other parts of the department that do nothing (or do a little something and don't make money). Guess who's salary is going even lower now (or at least not increasing any time soon)? New instructors and junior attendings. Thought it couldn't get worse than $120K per year? Think again.

LOL, the clinician owners will just screw their pathologists and cut their PC reimbursement. A smaller TC revenue is still revenue. It's free money for in-office owners.

Actually a GI group around here recently decided not to open up their own in office lab because of potential TC cuts looming.
 

mlw03

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Wow - didn't realize private practice pathology was quite so shady. Never realized groups had to offer a share of the technical component to the referring docs just to get their specimens. How that's legal is beyond me, but it sure stinks of conflict.
 

WEBB PINKERTON

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This will effect everyone if it happens. Get ready for even more consolidation and less places to work. The surviving labs will be sweatshops.
 
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WEBB PINKERTON

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Only just less than half of pathologists bill for TC of surgical pathology services anyway. Many practices won't be affected at all. In office labs, however, will take a huge hit since that is their primary revenue. Many have said for a long time that this is what it would take to keep greedy hands out of the pathology pie.

And honestly, the TC is WAY overvalued anyway. It was only a matter of time before CMS figured that out.


TC is not overvalued for 88305. You obviously have no idea all the costs involved. Its a heck of a lot more than slides, stain and coverglass. And many labs need the medicare patients to reimburse well to cover all the client billing that still occurs in 30+ states. Medicare/medicaid are known as pull through business. It allows you to keep your doors open since client pricing is WAY below medicare/medicaid.
 

pathstudent

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That $35 or $60 is PC only though. It doesn't include the TC which is much more.



.

Well you just said you don't get TC where you are, so for you it is never more. And I am only talking about PC.

There is no way they can drop the PC any lower in pathology. It would just devalue the important job we do way too much.
 
D

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Well you just said you don't get TC where you are, so for you it is never more. And I am only talking about PC.

There is no way they can drop the PC any lower in pathology. It would just devalue the important job we do way too much.

quite frankly, the gov't certainly can lower it. i think the TC will go way down. They DO NOT CARE. after all, we are "rich doctors" and someone will always step in to fill the void. and i am talking about incomes going down to 120k-150 eventually with everybody employees or working for the gov't. That is the ballpark of what military/federal docs are paid and they will put us in that tribe.the gov't option is the goal of the gov't and they are herding us like cattle into that chute. any young doctor today should seriously consider having the military ( or other feds) pay for their med school. then they will do their residency/ fellowship and obligation in the military at a much higher pay scale than civillian residents. they will have NO DEBT. then they will retire after 20 years at the equivalent of colonel (navy captain) with a VERY generous retirement and embark on a second civilian career for 20 years and be WAY ahead of the game.

and, please, "devaluing the job" we do----give me a break. that is the LEAST of the gov't's concern.
 

2121115

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TC is not overvalued for 88305. You obviously have no idea all the costs involved. Its a heck of a lot more than slides, stain and coverglass. And many labs need the medicare patients to reimburse well to cover all the client billing that still occurs in 30+ states. Medicare/medicaid are known as pull through business. It allows you to keep your doors open since client pricing is WAY below medicare/medicaid.

Oh I have some idea of the costs. For instance, the 88305 TC pays for a lot of stuff.

http://www.findacode.com/cpt/88305-cpt-code.html

Click RVU, then facility. Then look at the practice expense portion. It costs less to do all that for most labs than what the code pays. And that is per specimen, so if you get a rule out colitis endoscopy from 8 sites it pays for all that 8 times. Economies of scale, my friend. Easy to build profitable efficiencies into that system, eh?

But you are right about client pricing and pull through.
 
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2121115

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Wow - didn't realize private practice pathology was quite so shady. Never realized groups had to offer a share of the technical component to the referring docs just to get their specimens. How that's legal is beyond me, but it sure stinks of conflict.

Try going to a GI group or urology group and asking them to send you their outpatient biopsies with nothing it it for them. It will be a short conversation. Particularly when the pathology group down the road will give up the TC in a heart beat to get the work. Not to mention incentives put on the table by larger labs (Caris, Bostwick) also wanting their business. You come to their lab and sign the cases out and get the PC and they keep the TC or they don't play ball with you. And they are not spending all of that TC cutting an H&E slide for you to read either.

And if you are hospital based, the hospital likely takes the entire TC for hospital/OR surgicals and in return you get the privelidge of working there.

Now I realize based on past posts that many here work in less competitive environments. Maybe some are even in smaller cities/towns with only one pathology group and a much different situation where there are plenty of specimens and they bill PC/TC global and work 6 hours per day. I respect that and it sounds like a good gig. But I am just posting my personal experience.
 

KeratinPearls

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Try going to a GI group or urology group and asking them to send you their outpatient biopsies with nothing it it for them. It will be a short conversation. Particularly when the pathology group down the road will give up the TC in a heart beat to get the work. Not to mention incentives put on the table by larger labs (Caris, Bostwick) also wanting their business. You come to their lab and sign the cases out and get the PC and they keep the TC or they don't play ball with you. And they are not spending all of that TC cutting an H&E slide for you to read either.

And if you are hospital based, the hospital likely takes the entire TC for hospital/OR surgicals and in return you get the privelidge of working there.

Now I realize based on past posts that many here work in less competitive environments. Maybe some are even in smaller cities/towns with only one pathology group and a much different situation where there are plenty of specimens and they bill PC/TC global and work 6 hours per day. I respect that and it sounds like a good gig. But I am just posting my personal experience.

Hopefully one of these days, in office labs will be illegal and the only ppl you have to compete with are other groups and reference labs.

Do internal medicine of family practice physicians ever say "what is in it for me?" to cardios, gastros, when they come asking for referrals?
 
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pathstudent

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quite frankly, the gov't certainly can lower it. i think the TC will go way down. They DO NOT CARE. after all, we are "rich doctors" and someone will always step in to fill the void. and i am talking about incomes going down to 120k-150 eventually with everybody employees or working for the gov't. That is the ballpark of what military/federal docs are paid and they will put us in that tribe.the gov't option is the goal of the gov't and they are herding us like cattle into that chute. any young doctor today should seriously consider having the military ( or other feds) pay for their med school. then they will do their residency/ fellowship and obligation in the military at a much higher pay scale than civillian residents. they will have NO DEBT. then they will retire after 20 years at the equivalent of colonel (navy captain) with a VERY generous retirement and embark on a second civilian career for 20 years and be WAY ahead of the game.

and, please, "devaluing the job" we do----give me a break. that is the LEAST of the gov't's concern.

Wow that's so depressing. To think that diagnosing a brain tumor will be considered less valuable than having your toilet plunged or sidewalk shoveled after a snowstorm or getting a pedicure or getting a bikini wax. Sad!
 
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sssamsss

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Commercial opportunists swoop in when excess profits are to be made. Take out the excess profits and the opportunists will search elsewhere for investment opportunities, leaving Medicine in the hands of physicians and non-profit philanthropic, religious, and govermental organizations whose first obligation is to the Patient. If profit margins decrease to the point where Corporate and Wall Street incentives disappear, then the physicians and the organizations whose first obligation is to Patients (rather than to themselves or investors) will find it easier to realize their purpose.
 

malchik

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This is sobering stuff. I just may decide to consult for my brother's hedge fund if I feel too unfairly compensated in the future. And what is client pricing?
 

sssamsss

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Commercial opportunists swoop in when excess profits are to be made. Take out the excess profits and the opportunists will search elsewhere for investment opportunities, leaving Medicine in the hands of physicians and non-profit philanthropic, religious, and govermental organizations whose first obligation is to the Patient. If profit margins decrease to the point where Corporate and Wall Street incentives disappear, then the physicians and the organizations whose first obligation is to Patients (rather than to investors or themselves) will find it easier to realize their purpose.
 
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MOHS_01

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Commercial opportunists swoop in when excess profits are to be made. Take out the excess profits and the opportunists will search elsewhere for investment opportunities, leaving Medicine in the hands of physicians and non-profit philanthropic, religious, and govermental organizations whose first obligation is to the Patient. If profit margins decrease to the point where Corporate and Wall Street incentives disappear, then the physicians and the organizations whose first obligation is to Patients (rather than to investors or themselves) will find it easier to realize their purpose.

kool1.jpg


Okay... so... wait -- are you suggesting that we should be happy that the ability to earn to profit is going to ****? Are you mad, man?
 

Nilf

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Commercial opportunists swoop in when excess profits are to be made. Take out the excess profits and the opportunists will search elsewhere for investment opportunities, leaving Medicine in the hands of physicians and non-profit philanthropic, religious, and govermental organizations whose first obligation is to the Patient. If profit margins decrease to the point where Corporate and Wall Street incentives disappear, then the physicians and the organizations whose first obligation is to Patients (rather than to themselves or investors) will find it easier to realize their purpose.

Get off your moral high horse. The first obligation that we have is to our families and ourselves. If these are not your priorities, then you are incredibly altruistic, or stupid.
 

sssamsss

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I am suggesting that we are in a transition period; the end game in decreasing medical expenses and increasing transparency is that our fiduciary responsibility to the patient will demonstrate our value to Patients and Ourselves.
Those Pathologists for whom the present system is working are free to submit the lowest bid for the chance to work in the corporate-owned cubicle o their choice.
 
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MOHS_01

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I am suggesting that we are in a transition period; the end game in decreasing medical expenses and increasing transparency is that our fiduciary responsibility to the patient will demonstrate our value to Patients and Ourselves.
Those Pathologists for whom the present system is working are free to submit the lowest bid for the chance to work in the corporate-owned cubicle o their choice.

Well... either you have not thought this through very well... or your capacity for critical thought is brought into question. The bolded phrase may make a policy wonk feel good but means absolutely nothing in the real world for those who understand we operate in a price fixed environment and take what they choose to ******** give us. Superfluous feel good rhetoric about fiduciary this and patient advocate that will not keep your lights on or your tech cutting, friend... and patients are clueless when it comes to your services. The only thing certain going forward is that the insurers are guaranteed profits by law.... even if that means putting you, me, and those like us completely out of business.
 

MOHS_01

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Get off your moral high horse. The first obligation that we have is to our families and ourselves. If these are not your priorities, then you are incredibly altruistic, or stupid.

3 posts and coming in here with that type of nonsense? I'm calling BS, if not outright propagandizing troll.:mad:
 

sssamsss

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Those are my observations. Readers of this forum are free to disagree with them, as they may be wrong. Some rather emotional responses to those observations, however, may suggest that they may have some validity.

I do apologize about the bolding. I didn't need to shout. And the repeat posting was only my ignorance in how to use the system. Sorry for double posting.

If our professional obligations are primarily to ourselves, then we really don't have much of an argument complaining about profiteering corporate employers or clinicians' in-office labs maximizing their profit by billing insurance companies/patients to the max while ordering as many special stains and molecular tests as can be reimbursed.

Again, you are free to disagree. Logical argumentation is preferable to ad hominem attack.
 

WEBB PINKERTON

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This is sobering stuff. I just may decide to consult for my brother's hedge fund if I feel too unfairly compensated in the future. And what is client pricing?


Client pricing is the biggest problem with the lab industry. The lab charges the physician office a very small fee for a test and the physician office then bills the patient. We have had competitors in the area going 5 dollars for the TC component on 88305 and 18 dollars for 88142. Good luck surviving unless you are a sweatshop. It just leads to RECKLESS labs where specimens are mixed up, there is a constant turnover in staff etc. It is not a rewarding career anymore.

The effects of in-office labs is small compared to client billing. Even in states that have eliminated it for AP specimens, it still leaves all the high volume tests in the clinical lab open.
 

Pathwrath

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Actually a GI group around here recently decided not to open up their own in office lab because of potential TC cuts looming.


Glad to hear it! But as I said, existing in-office labs will just pass on the cuts to their pathologists. Nobody turns off a money spigot when there's still cash flowing. Let me know when TC cuts make in-office labs unprofitable.
 
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2121115

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Glad to hear it! But as I said, existing in-office labs will just pass on the cuts to their pathologists. Nobody turns off a money spigot when there's still cash flowing. Let me know when TC cuts make in-office labs unprofitable.

I don't disagree with your general point, BTW. If a lab is already started, this won't shut it down by any means. But it make some think twice about starting one from scratch. And it may make it less profitable for those companies that help clinicians start these labs.
 

Nilf

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Here is the full text of the CAP memo about the reimbursement cuts:

Changes Anticipated in Surgical Path Reimbursement in 2013

Reimbursement for certain high volume anatomic pathology codes will likely be reduced beginning in January 2013, as part of CMS efforts to advance initiatives embedded in the health care reform law that scrutinize high volume codes as potentially overvalued while boosting support for primary care services.

Medicare first announced its intention to review the codes as potentially overvalued last year in the 2012 proposed physician fee schedule, and finalized this request for the technical component (TC) of 88305 to undergo review last November in the agency’s final 2012 physician fee schedule regulation. The expected reimbursement changes to the TC of the surgical pathology code family (88300-88309) will be announced in November when CMS releases the Final Physician Fee Schedule for calendar year 2013.

“The Health Care Reform law empowered CMS to review and revalue high volume codes from all specialties as potentially overvalued services,” said Jonathan L. Myles, MD, FCAP, Chair of CAP’s Economic Affairs Committee (EAC). “In 2010, the CAP was able to maintain the value for the PC of 88305 and other surgical pathology codes.”

Last year, CMS flagged the PC and TC of 88305 for review. After the College successfully argued that the 88305 PC had been reviewed as recently as April 2010, CMS limited their request for review to the TC. However, as the TC was originally valued in 2000, scrutiny of the costs associated with this code has been steadily increasing. “The College continues to advocate for appropriate value through the AMA/Specialty Society Relative Value Scale Update Committee [RUC] review process,” stated Dr. Myles, who is the CAP Advisor the RUC.

Be Prepared for Medicare Reimbursement Changes

As these codes are most likely to be revalued, pathologists need to start preparing, advised Mark Synovec, MD, FCAP, a member of the CAP EAC team. “It’s very likely that CMS will decrease the reimbursement of these high volume codes,” explained Dr. Synovec, who practices with the independent group Topeka Pathology Group PA in Kansas. “All pathologists need to be aware that this is likely to happen and assess the impact on their practices.”

The extent of the impact will depend on the nature of each practice’s contracts and billing arrangements. “This is very complex and requires planning and scrutiny of one’s own practice,” said Dr. Synovec, “The impact will depend on the percentage of cases that you are billing the technical component of these services to Medicare, as well as the distribution of the codes used, as the revaluation will likely effect different codes to varying degrees. Knowledge of the code distribution for a practice would aid in planning for anticipated changes.”

Changes in the Medicare TC valuation may affect other billing arrangements such as if your practice dealt with the end of the TC-grandfather exemption by forming a hospital contract linking TC-payments to a percentage of the Medicare rate. “For all of these reasons, even though we don’t know the details until CMS releases the final Physician Fee Schedule in November, if you bill TC at all, these changes will impact you,” explained Dr. Synovec.


Start preparing plan B guys and gals.
 
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pathstudent

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Here is the full text of the CAP memo about the reimbursement cuts:

Changes Anticipated in Surgical Path Reimbursement in 2013

Reimbursement for certain high volume anatomic pathology codes will likely be reduced beginning in January 2013, as part of CMS efforts to advance initiatives embedded in the health care reform law that scrutinize high volume codes as potentially overvalued while boosting support for primary care services.

Medicare first announced its intention to review the codes as potentially overvalued last year in the 2012 proposed physician fee schedule, and finalized this request for the technical component (TC) of 88305 to undergo review last November in the agency’s final 2012 physician fee schedule regulation. The expected reimbursement changes to the TC of the surgical pathology code family (88300-88309) will be announced in November when CMS releases the Final Physician Fee Schedule for calendar year 2013.

“The Health Care Reform law empowered CMS to review and revalue high volume codes from all specialties as potentially overvalued services,” said Jonathan L. Myles, MD, FCAP, Chair of CAP’s Economic Affairs Committee (EAC). “In 2010, the CAP was able to maintain the value for the PC of 88305 and other surgical pathology codes.”

Last year, CMS flagged the PC and TC of 88305 for review. After the College successfully argued that the 88305 PC had been reviewed as recently as April 2010, CMS limited their request for review to the TC. However, as the TC was originally valued in 2000, scrutiny of the costs associated with this code has been steadily increasing. “The College continues to advocate for appropriate value through the AMA/Specialty Society Relative Value Scale Update Committee [RUC] review process,” stated Dr. Myles, who is the CAP Advisor the RUC.

Be Prepared for Medicare Reimbursement Changes

As these codes are most likely to be revalued, pathologists need to start preparing, advised Mark Synovec, MD, FCAP, a member of the CAP EAC team. “It’s very likely that CMS will decrease the reimbursement of these high volume codes,” explained Dr. Synovec, who practices with the independent group Topeka Pathology Group PA in Kansas. “All pathologists need to be aware that this is likely to happen and assess the impact on their practices.”

The extent of the impact will depend on the nature of each practice’s contracts and billing arrangements. “This is very complex and requires planning and scrutiny of one’s own practice,” said Dr. Synovec, “The impact will depend on the percentage of cases that you are billing the technical component of these services to Medicare, as well as the distribution of the codes used, as the revaluation will likely effect different codes to varying degrees. Knowledge of the code distribution for a practice would aid in planning for anticipated changes.”

Changes in the Medicare TC valuation may affect other billing arrangements such as if your practice dealt with the end of the TC-grandfather exemption by forming a hospital contract linking TC-payments to a percentage of the Medicare rate. “For all of these reasons, even though we don’t know the details until CMS releases the final Physician Fee Schedule in November, if you bill TC at all, these changes will impact you,” explained Dr. Synovec.


Start preparing plan B guys and gals.

Yeah but how big is the cut going to be! If it is 5% or less, it won't change our lifestyles. If it is 50% it will be devastating. That would be a 33% cut in revenue for pathology departments and private groups that bill global.

Fortunately it will only be for governement insurers. United, Anthemm Cigna of course will try to implement it too but we have to fight that as it is not like they are going to take the money and give it to primary care. They will take the money and give it to their CEOs.
 

Tissue issue

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As these codes are most likely to be revalued, pathologists need to start preparing, advised Mark Synovec, MD, FCAP, a member of the CAP EAC team. “It’s very likely that CMS will decrease the reimbursement of these high volume codes,” explained Dr. Synovec, who practices with the independent group Topeka Pathology Group PA in Kansas. “All pathologists need to be aware that this is likely to happen and assess the impact on their practices.”

Umm, has the CAP EAC talked to the CAP RF?? Is increasing residency slots going to help?
 

Thrombus

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Zing. That stings.

Academia is and has been preparing. They need more residents (free government money and labor) and junior faculty (indentured serfs) to subsidize the department as they see diminishing returns on these folks' work.
 

WEBB PINKERTON

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Yeah but how big is the cut going to be! If it is 5% or less, it won't change our lifestyles. If it is 50% it will be devastating. That would be a 33% cut in revenue for pathology departments and private groups that bill global.

Fortunately it will only be for governement insurers. United, Anthemm Cigna of course will try to implement it too but we have to fight that as it is not like they are going to take the money and give it to primary care. They will take the money and give it to their CEOs.


The government insurers are the only ones that you can't client bill in most states so it is a big deal. You will be doing the other work for FAR less than what medicare/medicaid pay since you will be client billing it. The medicare/medicaid patients are "pull through" business and the most profitable stuff. Its sad when many physicians are threatening to quit seeing those patients and they are pathology's best. And even if client billing is outlawed in your state, you will run into a lot of managed care nightmares. Specimens must go to quest, labcorp.
 

2121115

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The government insurers are the only ones that you can't client bill in most states so it is a big deal. You will be doing the other work for FAR less than what medicare/medicaid pay since you will be client billing it. The medicare/medicaid patients are "pull through" business and the most profitable stuff. Its sad when many physicians are threatening to quit seeing those patients and they are pathology's best. And even if client billing is outlawed in your state, you will run into a lot of managed care nightmares. Specimens must go to quest, labcorp.

Medicare is your best reimbursement? And here I thought we had some challenges.
 

pathstudent

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Medicare is your best reimbursement? And here I thought we had some challenges.



Isn't there a law saying you can't charge less than Medicare (except of course medicaid). You can't sign a contract with United Health Care for less than medicare. I am pretty sure of that.
 

WEBB PINKERTON

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Isn't there a law saying you can't charge less than Medicare (except of course medicaid). You can't sign a contract with United Health Care for less than medicare. I am pretty sure of that.


You are going to be "client billing" most of the non-medicare patients IF you are in the 33 states that still allow it. The physician office will be paying you 10 bucks or even less for the TC so get used to it. Before my state outlawed client billing, we were forced to do this otherwise we wouldnt have had any outreach.

I dont know of any law that prevents you from signing a contract for less than medicare with an insurer. I'd guess that the managed care contracts United has with Labcorp are below medicare rates. In areas that are heavily United, it would pressure the physician's office to use Labcorp for all their business (for convenience) so the "pull through" work (medicare, other insurers) would also go to Labcorp.

In California, there is a law that MediCal should be billed at the lowest rate but it has never been enforced. BUT MediCal is fighting to get "client pricing" because the state is so desperate for money. The days of using MediCal as "pull through" business are probably nearing an end there.
 

2121115

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You are going to be "client billing" most of the non-medicare patients IF you are in the 33 states that still allow it. The physician office will be paying you 10 bucks or even less for the TC so get used to it. Before my state outlawed client billing, we were forced to do this otherwise we wouldnt have had any outreach.

Oh I see what you mean now. We don't get even get TC at all anymore, so I wasn't even thinking in those terms.
 

pathstudent

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You are going to be "client billing" most of the non-medicare patients IF you are in the 33 states that still allow it. The physician office will be paying you 10 bucks or even less for the TC so get used to it. Before my state outlawed client billing, we were forced to do this otherwise we wouldnt have had any outreach.

.

So is that what "Client Billing" is? You charge the doc to process and interpret their specimens and let them bill global?

How shady. I got to partly blame pathologists for getting involved with this.

Can you imagine if your primary care doc was sending you off to a cardiologist and then billing for the cardiologists services and the cardiologist was "client billing" the primary care doc? What would you think about your doc? What would you think about the cardiologist you are getting referred to?

That would not fly.

Why is anatomic pathology considered differently?
 

TMZ2007

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Oh I see what you mean now. We don't get even get TC at all anymore, so I wasn't even thinking in those terms.

Wait a sec, does your practice run the lab that is processing the meat? And you get nothing at all, zero dollars, to process it?
 

2121115

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Wait a sec, does your practice run the lab that is processing the meat? And you get nothing at all, zero dollars, to process it?


For hospital specimens, the hospital keeps 100% of the TC. Nowadays, outpatient "out reach" biopsies are almost all done in so-called "in office labs" where clinician groups keep 100% of the TC and we get PC (thankfully) for reading them (GU, GI, GYN, derm, etc). There are a large number of pathology practices these days that are PC only, and most models are heading this way now.

There are indeed some labs where they do process the specimen and keep just enough TC to pay for it (as mentioned above ~10 bucks or so), while the rest of the TC gets client billed and the clinician profits. Which just goes to show you why clinicians want a piece of the that TC pie.
 

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It is pathetic that client billing is still legal. It is a FAR worse problem than in-office labs and is a major drain on the health care system. Even the states that have outlawed the practice, only did it for AP specimens (tissue, paps etc). The high volume clinical lab is still anything goes. In Ohio they got a law passed to get rid of client billing but the dermatologists somehow managed to make their specimens exempt. So you can still client bill derm specimens but no other types of tissue.

You do all this work for BELOW medicare rates and still have to provide EMR, in-office phlebs and whatever else they demand. It doesnt take Einstein to figure out that the only labs that are gonna be able to survive will be high volume, reckless sweatshops where quality is low on the priority list. Mixed up biopsies and constant staff turnover/burnout are the norm and tolerated. Like someone else pointed out, you dont feel like a physician at these places. Any students out there still wanna go into pathology now?

So thank the programs for saturating the market with too many pathologists. And thank the previous generations of pathologists, who took the money and threw the all future docs under the bus.
 

pathstudent

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For hospital specimens, the hospital keeps 100% of the TC. Nowadays, outpatient "out reach" biopsies are almost all done in so-called "in office labs" where clinician groups keep 100% of the TC and we get PC (thankfully) for reading them (GU, GI, GYN, derm, etc). There are a large number of pathology practices these days that are PC only, and most models are heading this way now.

There are indeed some labs where they do process the specimen and keep just enough TC to pay for it (as mentioned above ~10 bucks or so), while the rest of the TC gets client billed and the clinician profits. Which just goes to show you why clinicians want a piece of the that TC pie.

True about in house cases. Hospitals bill for processing the patient or it is presumed to be part of the paytment based on DRG or insurance contracts.

Well that's pathetic as the TC is about 65-70% of the global. So even if you bill PC, they are making more of the biopsy than you are of the pathology services. Amazing. Must be nice.
 

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Why are they (whoever they are) targeting general pathologists? How about those physicians making 800K-1 mil+ (dermatologists, dermpaths, orthopedics, opthos, etc.)?
 

lipomas

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Why are they (whoever they are) targeting general pathologists? How about those physicians making 800K-1 mil+ (dermatologists, dermpaths, orthopedics, opthos, etc.)?

They target things that are likely to get the least volume of hostile complaints that translate into political action.

The 88305 is a very common code, accounts for a large percentage overall of medicare spending, thus it is a target.

Patients don't really care about this because it doesn't really affect their access to clinicians or who is going to pay for their pills.Fewer of them complain to their congressman that cuts to medicare will end civilization.

Thus, cut the 88305.
 

pathstudent

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They target things that are likely to get the least volume of hostile complaints that translate into political action.

The 88305 is a very common code, accounts for a large percentage overall of medicare spending, thus it is a target.

Patients don't really care about this because it doesn't really affect their access to clinicians or who is going to pay for their pills.Fewer of them complain to their congressman that cuts to medicare will end civilization.

Thus, cut the 88305.

I seriously doubt it accounts for a large percentage of overall medicare spending. Think about cardiology procedures, or people in ICUs or radiology studies.

Overall medicare spending is around 1 trillion dollars. A large percentage of that would have to be at least 10%, don't you think, which would be 100 billion dollars.

Given that CMS spends about 100 per biopsy that would mean it would take a billion 88305s to account for a large percentage of overall medicare spending.
 
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