National Survey about In-house labs

[WEBB PINKERTON]

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http://www.darkdaily.com/survey-set...e-anatomic-pathology-laboratories-093011#more-

Good article in the dark report with a link to fill out a survey about in-office labs. In-office labs are really becoming a nuisance in our area. Lost a lot of referrals in recent years. I am curious to see the results of this survey.

Tell us how great pathology is again BU.

 

[Pathwrath]

I laugh because back in the day I was told that one of the many great things about pathology was that the specimens came to you. Now I'm on the road more than any clinician.

Keep in mind, too, that not only do you lose the tech fee and a chunk of your professional fee by these in-office arrangements, you also sacrifice essential flexibility and efficiency. Unless you are a hologram, you can't simultaneously signout in some rotten scope mill and also cover hospital frozens, supervise PA's, cover FNA rapid assessments, or even take a colleague's consult. You become as useless to your group as the stomach biopsies you're reading.

 

[WEBB PINKERTON]

I laugh because back in the day I was told that one of the many great things about pathology was that the specimens came to you. Now I'm on the road more than any clinician.

Keep in mind, too, that not only do you lose the tech fee and a chunk of your professional fee by these in-office arrangements, you also sacrifice essential flexibility and efficiency. Unless you are a hologram, you can't simultaneously signout in some rotten scope mill and also cover hospital frozens, supervise PA's, cover FNA rapid assessments, or even take a colleague's consult. You become as useless to your group as the stomach biopsies you're reading.

I guess we should be glad we are still needed and happy for the crumbs.

 

[mlw03]

Thank you all for validating my decision to go into forensic pathology. I feel for ya'll and hope my diagnostic pathology colleagues are able to successfully overcome these types of attacks on their autonomy and their ability to make a fair living.

 

[pathstudent]

I laugh because back in the day I was told that one of the many great things about pathology was that the specimens came to you. Now I'm on the road more than any clinician.

Keep in mind, too, that not only do you lose the tech fee and a chunk of your professional fee by these in-office arrangements, you also sacrifice essential flexibility and efficiency. Unless you are a hologram, you can't simultaneously signout in some rotten scope mill and also cover hospital frozens, supervise PA's, cover FNA rapid assessments, or even take a colleague's consult. You become as useless to your group as the stomach biopsies you're reading.

You take this ****. You go and sign out for the clinicians in their offices to make them money? You are the problem.

 

[caffeinegirl]

This article is interesting, but really only a plug to participate in the survey (link is at the end of the article).

The chart they show is how histology accession #'s have decreased for Quest and Labcorp from 2006-2010...and then they postulate that this is due to in-office histology labs. The only other data point listed is:

"As of the last data point (March), Laboratory Economics estimates that roughly 907 urologists, 912 gastroenterologists, 181 dermatologists, and a total of 2,755 physicians have in-sourced anatomic pathology laboratory testing representing greater than $300 million in annual revenue."

My question is what percentage of the total national annual revenue does this $300 million represent? And, is the decrease in histology accessions in Quest and Labcorp just due to in-office labs or do other competitors also play a role (ie. Caris). In order to get the full picture, I do think this needs to be put in perspective....

As for the anecdotal evidence, yes we have also lost a chunk of 88305's to inhouse urologist and gastroenterologist practices in the last 3-4 years as well as to Caris. But percentage-wise it was not a huge chunk.

 

[caffeinegirl]

I guess I just am answering my own question


In 2006, the annual anatomic national revenue is approx $9 billion, and for cytology $2 billion (http://www.ascls-sd.org/sitebuildercontent/sitebuilderfiles/laboratory_medicine_-_a_national_status_reportmay08.pdf). So if in house labs represent approximately $300 million...that's about 3.33% of the national anatomic path revenue.

 

[mlw03]

You take this ****. You go and sign out for the clinicians in their offices to make them money? You are the problem.

I'm not going to criticize another person's choices about how to make a living, so long as it's not something illegal or immoral. We're all "free agents" taking the best overall jobs we can find. Let's not be biting at each other - unless all pathologists in the US agreed to decline these jobs, it serves little purpose to criticize those that have taken them.

 

[WEBB PINKERTON]

I dont agree with the article implying that in-office labs are the main reason the big two have less accessions. Labcorp and Quest are losing business due to a number of reasons. Specialty labs (Caris etc) and physician offices selling out to hospitals are a huge reason the big labs growth has slowed. Our cytology volume has increased due the hospital buying out OBGYN practices but our tissue volumes are down.

The survey asks you to rate the biggest threats. I listed specialty labs as the biggest one for our lab. Caris and Bostwick have been huge thorn. Luckily their unethical billing and worthless snake oil tests catch up with them and sometimes we are able to get the business back. The only in-office lab in our area is a large urology practice. They even have DaVinci there. I ranked in-office labs as the 3rd biggest threat right now but it could change. Now that client billing is illegal in my state, I expect more in-office labs to pop up.

 

[yaah]

They have DaVinci in the office? That doesn't make sense. You can't perform surgeries which require an inpatient stay at a private office.

 

[pathstudent]

They have DaVinci in the office? That doesn't make sense. You can't perform surgeries which require an inpatient stay at a private office.

They could own their own surgery center/small inpatient hospital that has a davinci

Urology is a license to print money.

Just think about the biopsies alone, you get the money from doing them, then you get 100% of the pathology TC, and 66-75% of the pathology PC.

And then I heard of a non-profit religious organization hospital that pays the urologists to do some prostate cases at their hospital. Of course it would be illegal for hospitals to pay doctors like that so they do it via making them "directors of robotic surgery" or some bs title like that. It must be nice to get paid on top of getting paid.

An orthopedic friend of mine has an office in medical building next to a group of 8 urologists who are part of a regional conglomerate of urologists that own their own urology surger center and have a pathologist like pathwrath coming to their office to make them money off the pathology, and says every single one drives a 150k car to work even the newbies. As the orthopedic said "you shouldn't drive that **** to work". It just looks bad.

 

[Pathwrath]

You take this ****. You go and sign out for the clinicians in their offices to make them money? You are the problem.

I've forgotten who's who on this thread, but aren't you the perpetual shill for academic pathology? If you are, why are you even commenting on this thread? You have zero experience in community pathology. Your opinion is uninformed and worthless.

 

[Pathwrath]

You take this ****. You go and sign out for the clinicians in their offices to make them money? You are the problem.

On the offside chance that I was mistaken and you actually know what you are talking about, then tell me how your group managed to keep its younger hires when all of its GI and urology work walked out the door.

Really, I'm all ears.

 

[pathstudent]

On the offside chance that I was mistaken and you actually know what you are talking about, then tell me how your group managed to keep its younger hires when all of its GI and urology work walked out the door.

Really, I'm all ears.

You can't really bitch about it if you are going to play ball with them.

 

[Pathwrath]

You can't really bitch about it if you are going to play ball with them.

Sure I can. I just did. See?

By your reasoning, you can't criticize a politician after you voted for him only because he was the better of the two choices available. Making the best of a bad situation does not preclude complaining about it.

You still haven't provided another solution to keeping a group intact when faced with a massive loss of revenue. I take it you see yourself proudly walking away from these rotten deals, but for the moment, your assertion is purely theoretical.

When the opportunity arises and you actually take one for the team and suffer the real consequences, then I invite you to come here and gloat all about it.

 

[pathstudent]

Sure I can. I just did. See?

By your reasoning, you can't criticize a politician after you voted for him only because he was the better of the two choices available. Making the best of a bad situation does not preclude complaining about it.

You still haven't provided another solution to keeping a group intact when faced with a massive loss of revenue. I take it you see yourself proudly walking away from these rotten deals, but for the moment, your assertion is purely theoretical.

When the opportunity arises and you actually take one for the team and suffer the real consequences, then I invite you to come here and gloat all about it.

I guess you got to do what you got to do to survive, just like the Uruguayan rugby team. Community practice pathology sure has been gutted. Insurers don't bother to pay for PCCL anymore and the best AP revenue has been taken away. The biggest joke is that the gastroenterologists don't want to give you their biopsies but then they do want you to do the on site FNA adequacies and tumor boards which pay little to nothing.

CMS says it is illegal for docs to refer to their own path labs (so the GIs can't bill for medicare unless they can get a pathologist to come sign it out in their office), but the insurers don't bother to respect that. Why can't CAP get rid of the in-office loop hole and help make it illegal for GIs to send their private insured cases to themselves?

 

[2121115]

Why can't CAP get rid of the in-office loop hole and help make it illegal for GIs to send their private insured cases to themselves?

Because it is not as simple as just waving a magic wand and closing the IOASE. CAP is out numbered on this one. For every 1 pathologist vote against it, there is 1 GI doc, 1 urologist, 1 gynecologist, and 1 dermatologist voting for it (all of whom benefit from the loophole). That is the way democracy works. In order to get rid of it we have to prove that it hurts patient care in quality terms or that it causes over utilization of resources, which is very difficult to prove (rather than merely suggest). And then we would have to do it without pissing anyone off so they don't vote to cut our CPT RVU's the next time they are up for review. Contrary to popular belief, this is a tough tightrope to walk.

 

[lipomas]

They could own their own surgery center/small inpatient hospital that has a davinci

Inpatient centers are pretty strictly regulated. And very expensive. Groups do not routinely have their own inpatient facilities. I call BS on the "Da vinci in the office for prostatectomy" posting. That sounds like an inflammatory claim that is issued to make a point that doesn't really exist for the purposes of sounding convincing. Also, urology groups are not really likely to be able to afford their own Da Vinci. The robot + maintenance is hella expensive. Like $1.5 mil up front + hundreds of thousands in cost a year. I thought I even read that they lose money for hospitals for the procedure + surgeon costs, they only have them so they can compete for patients and gain money through the other benefits of the patient being there. So I think you're wrong.

Did you know that pathologists are now using the Da Vinci robot to cut frozen sections remotely? I didn't either, but since I read it right here on an internet message board it must be true!

 

[pathstudent]

Inpatient centers are pretty strictly regulated. And very expensive. Groups do not routinely have their own inpatient facilities. I call BS on the "Da vinci in the office for prostatectomy" posting. That sounds like an inflammatory claim that is issued to make a point that doesn't really exist for the purposes of sounding convincing. Also, urology groups are not really likely to be able to afford their own Da Vinci. The robot + maintenance is hella expensive. Like $1.5 mil up front + hundreds of thousands in cost a year. I thought I even read that they lose money for hospitals for the procedure + surgeon costs, they only have them so they can compete for patients and gain money through the other benefits of the patient being there. So I think you're wrong.

Did you know that pathologists are now using the Da Vinci robot to cut frozen sections remotely? I didn't either, but since I read it right here on an internet message board it must be true!

. There are innumeruable examples where docs own their own surgery centers or hospitals with or without outside investors.

I would be shocked if there were not at least a few examples of urologists owning their own urological surgery centers or small sub specialized hospital.

Just met an administrator who was on his way to go be the CEO of pure orthopedic surgery hospital owned by 50 orthopedic surgeons in Texas.

 

[yaah]

. There are innumeruable examples where docs own their own surgery centers or hospitals with or without outside investors.

I would be shocked if there were not at least a few examples of urologists owning their own urological surgery centers or small sub specialized hospital.

Just met an administrator who was on his way to go be the CEO of pure orthopedic surgery hospital owned by 50 orthopedic surgeons in Texas.

He's right- inpatient surgery is a different animal. There is a major difference between outpatient surgery centers/procedure units which are privately owned by physicians and inpatient surgery. And I think the numbers on robot cost are correct - they are extremely expensive and they are a net loss for hospitals. So I highly doubt anyone is operating a robot in their strip mall urology clinic.

 

[pathstudent]

He's right- inpatient surgery is a different animal. There is a major difference between outpatient surgery centers/procedure units which are privately owned by physicians and inpatient surgery. And I think the numbers on robot cost are correct - they are extremely expensive and they are a net loss for hospitals. So I highly doubt anyone is operating a robot in their strip mall urology clinic.

You don't get it. I am not saying it is in their clinic. I am saying it is possible that a large group of urologists could own a specialty hospital or surgery center that can handle overnight stays and could have a Davinci.

having just looked up "urology hospital and Urology Center" it seems like many urologists own centers that have clinics, out-patient procedures, pathology, radiology, and radiation oncology. They are killing even without a davinci

 

[lipomas]

You don't get it. I am not saying it is in their clinic. I am saying it is possible that a large group of urologists could own a specialty hospital or surgery center that can handle overnight stays and could have a Davinci.

I have never heard of that. Like I said, Da Vinci is hella expensive. So is overnight care. Hospitals can do it because of volume.

having just looked up "urology hospital and Urology Center" it seems like many urologists own centers that have clinics, out-patient procedures, pathology, radiology, and radiation oncology. They are killing even without a davinci

Well yes, of course they do. They own these mammoth proton machines and things like that to treat cancer. They own imaging. And they definitely do outpatient procedures, like most physicians do.