New anatomic business sank by Admin. Opinions?

[Torsed]

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So I managed to procure a plastic surgeons anatomic specimens which would boost our numbers. Going great but after a month admin does not want to pay for a courier because the office is 45 minutes away and refuses to let the surgeons office use the hospital FedEx number. It’s a junior admin of course calling the shots. I estimate we would get a few hundred specimens a year. The hospital billed 9k in technical and are stating they only collected a fraction in the last month. I told them some insurers take 60 to 90 days or longer to pay so such analysis may be premature.

I think I’ll just give up on more business attempts. Anyone hiring?

Torsed

 

[Pingu]

I was in the exact same situation about a year ago. Courier cost was the hill my admin was willing to die on so I offered to pay for the courier costs myself. However, since I don't know what region you're in, you may want to research the going rate for couriers in your area to see if the specimen volume you are getting is worth it. You may also want to see if there is already a courier picking up in that area that would be willing to add on your pick up.

 

[cmz]

A few hundred specimens is nothing to scoff at. What sort of CPT codes are we talking here? If you add up all the special stains the hospital does TC for (including maybe IHC if they have their own machine)... it should add up to a nice tidy sum. You could try batching the specimens to save on FedEX shipping but that will be at the cost of TAT. It's up to the client.

You have to keep in mind that your hospital may be out of network for certain commercial carriers, so you need to pay attention to what's coming in. Are these self-pay patients? If so, can you make some sort of arrangement with the plastic surgeon's office where you can client bill them depending on the specimen type? For instance, my outpatient lab has arrangements with certain radiology suites where the patient has no insurance but they will pay an up-front pathology fee to have their specimen processed and read.

It sounds like you have great business sense and you're honestly wasting your time at that hospital. Are you a hospital employee? Belong to a group? I think the admin needs to be taken down a notch and what better way than to go to administration and complain that they are costing the hospital valuable AP revenue that you're helping bring to the table. You're helping grow their outreach and this is the thanks you get?

If it's not worth fighting over, I would take your entrepreneurial skills and a) start your own lab or b) take a safer route and find a willing pathology group who wouldn't mind having someone with your skill set who is hungry enough to get more business.

 

[WEBB PINKERTON]

I get the impression many hospitals would love to rid themselves of AP (and most do once they sell out to a large hospital chain). It does feel like you are flogging a dead horse sometimes. Administrators just don't seem interested in doing business with non-affiliated offices anymore in my opinion.

About all we get from plastics is breast reductions and skin lesions.

I would try to batch the specimens up and save on shipping that way.

 

[Dave CX]

Approach admin with the idea of your group globally billing your outpatient work. Offer to cut them a check for maybe 15 bucks per 88305 if they support with fedex labels. The administrator may see this a s close to free money to go on his books and you would get a great deal making a margin off the TC.

 

[LADoc00]

TBH, hospitals really dont want ANY OP biz anymore. As of now, they might turn a small profit but at least in terms of CP outreach, PAMA will essentially destroy that market completely. From what I can tell, hospital execs are writing anatomic OP along with it.

I hide in the niche codes, where it is safe and cozy.

 

[cmz]

I used to think that most hospitals wanted nothing to do with AP anymore (especially in my region) and saw it more or less as a cost center. I was totally wrong. I am not sure if the hospital execs I speak with daily know how much money they lose annually on the AP side. It's baffling. Perhaps it's something to flex to others, "hey, check out this hot AP lab we have in-house."

I also kind of wonder about the CP side since Medicare comprises a large chunk of the hospitals I run. PAMA is going to hurt right?

Anyway, I like my 88377-26's and 88189s and 88360s.

 

[Dave CX]

TBH, hospitals really dont want ANY OP biz anymore. As of now, they might turn a small profit but at least in terms of CP outreach, PAMA will essentially destroy that market completely. From what I can tell, hospital execs are writing anatomic OP along with it.

I hide in the niche codes, where it is safe and cozy.

This is true, but admins also like to get a clean check which appears to come from nowhere (even though there is a cost attached to it) but with there stupid accounting it seems like free money. If they get a paycheck from a pathology group for even a small amount, say 5000 per month they will probably love it, not either knowing or caring about the cost of producing those slides and supporting the marketing transcription etc. As you know, a hospital lab is rarely run like a proper for profit business.

 

[Dave CX]

From 2002 thru 2012, we paid our hospital 13 bucks per 305tc and that was back when the tc reimbursement was over 70. We made herds of cash that way ( non medicare). The reason they went for it is for some bizarre reason, the lab was arbitrarily deemed a "cost center" and lumped in with something called "shared services" which included the cafeteria and ****. They couldn't have cared less about the opportunity cost of our global billing outpatient AP. In fact they liked it. They didn't have to worry about billing and bad debt, and the check they got every month descended from the heavens. It went on a whole separate set of books and looked like pure profit.

 

[Torsed]

thanks. Good idea.

 

[Torsed]

A few hundred specimens is nothing to scoff at. What sort of CPT codes are we talking here? If you add up all the special stains the hospital does TC for (including maybe IHC if they have their own machine)... it should add up to a nice tidy sum. You could try batching the specimens to save on FedEX shipping but that will be at the cost of TAT. It's up to the client.

You have to keep in mind that your hospital may be out of network for certain commercial carriers, so you need to pay attention to what's coming in. Are these self-pay patients? If so, can you make some sort of arrangement with the plastic surgeon's office where you can client bill them depending on the specimen type? For instance, my outpatient lab has arrangements with certain radiology suites where the patient has no insurance but they will pay an up-front pathology fee to have their specimen processed and read.

It sounds like you have great business sense and you're honestly wasting your time at that hospital. Are you a hospital employee? Belong to a group? I think the admin needs to be taken down a notch and what better way than to go to administration and complain that they are costing the hospital valuable AP revenue that you're helping bring to the table. You're helping grow their outreach and this is the thanks you get?

If it's not worth fighting over, I would take your entrepreneurial skills and a) start your own lab or b) take a safer route and find a willing pathology group who wouldn't mind having someone with your skill set who is hungry enough to get more business.

Thanks for the vote of confidence. I appreciate it. I’m a contractor (self employed) and the medical director. I recognize the laboratory is in the service portion of the hospital but I never thought we would be turning down business.

With regards to insurance etc these are all insured or Medicare and the hospital and myself are in network. Very frustrating.

 

[Torsed]

Approach admin with the idea of your group globally billing your outpatient work. Offer to cut them a check for maybe 15 bucks per 88305 if they support with fedex labels. The administrator may see this a s close to free money to go on his books and you would get a great deal making a margin off the TC.

Thanks Dave CX. Never thought of that.

 

[yaah]

I think admins can get lost in the relative numbers. They don't see something that might bring them in more money if there is something else that might bring in more. So they focus on the higher reward stuff at the expense of everything else. There may be others in admin who you can get to help advocate for you, particularly if they don't have to do much work themselves. Then they can focus on their ortho stuff or whatever.