One strike against podlabs... read this...

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Nilf

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Court Supports HHS Clampdown on Pod Lab

A U.S. District Court dismissed a lawsuit yesterday challenging the Medicare Anti-Markup provisions in the 2008 Medicare Physician Fee Schedule rule, a landmark decision that dissolves a preliminary injunction barring implementation of the provisions and makes them immediately enforceable.

The case was brought when UroPath, LLC and three urology groups filed suit against the Department of Health and Human Services seeking an injunction to halt implementation of the provisions in the rule, which came into effect on Jan. 1, 2008.

Citing a recent Supreme Court decision and existing case law, Judge Mary M. Collyer concluded that Section 405 (h) of the Medicare Act mandates the "channeling" of virtually all legal attacks through the agency, and dismissed the case on the grounds that the federal court does not have jurisdiction in this matter.

The three urology groups and their principals would now be required to file a claim against the rule with the Secretary of HHS, and exhaust the agency's grievance process before pursuing civil action.

In addition, the judge ruled that UroPath and its medical director have no standing to challenge the anti-markup rule as they do not participate in Medicare.

The College provided to the court an amicus curie, or "friend of the court" brief, explaining why pod lab arrangements do not comply with the intent of the in-office ancillary exception to the Stark law prohibition on self-referrals.

Additionally, the brief demonstrated how pod labs can lead to over-utilization, and argues for immediate implementation of the November final rule as it relates to pathology services.

In the final ruling, the judge cited the College's amicus brief, noting that:

"The CMS final rule that is the subject of this action [i.e. the Anti-Markup Rule] is a reasonable attempt to remove from anatomic pathology the referring physician's profit motive that can corrupt medical decisions."

The anti-markup rule is now effective for anatomic pathology services if the physician group is billing for services performed in a "centralized building," and the location does not meet the definition of the "same building," as both are defined in the Stark regulations.

The College applauds the decision of the court, and will continue to advocate for changes to the in-office ancillary services exception to the Stark Law to prevent referring physicians from profiting from pathology services, regardless of whether the service is performed offsite or in-office."

Can anybody translate this into plain English?

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Sounds to me like pathologists are winning the battle.

Physicians who exploit pathologists will no longer be able to do so. Scum will eventually lose the battle.
 
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Can anybody translate this into plain English?


In the final ruling, the judge cited the College's amicus brief, noting that:

"The CMS final rule that is the subject of this action [i.e. the Anti-Markup Rule] is a reasonable attempt to remove from anatomic pathology the referring physician's profit motive that can corrupt medical decisions."

The anti-markup rule is now effective for anatomic pathology services if the physician group is billing for services performed in a "centralized building," and the location does not meet the definition of the "same building," as both are defined in the Stark regulations.

The College applauds the decision of the court, and will continue to advocate for changes to the in-office ancillary services exception to the Stark Law to prevent referring physicians from profiting from pathology services, regardless of whether the service is performed offsite or in-office."

BUT

Citing a recent Supreme Court decision and existing case law, Judge Mary M. Collyer concluded that Section 405 (h) of the Medicare Act mandates the "channeling" of virtually all legal attacks through the agency, and dismissed the case on the grounds that the federal court does not have jurisdiction in this matter.

The three urology groups and their principals would now be required to file a claim against the rule with the Secretary of HHS, and exhaust the agency's grievance process before pursuing civil action.

Basically it says that the POD lab do fall under the provisions of the Stark law, and that the law is designed to protect against the ordering physician from profiting by earning money on the basis of submitting the work...

And it applies to pathology pod labs.


BUT

The courts are not the place to decided this and Health and Human services is where the companies should take their case..
 
Yes - I agree with djmd's point. The problem for these podlabs is that they do not (to my knowledge) have the backing of any major funding source or organization. Whereas legislation that would harm a large reference lab like Quest would be lobbied against, the podlabs are small entities and are unlikely to get any sympathy - particularly because their primary reason for existence is skimming profit in a sleazy manner.

Basically, the pod lab issue comes down to whether they violate the Stark Law. The Stark Law is complicated and has many exceptions but it is designed to prevent self referral for the purposes of profit. As Henry says, "physicians are prohibited from referring Medicare patients to laboratories in which the physician (or close family member) has a financial interest." Self referral is allowed within the "safe harbor" of your own in-office ancillary services, however, and it extends to, technically, within the same building. Which makes me (and everyone else, I'm sure) wonder if podlabs would be legal if they just simply moved them into the same building as the urologist's office where he/she sees patients (this gets at the "same building" vs "centralized building" that is mentioned above). Thus, it's very complicated and full of legalese. But since the podlabs are really fighting it, that suggests that it's a problem for them.
 
Which makes me (and everyone else, I'm sure) wonder if podlabs would be legal if they just simply moved them into the same building as the urologist's office where he/she sees patients (this gets at the "same building" vs "centralized building" that is mentioned above). Thus, it's very complicated and full of legalese. But since the podlabs are really fighting it, that suggests that it's a problem for them.

The "same building" rule is (if I remember correctly) a provision that exempts hospitals and hospitals where the entire hospital is physician-partnership owned... I think...
 
Whether the lab is in-house or outside is a non-issue. In both scenarios, the referring clinician is looking to make some profit and exploit the pathologist. Both should be illegal.
 
Yes - I agree with djmd's point. The problem for these podlabs is that they do not (to my knowledge) have the backing of any major funding source or organization. Whereas legislation that would harm a large reference lab like Quest would be lobbied against, the podlabs are small entities and are unlikely to get any sympathy - particularly because their primary reason for existence is skimming profit in a sleazy manner.

Basically, the pod lab issue comes down to whether they violate the Stark Law. The Stark Law is complicated and has many exceptions but it is designed to prevent self referral for the purposes of profit. As Henry says, "physicians are prohibited from referring Medicare patients to laboratories in which the physician (or close family member) has a financial interest." Self referral is allowed within the "safe harbor" of your own in-office ancillary services, however, and it extends to, technically, within the same building. Which makes me (and everyone else, I'm sure) wonder if podlabs would be legal if they just simply moved them into the same building as the urologist's office where he/she sees patients (this gets at the "same building" vs "centralized building" that is mentioned above). Thus, it's very complicated and full of legalese. But since the podlabs are really fighting it, that suggests that it's a problem for them.

kk... so should we be opening champagne now?
 
This is one of the things that went immediately into effect this year. That's why I stated on the other thread that I had no idea why everyone was making such a big fuss over POD labs. There still could be loop holes to how Pathologists are used. Technically there are exceptions to the provisions that took effect this year. But in each case the clinician is likely to cease having the upper hand.

It seems more like a, "strike one, you're out" kind of deal:

Here are some comments and reviews over this stuff-----


http://www.faegre.com/articles/article_2359.aspx

http://urologytimes.modernmedicine....ologist/ArticleStandard/Article/detail/475195

I love the title of the second article (especially since it's a urology journal)- Medicare final rule: Little good news for urologists
 
http://urologytimes.modernmedicine....ologist/ArticleStandard/Article/detail/475195

I love the title of the second article (especially since it's a urology journal)- Medicare final rule: Little good news for urologists

:laugh: I love this (unrelated to path, but still funny) from that article

Under CPT, the phone calls for patient care have been revised into three separate codes with specific times: 99441, 5 to 10 minutes, $12; 99442, 11 to 21 minutes, $22.65; and 99443, 21 to 30 minutes, $33.44. If you calculate this, your time on the telephone to a patient is valued at approximately $67 per hour.

But yes, perhaps "bad news for urologists." No more making money for someone else doing work! :laugh:
 
I don't understand what the ruling is or what it says. I guess it is good. It breaks my heart to read the urologist's article where they refer to a "urology group's technician and pathologist". We are basically like ancillary support staff for these people that were once our colleagues.

I wish they would call these arrangements what they really are and that is fee splitting. A pathologist is doing a service and agreeing to give another physician a cut of the fee.
 
I wish they would call these arrangements what they really are and that is fee splitting. A pathologist is doing a service and agreeing to give another physician a cut of the fee.

Yeah, I agree. I think national organizations are trying to take some action on these issues, but apparently there is only so much they can do so long as there is a subset of the population that supports the contrary, or so long as most of the population doesn't really care (because they think it doesn't directly affect them).

It is basically akin to us billing the urologist for his/her conversation with the patient where they go over the biopsy results and discuss treatment. It's asinine, I can't believe people get away with this stuff. And the problem is that as it goes on, cuts to reimbursement will be made instead of reinstating "lost" income to pathologists. I don't understand the clinicians' argument on these issues - you shouldn't be able to bill for simply ordering a test!
 
I guess the urologists are asking themselves, "why can't we do what dermatologist have been doing for years."

I am no expert of this subject and I believe that pod labs should be burned to the ground, but it seems like a similar thing is going on with respect to dermatology. Several determatology practices hire their own personal pathologist to read their slides, or they simply read their own slides. Either way, it is nothing less than a self referral racket. A dermatologist can biopsy anything they want and establish a situation where they get the diagnosis needed to obtain maximum reimbursement--whether it is by a pathologist or by themselves, this system is just wrong. The diagnosis should be unbiased and not based on compensation. If the dermatologist is not happy with the dermatopathologist who is employed by the dermatology practice, the person could easily be canned and replaced with someone who is willing to sing the right tune. I know that dermatology practices can just as easily shop for the right independent pathology practice, but at least the dermatologist is required to put forth a little more effort to set-up their cushy little lives.
:thumbup:
 
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I guess the urologists are asking themselves, "why can't we do what dermatologist have been doing for years."

Because the Dermatologists are dermatopathologists...
they are qualified to read their own slides, and so if they want to they can...

I'm sure they may be some Derm groups where they have Derms, Derm-dermpaths, and pathologist-dermpath... (maybe even Derm and path-dermapth), but dermpath has always been sort of separate...
 
Well whether POD labs were right or wrong they pretty much have little future now.

Pathologists are not the only Physicians exploited. Radiologists, Radiation oncologists are also exploited. Urologists are using their own irradiation machines for prostate cancer instead of referring them to a RadOnc. In these situations they hire a radonc, have them do the dose calculations and make a hefty profit. Clinicians can also read their own images or own their own MRIs/CTs and hire a Radiologist for interpretation.

The clinicians make money by NOT referring. That is/was their only power.

So while it's easy to just think, "oh my Pathologists are the only Physicians exploited!!!". It is far from the truth and this like many other SCAMS in medicine has caught up to them. We have to be more preemptive in the future for similar schemes.
 
I guess that is my whole point--why should dermatopathology be held to a different standard. I personally don't believe dermatologists should be allowed to read their own slides. How much more blatant can a self-referral be. Since we know that not even doctors are 100% ethically moral, how hard is it to believe there are dermatologists doing unnecessary procedures so that they can bill for pathology work to generate more revenue. Even if it is only occasionally done, it is still wrong. If a dermatologist can do it, why can't other fields do it like GI, GU or GYN. I know some orthopedic oncology surgeons who are better at sarcoma pathology than most pathologists, so why are they not allowed to sign-out their own pathology--because of self-referral issues. Bottom line, determatologists should not be in control of dermatopathology.
 
See this article on how RadOncs are exploited by Urologists.

http://www.nytimes.com/2006/12/01/business/01beam.html?pagewanted=print

So perhaps the lesson in all this is that we need to TEAM UP with our counterparts who are similarly being exploited.




Profit and Questions on Prostate Cancer Therapy



By STEPHANIE SAUL
The nearly 240,000 men in the United States who will learn they have prostate cancer this year have one more thing to worry about: Are their doctors making treatment decisions on the basis of money as much as medicine?
Among several widely used treatments for prostate cancer, one stands out for its profit potential. The approach, a radiation therapy known as I.M.R.T., can mean reimbursement of $47,000 or more a patient.
That is many times the fees that urologists make on other accepted treatments for the disease, which include surgery and radioactive seed implants. And it may help explain why urologists have started buying multimillion-dollar I.M.R.T. equipment and software, and why many more are investigating it as a way to increase their incomes.
Already, dozens of the nation’s 10,000 urologists have purchased the technology for intensity modulated radiation therapy, which is what I.M.R.T. stands for, and some of them are recommending its use for growing numbers of their patients.
Critics see a potential conflict of interest on the part of urologists, the specialists who typically help prostate patients choose a course of treatment. The critics say that urologists who can profit from the new form of therapy may be less likely to recommend other proven approaches, which for some older men can involve forgoing treatment altogether.
If the patient has insurance, the added expense may not be a concern for him. And like the other treatments, the new therapy can be highly effective. But doctors say that prostate cancer treatments should be tailored to the individual.
Compared with seed implants, for example, I.M.R.T. involves a large time commitment, requiring patients to visit a radiation center 45 times over the course of nine weeks.
More worrisome for some experts is a concern that the multiple-beam radiation of I.M.R.T. may raise the risk of secondary cancers, although no medical studies have proved such a link.
Helping drive the trend is a Texas company, Urorad Healthcare, which sells complete packages of I.M.R.T. technology and services, and hopes to persuade even more urologists to buy them.
“Join the Urorad team and let us show your group how Urorad clients double their practice’s revenue,” the company says in a marketing pitch to doctors on its Web site.
Urologists who have purchased the new multiple beam systems say they are embracing a superior way to treat prostate cancer. But because there is little research directly comparing I.M.R.T. with the other treatments, there is little consensus among urologists about which approach is best.
That is why some doctors worry that I.M.R.T. may be emerging as yet another example of the way financial incentives can influence medical decisions in this nation’s for-profit health care economy.
“It’s all money-driven, and it’s a shame medicine has come down to this,” said Dr. Brian Moran, a radiation oncologist in Chicago, who specializes in radioactive-seed implants, in which tiny radioactive pellets are placed into the prostate. His clinic is paid $15,000 or less for the procedure, with the urologist on the case getting about $900.
Dr. Eli Glatstein, a professor of radiation oncology at the University of Pennsylvania, said he was concerned that some urologists would steer patients to the new treatment because they owned the technology and could greatly profit from its use.
“It’s not illegal to do this,” Dr. Glatstein said. “That doesn’t make it right.”
I.M.R.T. was introduced in the mid-1990s and has proved useful for delivering multiple beams of radiation to a small area while avoiding healthy tissue. Like other treatments for prostate cancer, though, it has possible side effects, potentially including impotence.
The one certainty about I.M.R.T. is that for doctors who own the technology, it can be much more lucrative than alternative treatments. Medicare and other insurers typically pay urologists only $2,000 or less for performing surgery to remove the prostate or for implanting radioactive seeds. The insurers say the much higher I.M.R.T. payments, which in some cases exceed $50,000, are based on the technology’s cost.
Leslie Norwalk, Medicare’s chief administrator, said she was not worried that doctors who invest in I.M.R.T. would use it on patients who require no treatment.
“You’re just not going to do beam therapy on someone who doesn’t need it,” Ms. Norwalk said in a telephone interview.
But because of the potential conflicts, urologist-owned I.M.R.T. is the type of arrangement that Medicare should be watching, she said.
Dr. Juan A. Reyna, president of a San Antonio urology group that was among the first to order I.M.R.T. technology in 2004, said that the revenue opportunities were a factor in the decision to buy it.
“These are the kind of things you have to do to be able to maintain yourself in practice,” Dr. Reyna said, noting that Medicare has been cutting back payments for other forms of prostate cancer treatment. Dr. Reyna says he recommends the treatment more frequently now because he is convinced of its value.
Some other urologists, though, say they are uncomfortable with the I.M.R.T. ownership trend. For example, Dr. Robert Waldbaum of Manhasset, N.Y., said he declined to go along when a large group of Long Island urologists invested in the technology, fearing it might influence his advice to patients.
“I felt in my own mind that it would be a conflict of interest to me,” said Dr. Waldbaum, the former chairman of urology at North Shore University Hospital, who is in private practice.
Varian Medical Systems, a leading maker of the technology, still sells it mainly to hospitals and free-standing radiation oncology centers. But it has sold about 20 I.M.R.T.-capable machines to urology groups, according to a company spokesman, Spencer Sias. Typically, doctor groups pool their money to buy the technology.
“There’s definitely heightened interest from urology practices in this,” Mr. Sias said.
Helping drive that interest is Urorad, based in McAllen, Tex., which has been aggressively marketing I.M.R.T. to urologists across the country, who must either hire a radiation oncologist or form a partnership with one. The company helps arrange a complete setup as well as consulting services to calculate radiation doses for patients, with costs to get started estimated at about $3 million.
Five Urorad centers are already operating around the country, according to Dr. Mark L. Harrison, the chief executive, who said that contracts had been signed for six more.
The majority of prostate cancers are caught early, owing mainly to use of the prostate-specific antigen test. Still, prostate cancer is the second-leading cause of cancer-related deaths in men, after lung cancer.
The prostate cancers that are detected early have several treatment alternatives with high success rates — among them surgery, radioactive seed implants, and external radiation, like the multiple beam therapy.
In some cases, especially for older men, doctors recommend “watchful waiting,” or no treatment at all. An estimated 40 percent to 50 percent of men with the disease get surgery, which many doctors still consider the gold standard for a cure. But surgery also carries a risk of incontinence; up to 29 percent of men who have their prostates removed report wearing pads to keep dry, according to one large study.
As with surgery and seed implants, men treated with I.M.R.T. run a risk of eventual impotence. A recent study at Memorial Sloan-Kettering Cancer Center, which has conducted much of the early research on the therapy, found that eight years after treatment, 49 percent of men who were potent before treatment developed erectile dysfunction.
Compared with surgery, neither seed implants nor I.M.R.T. carry high risks of incontinence, though. And the arguments in favor of the multiple beam therapy include a new research study indicating that urinary complications, like painful urination and a narrowing of the urethra, are lower with I.M.R.T. than with seed implants.
Depending on the region of the country, the owner of an office-based I.M.R.T. system can be reimbursed up to $47,000 for a nine-week course of daily treatments, including the physician’s fee, which often goes to the radiation oncologist.
Medicare and commercial insurers have said the reimbursements are based not only on the cost of the software and equipment, but on the complicated mathematical calculations required in administering the treatments.
Yet Dr. Ivan A. Brezovich, a physicist at the University of Alabama at Birmingham, said that delivering multiple beam therapy to the prostate was a relatively simple procedure compared with using it on more complex conditions like head and neck cancers.
“You can do it almost on an assembly-line basis,” Dr. Brezovich said.
Medicare, which has reviewed the issue, is scheduled to begin reducing I.M.R.T. reimbursements. For example, reimbursement in the Atlanta area, considered close to the national median, is scheduled to be cut by 8.2 percent, from $39,000 this year to $35,800 in 2007.
But because Medicare or another insurer pays for the treatment, cost is often not a factor for patients as they assess their options.
Leonard Streim, 58, a clinical psychologist in Deer Park, N.Y., learned he had prostate cancer this year. He said he researched various options, including seed implants and surgery, before deciding on multiple beam treatment, which was covered by his medical insurance.
Mr. Streim said his side effects were minimal.
“As compared to surgery, as compared to walking around being radioactive, I don’t think there’s any choice there, at least not for me,” he said.
His urologist is a member of a large Long Island group, Integrated Medical Professionals, formed in July by 13 different practices with a total of more than 30 doctors. Now the largest urology group on Long Island, it pooled its resources to invest in an image-guided I.M.R.T. system, which uses markers implanted in the prostate to more accurately direct the beams of radiation. Some say that the group’s formation has contributed to a shift in prostate cancer treatment in the region.
Fewer patients in the area now appear to be getting seed implants, according to Dr. Jay Bosworth, a radiation oncologist involved with another Long Island group of diagnostic and treatment centers whose services include I.M.R.T.
According to three hospitals where doctors in the Integrated Medical Professionals group have practiced, about 300 seed procedures were performed in 2005 compared with about 100 this year through mid-October.
Dr. Deepak A. Kapoor, Integrated Medical’s chief executive, said the downturn in seed implants began before his group’s formation, as urologists began to recognize the benefits of I.M.R.T. He denied that financial incentives were a driving force.
“All of our physicians are required to discuss all available options with every patient,” Dr. Kapoor said.
One of Dr. Kapoor’s Long Island patients, Daniel Staiano of Massapequa, N.Y., who is covered by Medicare, said he was not concerned to learn that his urologist had a financial stake in the therapy.
Mr. Staiano, 75, was one of several patients treated by I.M.R.T. in Plainview, N.Y., who said they suffered only minor side effects after the nine-week course of radiation.
“This treatment is fabulous,” said Mr. Staiano, a retired tape editor for NBC, who said that his side effects were minimal. “If I ever get cancer again,” he said, “this is the way I want to go.”
 
I like the article. It simply proves that even doctors will strong-arm each other just to make a profit. The lure of that new BMW is just too much to ignore. If I had a skin lesion removed by a dermatologist and if they told me the lesion was worrisome thus requiring a re-excision and they were the one who read the slide, it would demand a second opinion.
 
I like the article. It simply proves that even doctors will strong-arm each other just to make a profit. The lure of that new BMW is just too much to ignore. If I had a skin lesion removed by a dermatologist and if they told me the lesion was worrisome thus requiring a re-excision and they were the one who read the slide, it would demand a second opinion.

Well by extension, we shouldn't allow the GI/GU doc who examines you to do your Bx... because he gets paid to Bx. Clearly there have to be reasonable allowances made...

I guess all pathologists could sign things out as can not rule out, because then we would likely see an other biopsy on that patient...
 
I guess all pathologists could sign things out as can not rule out, because then we would likely see an other biopsy on that patient...

I have never heard of a pathologist giving that diagnosis with the sole purpose to generate another biopsy for monetary reasons, but I guess it could be possible. Most pathologists who overuse that line diagnosis do so because they believe it will possibly save them from a lawsuit which I've heard is not entirely true; however, I do not have any direct evidence to argue that point. If you do decide to become an over obnoxious/ambiguous pathologist, you the run the risk of really ticking off the clinicians who have been know the run off a pathologist like one of those unwelcomed house guest even though they don't direct employ him/her.:smuggrin:
 
I have never heard of a pathologist giving that diagnosis with the sole purpose to generate another biopsy for monetary reasons, but I guess it could be possible. Most pathologists who overuse that line diagnosis do so because they believe it will possibly save them from a lawsuit which I've heard is not entirely true; however, I do not have any direct evidence to argue that point. If you do decide to become an over obnoxious/ambiguous pathologist, you the run the risk of really ticking off the clinicians who have been know the run off a pathologist like one of those unwelcomed house guest even though they don't direct employ him/her.:smuggrin:

It was an exercise in the absurd... of course pathologists don't do that...

Dermatologists don't over call positive margins for more procedures.. patients might get annoyed at all the surgeries...plus they can make more money by seeing more patients and doing punches on them...

My point is blocking the pod labs is good we don't need to try to remove dermatopathologist from reading their slides..
 
It was an exercise in the absurd... of course pathologists don't do that...

My point is blocking the pod labs is good we don't need to try to remove dermatopathologist from reading their slides..

Of course you were just making banter. However, I am not arguing that dermatopathologists need to be removed from reading slides, but it does seem like a dermatologist reading their own slides or adding a pathologist to their group are their personal dermatopathologist is in direct violation to Stark Law. From what I understand, by definition it is in violation of the law, but provisions are made that exclusively protect dermatology. If this is true, why should dermatology be given such a lucrative exception?:smuggrin:
 
Of course you were just making banter. However, I am not arguing that dermatopathologists need to be removed from reading slides, but it does seem like a dermatologist reading their own slides or adding a pathologist to their group are their personal dermatopathologist is in direct violation to Stark Law. From what I understand, by definition it is in violation of the law, but provisions are made that exclusively protect dermatology. If this is true, why should dermatology be given such a lucrative exception?:smuggrin:


If they are qualified to read their own slides, then they should be able to do so. It would be like prohibiting a GI/GU doc from doing his own biopsies...

(or to be more clear about it
That would be like saying Pathologist who order IHC can't bill for interpreting them.
Don't be overly reductionistic with the concept of self referral.. the Stark Law is a reasonable one, it allows for appropriate testing/studies)

If there is a partnership of pathologist-dermpath and derm-dermpath, and there is an equal division of profit (or based on some sharing of profit made) then that is fair too...

If there are any Derm and pathology groups were the pathologist are just paid employees, and the dermatologist are not dermpath... That would likely fall under Stark.. but like I said only if the Derms aren't dermpath... and the pathologist were partners..
 
(or to be more clear about it
That would be like saying Pathologist who order IHC can't bill for interpreting them.
Don't be pedantic with the concept of self refferal.. the Stark Law is a reasonable one, it allows for appropriate testing/studies)
..

Not quite the same thing. IHC is part of making the biopsy diagnosis. It is not a consult.

It would be like if you were a general pediatrician and you took every kid that came in with abdominal pain and said "you need an upper and lower endoscopy" and then left the room and then walked back in and said "hi I'm your pediatric gastroenterologist" and I'm going to scope you, and then charged their insurance or the patient directly for one visit to the pediatrician and one visit to the gastroenterologist.

Abusive ordering of IHC (when you own the lab and get paid for interpreting it) goes on, and we will all end up paying the price for it when medicare gets around to it, but it is not analogous.
 
Not quite the same thing. IHC is part of making the biopsy diagnosis. It is not a consult.

It would be like if you were a general pediatrician and you took every kid that came in with abdominal pain and said "you need an upper and lower endoscopy" and then left the room and then walked back in and said "hi I'm your pediatric gastroenterologist" and I'm going to scope you, and then charged their insurance or the patient directly for one visit to the pediatrician and one visit to the gastroenterologist.

Abusive ordering of IHC (when you own the lab and get paid for interpreting it) goes on, and we will all end up paying the price for it when medicare gets around to it, but it is not analogous.

The point of the Stark law is to prevent someone from making money on a test/procedure that they order, which they themselves can not do...

Dermatologist who are dermpath train can read their own slides.
GI/GU doctors can do their own biopsies.
And a pediatrician who was licensed and trained as a pediatric GI can do his own scoping...

The charging for two separate visit/consults/procedures is handled under billing/coding laws / regulations..


We just finished ripping into GI/GU docs for the fact that they tried to take money away from an established groups/practices, so now we want to turn around and take money from Derm? They almost got involved in this, but it was made clear that they are not in violation of Stark and are not targeted by this fight..
 
The point of the Stark law is to prevent someone from making money on a test/procedure that they order, which they themselves can not do...

Dermatologist who are dermpath train can read their own slides.
GI/GU doctors can do their own biopsies.
And a pediatrician who was licensed and trained as a pediatric GI can do his own scoping...

The charging for two separate visit/consults/procedures is handled under billing/coding laws / regulations..


We just finished ripping into GI/GU docs for the fact that they tried to take money away from an established groups/practices, so now we want to turn around and take money from Derm? They almost got involved in this, but it was made clear that they are not in violation of Stark and are not targeted by this fight..


Yeah, from reading the stark laws this seems to be the idea. In general they don't eliminate you from doing procedures that you are trained/qualified to do. If a derm guy is trained to read slides of course that is feasible/reasonable.

Stark laws are meant to get the business out of medical decisions such as in referrals. Say I'm Family doc that has part ownership of an MRI/CT center. I can't refer my patients to that Imaging center and expect compensation.

There are alot of gray areas with these laws and it seems that things become more clear only after some form of arbitration.
 
I think it's pretty hard to argue that dermpaths, rad oncs, and radiologists are in danger of "exploitation". Those are three of the most competitive and well-compensated specialties in medicine. They're not getting raw deals from anyone.

The Stark law is great, and I think the anti-pod lab decision is good for pathologists and the healthcare system in general, but the basic underlying problem is the fact that there are fully trained pathologists who are willing to give up 90% of their expertise to work as part-time underlings for urology groups. Until the pathology community finds ways to curb the oversupply of pathologists with low ambitions, this problem is not going away.
 
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