Deucedano

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My lab recently got a phase II deficiency due to lack of adequate performance evaluations for pathologists. The cytotechnologists do not screen the non-gyn specimens. Looking at the CAP guidance, it seems to apply to performance evaluations of cytotechnologists. The inspector said since the pathologists are primary screeners, it applies. Anyone have any experience with this or in a similar situation? We want to contest the citation because we dont feel it applies.

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WEBB PINKERTON

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It does apply if you are a primary screener of nongyns and you have to tediously document the number of slides you screen and hours screening etc. Lord knows you can't be screening more than 12.5 nongyn slides per hour. I highly doubt anyone is honest when they have 50 slides of blood that they blow through in like 15 minutes.

Don't feel bad. I think everyone gets cyto deficiencies at some point. There are so many stupid regulations.
 
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Alteran

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My lab recently got a phase II deficiency due to lack of adequate performance evaluations for pathologists. The cytotechnologists do not screen the non-gyn specimens. Looking at the CAP guidance, it seems to apply to performance evaluations of cytotechnologists. The inspector said since the pathologists are primary screeners, it applies. Anyone have any experience with this or in a similar situation? We want to contest the citation because we dont feel it applies.

View attachment 316375

I don’t do the bulk of the cytology in my group, but I know that it applies. There are AP LIS systems out there that have a cytology module built in to automatically track that, should you happen to own such a system.
 

WEBB PINKERTON

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You will need to figure out a way to evaluate your performance every 6 months (nongyn/tissue correlations or something). The regulation was meant for Paps but of course they made it apply to nongyn work. Very lame. It shouldn't have been meant for anything but Paps. It slows down case signouts having slide limits.
 

LADoc00

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Sigh....Both CLIA and state laws in the US were NEVER intended or written to apply to physicians but the CMS cytology section has told JC and CAP that they do.

I got a verbal from my state attorney general's office in a few years ago that indeed this was the case. I then got a legal opinion from a private firm to back this up and JC took it to CMS and CMS refused to relent.

I then got both my senator and US congressmen involved. BOTH. This is now months. I refused to sign off on the deficiency because it was not based in the law and therefore fraudulent.

I contacted the US AG office. I even hired a lobbyist and dropped a grand before I threw in the towel.

The reason: CMS has already fined pathology groups and hospitals nearly 8 figures for their new enforcement of the cytology CLIA law. As such they cannot back down now or else they would have to pay these fines back.

I am considering full legal action with the idea I have suffered irreparable harm to my practice as a result of the both the daily cap and time spent logging the total minutes I spend reviewing each slide. I could easily put that damages amount at 2-3 million with very good justification.
Heck maybe I roll the bones and do it.

CAP IS fighting this, google it and they have lost. This needs to go to a full federal court case.

Here was an example of what I was telling JC/CMS:


Thank for the opportunity to review this matter regarding Standard QSA.08.04.01: Cytology workload limits. As this issue came up with the prior JC inspection here and this was extensively discussed. I had assumed this was settled for us and we altered our processes at that time because we were told JC had sought and received legal counsel agreeing with our assessment of the Clinical Laboratory Improvement Amendment. I was shown internal JC communication logs to this effect and this was not included in our final written findings report as a result.

Currently, I practice in a relatively small rural medical facility that serves as a community's local trauma center. I am solo pathologist now and have staff of 2 histotechnologists. In 2009, my practice gave up review of gynecologic slides due to the cost of hiring a cytotechnologist in this relatively high cost of living location. We continued to offer diagnoses of non-gynecologic cytology as a service to our physicians and their patients because we felt this was an important part of serving our community. Of this type of specimen, our annual volume is roughly 350 cases a year.

In review of the CLIA 88 law, § 263a : part f, number 4 subparagraph (B) The standards established under subparagraph (A) shall include—(i) the maximum number of cytology slides that any individual may screen in a 24-hour period,(ii) requirements that a clinical laboratory maintain a record of (I) the number of cytology slides screened during each 24-hour period by each individual who examines cytology slides for the laboratory, and(II) the number of hours devoted during each 24-hour period to screening cytology slides by such individual.

Also pursuant to this clarification is California law which was an amendment to the Section 1271 of the Business and Professions Code, relating to cytotechnologists passed as part of Senate Bill 1355 and signed into law in 2004 by the Governor of California which states: 1271. (a) A cytotechnologist shall not examine more than 80 gynecologic slides in a 24-hour period when performing a manual review of slides.

(b) The maximum workload limit in subdivision (a) is the maximum number of gynecologic slides that a cytotechnologist shall examine in a 24-hour period without regard to the number of clinical laboratories or other persons for which the work is performed. Cytotechnologists, who examine both gynecologic and nongynecologic slides, shall do so on a pro rata basis so that the maximum workload limit in subdivision (a) is not exceeded, and so that the number of gynecologic slides examined is reduced proportionally if both gynecologic and nongynecologic slides are examined in a 24-hour period.

(c) The maximum workload limit in subdivision (a) is for a cytotechnologist who has no duties other than the evaluation of gynecological slides. Cytotechnologists who have other duties, including, but not limited to, the preparation and staining of cytologic slides, shall decrease on a pro rata basis the number of slides examined.


The state of New York has similar law to California in 10 CRR-NY 58-1.12 as additional legal reference.

In seeking legal review of this, I would add the following important and relevant details:

1.) My practice does not review any gynecologic slides at all.

2.) My practice does not employ a “screener” to review slides prior to rendering of a formal written diagnosis by a board certified pathologist, myself. Therefore , § 263a : part f, number 4 subparagraph (B) does NOT apply.

3.) “Screening” in cytology has a specific general in use definition in the field of pathology meaning initial review by an individual who identifies areas of interest (AOIs) within a cytologic preparation. “Screened” slides are then reviewed by a properly boarded and licensed physician to render the diagnosis. The processing of “screening” is not mandatory for billing of cytology related CPT codes in CMS guidance and is only present in some practices as merely a tool to enhance throughput volumes and efficiency.

4.) California’s law directly specifies the job classification whose workload is to be monitored: cytotechnologists, which I am not, making this clearly non-applicable to my practice.

In no way did the Clinical Laboratory Improvement Amendment intend to restrict properly licensed physicians from providing needed medical care to patients by capping their daily volume in rendering diagnoses.

I would urge your leadership staff and legal counsel to stop and think about the ramifications of restricting the number of patients a physician can care for in any setting.

I have since sought extensive legal opinion from private attorneys, the California state district attorney’s office specifically in regards to 2004 amendment to the Business and Professions Code here in my state as well as a judge within the California judiciary. I am fully confident in my interpretation of both the applicable laws and the standards of the Joint Commission but feel full and final clarification is needed to address this matter.
 
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doctor313

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Sep 24, 2016
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Sigh....Both CLIA and state laws in the US were NEVER intended or written to apply to physicians but the CMS cytology section has told JC and CAP that they do.

I got a verbal from my state attorney general's office in a few years ago that indeed this was the case. I then got a legal opinion from a private firm to back this up and JC took it to CMS and CMS refused to relent.

I then got both my senator and US congressmen involved. BOTH. This is now months. I refused to sign off on the deficiency because it was not based in the law and therefore fraudulent.

I contacted the US AG office. I even hired a lobbyist and dropped a grand before I threw in the towel.

The reason: CMS has already fined pathology groups and hospitals nearly 8 figures for their new enforcement of the cytology CLIA law. As such they cannot back down now or else they would have to pay these fines back.

I am considering full legal action with the idea I have suffered irreparable harm to my practice as a result of the both the daily cap and time spent logging the total minutes I spend reviewing each slide. I could easily put that damages amount at 2-3 million with very good justification.
Heck maybe I roll the bones and do it.

CAP IS fighting this, google it and they have lost. This needs to go to a full federal court case.

Here was an example of what I was telling JC/CMS:


Thank for the opportunity to review this matter regarding Standard QSA.08.04.01: Cytology workload limits. As this issue came up with the prior JC inspection here and this was extensively discussed. I had assumed this was settled for us and we altered our processes at that time because we were told JC had sought and received legal counsel agreeing with our assessment of the Clinical Laboratory Improvement Amendment. I was shown internal JC communication logs to this effect and this was not included in our final written findings report as a result.

Currently, I practice in a relatively small rural medical facility that serves as a community's local trauma center. I am solo pathologist now and have staff of 2 histotechnologists. In 2009, my practice gave up review of gynecologic slides due to the cost of hiring a cytotechnologist in this relatively high cost of living location. We continued to offer diagnoses of non-gynecologic cytology as a service to our physicians and their patients because we felt this was an important part of serving our community. Of this type of specimen, our annual volume is roughly 350 cases a year.

In review of the CLIA 88 law, § 263a : part f, number 4 subparagraph (B) The standards established under subparagraph (A) shall include—(i) the maximum number of cytology slides that any individual may screen in a 24-hour period,(ii) requirements that a clinical laboratory maintain a record of (I) the number of cytology slides screened during each 24-hour period by each individual who examines cytology slides for the laboratory, and(II) the number of hours devoted during each 24-hour period to screening cytology slides by such individual.

Also pursuant to this clarification is California law which was an amendment to the Section 1271 of the Business and Professions Code, relating to cytotechnologists passed as part of Senate Bill 1355 and signed into law in 2004 by the Governor of California which states: 1271. (a) A cytotechnologist shall not examine more than 80 gynecologic slides in a 24-hour period when performing a manual review of slides.

(b) The maximum workload limit in subdivision (a) is the maximum number of gynecologic slides that a cytotechnologist shall examine in a 24-hour period without regard to the number of clinical laboratories or other persons for which the work is performed. Cytotechnologists, who examine both gynecologic and nongynecologic slides, shall do so on a pro rata basis so that the maximum workload limit in subdivision (a) is not exceeded, and so that the number of gynecologic slides examined is reduced proportionally if both gynecologic and nongynecologic slides are examined in a 24-hour period.

(c) The maximum workload limit in subdivision (a) is for a cytotechnologist who has no duties other than the evaluation of gynecological slides. Cytotechnologists who have other duties, including, but not limited to, the preparation and staining of cytologic slides, shall decrease on a pro rata basis the number of slides examined.


The state of New York has similar law to California in 10 CRR-NY 58-1.12 as additional legal reference.

In seeking legal review of this, I would add the following important and relevant details:

1.) My practice does not review any gynecologic slides at all.

2.) My practice does not employ a “screener” to review slides prior to rendering of a formal written diagnosis by a board certified pathologist, myself. Therefore , § 263a : part f, number 4 subparagraph (B) does NOT apply.

3.) “Screening” in cytology has a specific general in use definition in the field of pathology meaning initial review by an individual who identifies areas of interest (AOIs) within a cytologic preparation. “Screened” slides are then reviewed by a properly boarded and licensed physician to render the diagnosis. The processing of “screening” is not mandatory for billing of cytology related CPT codes in CMS guidance and is only present in some practices as merely a tool to enhance throughput volumes and efficiency.

4.) California’s law directly specifies the job classification whose workload is to be monitored: cytotechnologists, which I am not, making this clearly non-applicable to my practice.

In no way did the Clinical Laboratory Improvement Amendment intend to restrict properly licensed physicians from providing needed medical care to patients by capping their daily volume in rendering diagnoses.

I would urge your leadership staff and legal counsel to stop and think about the ramifications of restricting the number of patients a physician can care for in any setting.

I have since sought extensive legal opinion from private attorneys, the California state district attorney’s office specifically in regards to 2004 amendment to the Business and Professions Code here in my state as well as a judge within the California judiciary. I am fully confident in my interpretation of both the applicable laws and the standards of the Joint Commission but feel full and final clarification is needed to address this matter.

Impressive.
 

Thr0mbus

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If you fight the Inspectors they will always win no matter how wrong they are. Then they will make your life HELL.

THERE IS NO ACCOUNTABILITY FOR THESE BASTARD INSPECTORS AND THEY SHOULD BE PROSECUTED FOR THEIR UNCONSTITUTIONAL CRIMES.
 
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Doormat

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Usually registered nurses (RNs) inspect laboratories during joint commission lab surveys.
 
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LADoc00

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Usually registered nurses (RNs) inspect laboratories during joint commission lab surveys.

No. You are probably thinking of the hospital or facility JC inspection. The lab inspection, which is usually totally separate from the facility inspection, is done by clin lab scientists.
 

Pathological_Liar

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Sigh....Both CLIA and state laws in the US were NEVER intended or written to apply to physicians but the CMS cytology section has told JC and CAP that they do.

I got a verbal from my state attorney general's office in a few years ago that indeed this was the case. I then got a legal opinion from a private firm to back this up and JC took it to CMS and CMS refused to relent.

I then got both my senator and US congressmen involved. BOTH. This is now months. I refused to sign off on the deficiency because it was not based in the law and therefore fraudulent.

I contacted the US AG office. I even hired a lobbyist and dropped a grand before I threw in the towel.

The reason: CMS has already fined pathology groups and hospitals nearly 8 figures for their new enforcement of the cytology CLIA law. As such they cannot back down now or else they would have to pay these fines back.

I am considering full legal action with the idea I have suffered irreparable harm to my practice as a result of the both the daily cap and time spent logging the total minutes I spend reviewing each slide. I could easily put that damages amount at 2-3 million with very good justification.
Heck maybe I roll the bones and do it.

CAP IS fighting this, google it and they have lost. This needs to go to a full federal court case.

Here was an example of what I was telling JC/CMS:


Thank for the opportunity to review this matter regarding Standard QSA.08.04.01: Cytology workload limits. As this issue came up with the prior JC inspection here and this was extensively discussed. I had assumed this was settled for us and we altered our processes at that time because we were told JC had sought and received legal counsel agreeing with our assessment of the Clinical Laboratory Improvement Amendment. I was shown internal JC communication logs to this effect and this was not included in our final written findings report as a result.

Currently, I practice in a relatively small rural medical facility that serves as a community's local trauma center. I am solo pathologist now and have staff of 2 histotechnologists. In 2009, my practice gave up review of gynecologic slides due to the cost of hiring a cytotechnologist in this relatively high cost of living location. We continued to offer diagnoses of non-gynecologic cytology as a service to our physicians and their patients because we felt this was an important part of serving our community. Of this type of specimen, our annual volume is roughly 350 cases a year.

In review of the CLIA 88 law, § 263a : part f, number 4 subparagraph (B) The standards established under subparagraph (A) shall include—(i) the maximum number of cytology slides that any individual may screen in a 24-hour period,(ii) requirements that a clinical laboratory maintain a record of (I) the number of cytology slides screened during each 24-hour period by each individual who examines cytology slides for the laboratory, and(II) the number of hours devoted during each 24-hour period to screening cytology slides by such individual.

Also pursuant to this clarification is California law which was an amendment to the Section 1271 of the Business and Professions Code, relating to cytotechnologists passed as part of Senate Bill 1355 and signed into law in 2004 by the Governor of California which states: 1271. (a) A cytotechnologist shall not examine more than 80 gynecologic slides in a 24-hour period when performing a manual review of slides.

(b) The maximum workload limit in subdivision (a) is the maximum number of gynecologic slides that a cytotechnologist shall examine in a 24-hour period without regard to the number of clinical laboratories or other persons for which the work is performed. Cytotechnologists, who examine both gynecologic and nongynecologic slides, shall do so on a pro rata basis so that the maximum workload limit in subdivision (a) is not exceeded, and so that the number of gynecologic slides examined is reduced proportionally if both gynecologic and nongynecologic slides are examined in a 24-hour period.

(c) The maximum workload limit in subdivision (a) is for a cytotechnologist who has no duties other than the evaluation of gynecological slides. Cytotechnologists who have other duties, including, but not limited to, the preparation and staining of cytologic slides, shall decrease on a pro rata basis the number of slides examined.


The state of New York has similar law to California in 10 CRR-NY 58-1.12 as additional legal reference.

In seeking legal review of this, I would add the following important and relevant details:

1.) My practice does not review any gynecologic slides at all.

2.) My practice does not employ a “screener” to review slides prior to rendering of a formal written diagnosis by a board certified pathologist, myself. Therefore , § 263a : part f, number 4 subparagraph (B) does NOT apply.

3.) “Screening” in cytology has a specific general in use definition in the field of pathology meaning initial review by an individual who identifies areas of interest (AOIs) within a cytologic preparation. “Screened” slides are then reviewed by a properly boarded and licensed physician to render the diagnosis. The processing of “screening” is not mandatory for billing of cytology related CPT codes in CMS guidance and is only present in some practices as merely a tool to enhance throughput volumes and efficiency.

4.) California’s law directly specifies the job classification whose workload is to be monitored: cytotechnologists, which I am not, making this clearly non-applicable to my practice.

In no way did the Clinical Laboratory Improvement Amendment intend to restrict properly licensed physicians from providing needed medical care to patients by capping their daily volume in rendering diagnoses.

I would urge your leadership staff and legal counsel to stop and think about the ramifications of restricting the number of patients a physician can care for in any setting.

I have since sought extensive legal opinion from private attorneys, the California state district attorney’s office specifically in regards to 2004 amendment to the Business and Professions Code here in my state as well as a judge within the California judiciary. I am fully confident in my interpretation of both the applicable laws and the standards of the Joint Commission but feel full and final clarification is needed to address this matter.

I love LADoc's angry post-morning coffee (and possibly cocaine) posts.
 
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As all will remember these regulations arose out of bad actors (pap mills) in the 80s. I even knew of one lab where to save money they reused pap slides. No lie. So regulation was needed but the regulations resulting went way overboard. Much of the blame in my opinion goes to CAP for not making stronger efforts to push practical regulation. The regulations should have never been applied to non-gyn as this was not the area of abuse. Why they did is beyond me. Maybe some others on here can remember the process, but when it happened in the 90s I felt we got steamrolled.
As one who often had to look at 20 to 40 slides of thyroid blood just reading these posts makes my blood boil.
 
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WEBB PINKERTON

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As all will remember these regulations arose out of bad actors (pap mills) in the 80s. I even knew of one lab where to save money they reused pap slides. No lie. So regulation was needed but the regulations resulting went way overboard. Much of the blame in my opinion goes to CAP for not making stronger efforts to push practical regulation. The regulations should have never been applied to non-gyn as this was not the area of abuse. Why they did is beyond me. Maybe some others on here can remember the process, but when it happened in the 90s I felt we got steamrolled.
As one who often had to look at 20 to 40 slides of thyroid blood just reading these posts makes my blood boil.

Try looking at 60 bloody bronch slides per case. LOL[/QUOTE]
 
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Try looking at 60 bloody bronch slides per case. LOL
[/QUOTE]
And I thought I had it bad. Luckily our cytotechs went on all bronchs and "trained the pulmonologists that blood is a bad sample" and would usually have no more than 4 slides per site. The thyroids with the bloody slides came from an outside group (no cytotech) and I guess that they would make slides till the syringe ran out of blood. I did get about 60 once but only once. I empathize. When I retired I told my group how glad I was that I will never have to read a thyroid FNA again. Alas your bane is pulmonary with a much higher risk of missing something and a possible lawsuit resulting.
 

Deucedano

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Aug 16, 2006
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Sigh....Both CLIA and state laws in the US were NEVER intended or written to apply to physicians but the CMS cytology section has told JC and CAP that they do.

I got a verbal from my state attorney general's office in a few years ago that indeed this was the case. I then got a legal opinion from a private firm to back this up and JC took it to CMS and CMS refused to relent.

I then got both my senator and US congressmen involved. BOTH. This is now months. I refused to sign off on the deficiency because it was not based in the law and therefore fraudulent.

I contacted the US AG office. I even hired a lobbyist and dropped a grand before I threw in the towel.

The reason: CMS has already fined pathology groups and hospitals nearly 8 figures for their new enforcement of the cytology CLIA law. As such they cannot back down now or else they would have to pay these fines back.

I am considering full legal action with the idea I have suffered irreparable harm to my practice as a result of the both the daily cap and time spent logging the total minutes I spend reviewing each slide. I could easily put that damages amount at 2-3 million with very good justification.
Heck maybe I roll the bones and do it.

CAP IS fighting this, google it and they have lost. This needs to go to a full federal court case.

Here was an example of what I was telling JC/CMS:


Thank for the opportunity to review this matter regarding Standard QSA.08.04.01: Cytology workload limits. As this issue came up with the prior JC inspection here and this was extensively discussed. I had assumed this was settled for us and we altered our processes at that time because we were told JC had sought and received legal counsel agreeing with our assessment of the Clinical Laboratory Improvement Amendment. I was shown internal JC communication logs to this effect and this was not included in our final written findings report as a result.

Currently, I practice in a relatively small rural medical facility that serves as a community's local trauma center. I am solo pathologist now and have staff of 2 histotechnologists. In 2009, my practice gave up review of gynecologic slides due to the cost of hiring a cytotechnologist in this relatively high cost of living location. We continued to offer diagnoses of non-gynecologic cytology as a service to our physicians and their patients because we felt this was an important part of serving our community. Of this type of specimen, our annual volume is roughly 350 cases a year.

In review of the CLIA 88 law, § 263a : part f, number 4 subparagraph (B) The standards established under subparagraph (A) shall include—(i) the maximum number of cytology slides that any individual may screen in a 24-hour period,(ii) requirements that a clinical laboratory maintain a record of (I) the number of cytology slides screened during each 24-hour period by each individual who examines cytology slides for the laboratory, and(II) the number of hours devoted during each 24-hour period to screening cytology slides by such individual.

Also pursuant to this clarification is California law which was an amendment to the Section 1271 of the Business and Professions Code, relating to cytotechnologists passed as part of Senate Bill 1355 and signed into law in 2004 by the Governor of California which states: 1271. (a) A cytotechnologist shall not examine more than 80 gynecologic slides in a 24-hour period when performing a manual review of slides.

(b) The maximum workload limit in subdivision (a) is the maximum number of gynecologic slides that a cytotechnologist shall examine in a 24-hour period without regard to the number of clinical laboratories or other persons for which the work is performed. Cytotechnologists, who examine both gynecologic and nongynecologic slides, shall do so on a pro rata basis so that the maximum workload limit in subdivision (a) is not exceeded, and so that the number of gynecologic slides examined is reduced proportionally if both gynecologic and nongynecologic slides are examined in a 24-hour period.

(c) The maximum workload limit in subdivision (a) is for a cytotechnologist who has no duties other than the evaluation of gynecological slides. Cytotechnologists who have other duties, including, but not limited to, the preparation and staining of cytologic slides, shall decrease on a pro rata basis the number of slides examined.


The state of New York has similar law to California in 10 CRR-NY 58-1.12 as additional legal reference.

In seeking legal review of this, I would add the following important and relevant details:

1.) My practice does not review any gynecologic slides at all.

2.) My practice does not employ a “screener” to review slides prior to rendering of a formal written diagnosis by a board certified pathologist, myself. Therefore , § 263a : part f, number 4 subparagraph (B) does NOT apply.

3.) “Screening” in cytology has a specific general in use definition in the field of pathology meaning initial review by an individual who identifies areas of interest (AOIs) within a cytologic preparation. “Screened” slides are then reviewed by a properly boarded and licensed physician to render the diagnosis. The processing of “screening” is not mandatory for billing of cytology related CPT codes in CMS guidance and is only present in some practices as merely a tool to enhance throughput volumes and efficiency.

4.) California’s law directly specifies the job classification whose workload is to be monitored: cytotechnologists, which I am not, making this clearly non-applicable to my practice.

In no way did the Clinical Laboratory Improvement Amendment intend to restrict properly licensed physicians from providing needed medical care to patients by capping their daily volume in rendering diagnoses.

I would urge your leadership staff and legal counsel to stop and think about the ramifications of restricting the number of patients a physician can care for in any setting.

I have since sought extensive legal opinion from private attorneys, the California state district attorney’s office specifically in regards to 2004 amendment to the Business and Professions Code here in my state as well as a judge within the California judiciary. I am fully confident in my interpretation of both the applicable laws and the standards of the Joint Commission but feel full and final clarification is needed to address this matter.

I figured someone tried to fight this fight already and am not suprised at all that it was you LADoc00. I dont know if its worth my time and energy to fight as you did and it sounds like its a loosing battle at this point. We will come up with some bullsh*t method for assessing performance or just make it up. The more in interact with CAP the more I want to make it my mission in life to take them down. They suck in every possible way. At least I dont pay any dues to them anymore.
 

LADoc00

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I figured someone tried to fight this fight already and am not suprised at all that it was you LADoc00. I dont know if its worth my time and energy to fight as you did and it sounds like its a loosing battle at this point. We will come up with some bullsh*t method for assessing performance or just make it up. The more in interact with CAP the more I want to make it my mission in life to take them down. They suck in every possible way. At least I dont pay any dues to them anymore.

Honestly I think this is a legal slam dunk if someone wanted to drop the time and money. For me, my ADD prevents me from focusing on one thing too long on anything unless Im heavily medicated :laugh: so I went all in for like 12 weeks before I got bored and moved to other stuff.
 

mikesheree

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Try looking at 60 bloody bronch slides per case. LOL
[/QUOTE]

I think i would shoot whoever presented me with/prepared 60 uninterpretable blood obscured slides. A little education needs to go on. A syringe full of that much s***would have gone straight into cytolyte if it was me. I only make smears(and instructed others) to make smears of “meat”, not blood.
 

WEBB PINKERTON

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I think i would shoot whoever presented me with/prepared 60 uninterpretable blood obscured slides. A little education needs to go on. A syringe full of that much s***would have gone straight into cytolyte if it was me. I only make smears(and instructed others) to make smears of “meat”, not blood.
[/QUOTE]

I can't tell meat from blood till they squirt it out. Our bronchs are a time consuming mess with lot of radiation and chemical exposure. There are attempts at FNA that yield mostly blood. A triple brush is also used that yields some malignancy BUT not enough to do all the follow-up testing. Eventually you can talk them into using forceps that finally get the diagnostic material and plenty for other studies. I don't understand why FNA is even attempted if they are confident they can hit the lesion with forceps. It has been my experience, with an annual volume of 500 bronchs for nearly 30 years, that forceps are far superior. Hell, I've been able to get them forcep the stations when they go to EBUS and those are superior to FNA as well.

You really need to use formalin for the material. I know it is the wild west and people are using different fixatives that aren't validated for all the follow-up testing we do. Feel bad for patients. I noticed CAP talks a bit about it in the new issue this month. It has went on too long.
 

LADoc00

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I told the radiology department we wont be accepting FNAs on any malignant or potentially malignant case due to the inability to perform IHC and the necessary NGS now required by NCCN guidelines....

Government wants cytology killed, congratulations its dead. Now just move all gyn to HPV testing and call it day.
 

Med Director New England

2+ Year Member
Aug 20, 2018
364
348
I think i would shoot whoever presented me with/prepared 60 uninterpretable blood obscured slides. A little education needs to go on. A syringe full of that much s***would have gone straight into cytolyte if it was me. I only make smears(and instructed others) to make smears of “meat”, not blood.

I can't tell meat from blood till they squirt it out. Our bronchs are a time consuming mess with lot of radiation and chemical exposure. There are attempts at FNA that yield mostly blood. A triple brush is also used that yields some malignancy BUT not enough to do all the follow-up testing. Eventually you can talk them into using forceps that finally get the diagnostic material and plenty for other studies. I don't understand why FNA is even attempted if they are confident they can hit the lesion with forceps. It has been my experience, with an annual volume of 500 bronchs for nearly 30 years, that forceps are far superior. Hell, I've been able to get them forcep the stations when they go to EBUS and those are superior to FNA as well.

You really need to use formalin for the material. I know it is the wild west and people are using different fixatives that aren't validated for all the follow-up testing we do. Feel bad for patients. I noticed CAP talks a bit about it in the new issue this month. It has went on too long.
[/QUOTE]
There is nothing saying you have to keep every direct smear stained onsite with DQ and reviewed during a ROSE / FNA. If your operator squirts blood only onto 5 slides from one pass and you review them and see only blood - you could just choose to keep only one and throw the other 4 away onsite.

Esp so if you get diagnostic material on say pass 4 or 5 after several passses of blood only.
 

Vicinal

2+ Year Member
Mar 5, 2018
129
93
Regulatory issues aside; The best way to prevent crappy non gyn FNAs is to have a great relationship with the procuring physicians and to help train them. It’s better for patient care and all involved. This can work wonderfully in a team setting.
 
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