per slide payment

[pathology2020]

Hello all,
Im a fellow and applying for positions. I am negotiating with a GI lab in nebraska who pays pathologist per slide (not per speciment, per slide). They do GI mostly. Their rate is $12. What do you guys think. Also would you accept this rate for reading gyn paps? Please no judging and whining about the state of pathology!

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[Thrombus]

Who are you, their nurse? Tell them you will bill for your work and they can bill for theirs. Anything else and they violate the Stark law. Screw that!!

 

[AZpath]

Who are you, their nurse? Tell them you will bill for your work and they can bill for theirs. Anything else and they violate the Stark law. Screw that!!

Quite legal if they have an in office lab.

Also, could be reasonable pay if you are reading two or three levels each placed on a separate slide.
That would generate 24-36 dollars per 88305. 36 dollars is close to CMS in most states.
Not the best deal , however it is easy to do high volumes in a GI only practices.

My guess is that most other local pathologists have bailed on any such deal. Otherwise they can put you in touch with someone works for them.

 

[WEBB PINKERTON]

I hope this is a fake post

 

[icpshootyz]

If they're only doing one slide per bottle (which is highly likely in a GI pod lab), then no, $12/slide is in no way a good deal. Maybe if they do 2-3 slides per specimen it would be tolerable, but still not great. Medicare, the lowest payer out there, pays around $36/88305 for the professional component. Chances are this GI "lab" is already getting the TC payment, and now wants to keep at least 2/3 of the PC as well? There's a reason you, a graduating fellow, are being offered the job - no other established pathologist wants it. My advice is to keep looking and hopefully leave these guys in a lurch. As long as we are willing to accept these scraps, they'll keep feeding them to us.

 

[schrute]

Hello all,
Im a fellow and applying for positions. I am negotiating with a GI lab in nebraska who pays pathologist per slide (not per speciment, per slide). They do GI mostly. Their rate is $12. What do you guys think. Also would you accept this rate for reading gyn paps? Please no judging and whining about the state of pathology!

Are you an IM GI fellow trying to gauge how to best rape your pathology colleagues, or a path GI fellow trying to gauge how to best care for the raping by your gastro colleagues?

 

[schrute]

Hello all,
Im a fellow and applying for positions. I am negotiating with a GI lab in nebraska who pays pathologist per slide (not per speciment, per slide). They do GI mostly. Their rate is $12. What do you guys think. Also would you accept this rate for reading gyn paps? Please no judging and whining about the state of pathology!

btw requesting ye not be judged for acknowledging you are OK getting paid 1/3 of the going rate while your professional colleagues pocket the difference (and hence contributing to the problem in the first place) is not a good way to garner sympathy or professional advice.
--no offense-- I know you're just looking at your options, but this is not a healthy one.

I understand employed positions take advantage of pathologists (and other specialties) the same way, but at least you have some bargaining power when negotiation overall compensation in that sense...a "per slide" pricing, while the GU/GI/Derm docs pocket the difference, is not a celebration of capitalism, it's lining their pockets at the expense of their professional colleagues.

What if the situation were reversed, and we owned the endoscopy suite and paid GI docs 1/3 the medicare rate for a colonoscopy while pocketing the difference because of some loophole in the laws...

 

[WEBB PINKERTON]

Was the job offer from these people? I like how they list the pathologist below the midlevel providers.
http://www.midwestgi.com/about-us

Ever notice how in-office labs are at the top of the wall street journal's medicare billing website? Guess what you see when you put in Nebraska?
http://projects.wsj.com/medicare-billing-2012/#/name=&special=Pathology&city=&state=NE

 

[LADoc00]

I would consider the following:

1.) Negotiating a % of Medicare Allowable of the -26 fee i.e. 88305-26.

2.) Explain to them payment "per slide" is not the community standard anywhere in the U.S. for pathologist reimbursement, say this nicely but firmly.

3.) Explain that their per slide model potentially puts them at risk of CMS fraud. This is a totally unnecessary risk for their practice.

4.) Explain they also need a BC-Pathologist to act a medical director of their high complexity lab and you have to do this for a flat fee per month per CMS guidelines unrelated to volume. I would go for 3-4K/mo depending on volume.

your welcome.

 

[pathology2020]

so I know that alot of pathologist hate this kinda deal, but this group already contracts with a private path lab at this rate and then im sure those path labs pay their employees only a portion of the 12/slide.

 

[pathology2020]

.

 

[pathology2020]

thank you ladoc for your advice. I dont understand alot of the business side of things and im trying to educate myself on it as fast as i can. do u own a private lab. can i give u a call lol

 

[icpshootyz]

thank you ladoc for your advice. I dont understand alot of the business side of things and im trying to educate myself on it as fast as i can. do u own a private lab. can i give u a call lol

This is my point - they're interested in you because you know nothing about the business yet or negotiating. Chances are they were paying the private path lab MORE than $12/slide, but they're testing the waters to see if they can just hire someone outright at a lower cost (i.e. you). FWIW my group does minimal business with pod labs, but for what we do we get $30/specimen for the PC. I've never heard of being paid per slide.

 

[pathology2020]

This is my point - they're interested in you because you know nothing about the business yet or negotiating. Chances are they were paying the private path lab MORE than $12/slide, but they're testing the waters to see if they can just hire someone outright at a lower cost (i.e. you). FWIW my group does minimal business with pod labs, but for what we do we get $30/specimen for the PC. I've never heard of being paid per slide.

I am sure there is some sort of advantage to hiring a new pathologist and probably im getting less than market value. But I have zero other options in this state, which is where I want to stray. Thank you though for sharing your rate. Dont you think a partnership tract will offset that in the future?

 

[gbwillner]

What kind of benefits are they offering? Are they telling you it is a partnership track? I find that hard to believe.
Is it really $12/slide? So that means for every level you get $12? Plus every IHC stain? If this is NOT the case, then you are getting $12/case, and they are taking home ~85% of the revenue. In order to make even a low level academic salary ($150K) you would have to see 12,500 cases per year. That's 52 cases per day assuming 4 weeks vacation and M-F. Yikes.

 

[pathology2020]

1

What kind of benefits are they offering? Are they telling you it is a partnership track? I find that hard to believe.
Is it really $12/slide? So that means for every level you get $12? Plus every IHC stain? If this is NOT the case, then you are getting $12/case, and they are taking home ~85% of the revenue. In order to make even a low level academic salary ($150K) you would have to see 12,500 cases per year. That's 52 cases per day assuming 4 weeks vacation and M-F. Yikes.

..

 

[schrute]

I am sure there is some sort of advantage to hiring a new pathologist and probably im getting less than market value. But I have zero other options in this state, which is where I want to stray. Thank you though for sharing your rate. Dont you think a partnership tract will offset that in the future?

I think this mentality is pervasive amongst too many trainees--"needing"/wanting to stay in a specific state, which--along with too many trainees--drives income down... Geographic restriction is a matter of attitude...unless you have some ridiculously extenuating circumstances, I don't understand why people aren't willing to find the best job they can, not just the most convenient one. I trained in a large metropolitan city with essentially 2 job options upon graduation--the university (excess hours /workload for minimal pay), or a national lab that had taken over the competing healthcare system (also excess hours /workload for minimal pay). Aside from the fact most university work-to-pay ratios are crap, the national lab gigs are quite frankly insulting, but every single year, a handful of people just have to stay in town so end up taking the offer...
Of course this is compounded by the fact there is always a surplus of mediocre candidates with poor diagnostic/interpersonal/language skills that will move anywhere just to be employed... God this field is depressing.

 

[gbwillner]

1

..

Cat got your tongue? or maybe the GI doc, along with the rest of your professional value?

 

[icpshootyz]

I am sure there is some sort of advantage to hiring a new pathologist and probably im getting less than market value. But I have zero other options in this state, which is where I want to stray. Thank you though for sharing your rate. Dont you think a partnership tract will offset that in the future?

Have they definitively offered partner track? I also find that suspicious, as that's generally not how pod labs work. If so, you'd have to make sure that was in concrete writing in any contract you sign. I'm not saying you won't have to pay your dues and earn less than the full value of your work, especially right out of fellowship, but these arrangements are generally far more beneficial for the referring GI doc than the pathologist reading the slides. Especially at $12/slide. I agree with schrute - unless you have definitive geographic limitations that cannot be changed, expand your job search and find a better job.

 

[LADoc00]

there is no way a private lab would be willing to read slides at a glass rate of 12 so their claim is B.S. That would be bizarre even in the backwoods of the deep South...

Glass rates or billing per actual glass slide made was basically made bunk back in the 70s but was continued into the 80s by some very old pathologists but most of those are now dead. When some of these dinosaurs kept doing it, even against repeated instructions they got RAC audited and cooked up/served.

It is possible that the GI has some ancient near death practitioner who early in his career remembers being told vaguely how pathologists bill and that is the basis for their offer. If they are turning around and glass billing, they will get destroyed in a RAC audit.

They sound like such UTTER TOOLS I would probably steer clear of them.

My thoughts are if they are pushing this model, they are probably breaks all sorts of Medicare billing rules and one approach would be to infiltrate them, identify the fraud with the idea of getting a nice Whistleblower payout from CMS.....

 

[WEBB PINKERTON]

there is no way a private lab would be willing to read slides at a glass rate of 12 so their claim is B.S. That would be bizarre even in the backwoods of the deep South...

Glass rates or billing per actual glass slide made was basically made bunk back in the 70s but was continued into the 80s by some very old pathologists but most of those are now dead. When some of these dinosaurs kept doing it, even against repeated instructions they got RAC audited and cooked up/served.

It is possible that the GI has some ancient near death practitioner who early in his career remembers being told vaguely how pathologists bill and that is the basis for their offer. If they are turning around and glass billing, they will get destroyed in a RAC audit.

They sound like such UTTER TOOLS I would probably steer clear of them.

My thoughts are if they are pushing this model, they are probably breaks all sorts of Medicare billing rules and one approach would be to infiltrate them, identify the fraud with the idea of getting a nice Whistleblower payout from CMS.....

That is a great idea. Start infiltrating labs believed to be shady and turn whistleblower. Good way to get a nice payout before retirement.

 

[pathology2020]

I dont understand where u guys got the idea that thats how they bill!. Thats how they pay the pathologist but not how they bill, so no fraud there.

 

[pathology2020]

My question is: have any of you in a partnership tract demand that this is stated in your contract?
I also got an offer from a pathology owned private lab but LOW volume for 180,000 signing out 15,000 cases/yr 80% gi bx. Funny that is 12/case, not even slide, and that is living in a very remote location, so when they gave me that rate, I wasn't shocked really.

 

[pathology2020]

Anyway if this thread is gonna turn into endless attacks, its probably a waste of my time

 

[octopusprime]

My question is: have any of you in a partnership tract demand that this is stated in your contract?
I also got an offer from a pathology owned private lab but LOW volume for 180,000 signing out 15,000 cases/yr 80% gi bx. Funny that is 12/case, not even slide, and that is living in a very remote location, so when they gave me that rate, I wasn't shocked really.

180 starting out isn't bad but is that partnership track or just indefinite employment?
but 15k cases is a LOT, especially for 180.

 

[icpshootyz]

My question is: have any of you in a partnership tract demand that this is stated in your contract?
I also got an offer from a pathology owned private lab but LOW volume for 180,000 signing out 15,000 cases/yr 80% gi bx. Funny that is 12/case, not even slide, and that is living in a very remote location, so when they gave me that rate, I wasn't shocked really.

Are you saying the whole lab signs out 15K cases a year, or you would be responsible for 15K cases a year? Cause 15K cases a year ain't low, even for 80% small GI bx's. My group of 7 pathologists signs out 24K cases total a year, and we all make much more than 180K.

I'm not trying to attack you, but I also don't want to see you suckered into a dead-end, low-pay job where your clinical colleagues are leeching off your work and getting rich while you push glass. As for partnership track, yes, it was clearly defined in my contract. I had a defined initial period pre-partnership track, sort of a test to see if I fit the group, and at the end of that they had to either put me on partner track or cut me loose. If you don't have any specifics in writing and in the contract, they can do what they want and the probably will.

 

[octopusprime]

Are you saying the whole lab signs out 15K cases a year, or you would be responsible for 15K cases a year? Cause 15K cases a year ain't low, even for 80% small GI bx's. My group of 7 pathologists signs out 24K cases total a year, and we all make much more than 180K.

I'm not trying to attack you, but I also don't want to see you suckered into a dead-end, low-pay job where your clinical colleagues are leeching off your work and getting rich while you push glass. As for partnership track, yes, it was clearly defined in my contract. I had a defined initial period pre-partnership track, sort of a test to see if I fit the group, and at the end of that they had to either put me on partner track or cut me loose. If you don't have any specifics in writing and in the contract, they can do what they want and the probably will.

24k for 7 people?
Do you have like 26 weeks vaca?

 

[icpshootyz]

24k for 7 people?
Do you have like 26 weeks vaca?

Just 8

 

[mario2010]

pathology2020: I would negotiate, tell the GI group nicely but firmly that $12 per slide is way below the going rate. Tell them they will be violating stark's in office exception if they pay you below 75% of medicare PC. This will come around $28 per specimen. I wouldnt go below $25 per specimen in any circumstances and you can also charge separately for stains. I have actually consulted some well known attorneys in past and got the figure of 70-75% of medicare PC for these kind of deals. The physician group will have to pay you fair market value and also cover your malpractice (ideally with tail) . They will also have to provide you with an office, microscope and transcrpition service and pay for it. I second LADOC above, ask for separate fee for medical directorship, I would also go for $3K-$5K per month. Your resposnsibilities as medical director should be clearly written in contract and it should be stated that your stipend is 'independent' of volume to fulfill the stark law. With 15K specimens, you should be taking home atleast $500K., preferably around $600K. I would also add another thing, you should be the exclusive provider of pathology services to the group by contract. Remember this, Inoffice exception to stark law will eventually go away , its only a matter of time, when this happens and if you have some contractual leverage and relationship, you can set up your own TC lab and get the complete pie. In any case, this is a business opportunity but don't sell yourself short. One more thing, no national lab can legally do the medicare work for $12 per specimen. It's illegal to client bill medicare cases in outpatient setting. It's possible, they are getting some dirt cheap client bill deal on private insurance cases from a national lab, even those hover around $20-25 but remember the national lab is getting full prosfessional on medicare cases which with stains will be around $45-$50 just for professional more if they are billing globally. The GI group will be making a boat load of money out of you, which is OK, as long as they are paying you fair market value.

 

[pathology2020]

pathology2020: I would negotiate, tell the GI group nicely but firmly that $12 per slide is way below the going rate. Tell them they will be violating stark's in office exception if they pay you below 75% of medicare PC. This will come around $28 per specimen. I wouldnt go below $25 per specimen in any circumstances and you can also charge separately for stains. I have actually consulted some well known attorneys in past and got the figure of 70-75% of medicare PC for these kind of deals. The physician group will have to pay you fair market value and also cover your malpractice (ideally with tail) . They will also have to provide you with an office, microscope and transcrpition service and pay for it. I second LADOC above, ask for separate fee for medical directorship, I would also go for $3K-$5K per month. Your resposnsibilities as medical director should be clearly written in contract and it should be stated that your stipend is 'independent' of volume to fulfill the stark law. With 15K specimens, you should be taking home atleast $500K., preferably around $600K. I would also add another thing, you should be the exclusive provider of pathology services to the group by contract. Remember this, Inoffice exception to stark law will eventually go away , its only a matter of time, when this happens and if you have some contractual leverage and relationship, you can set up your own TC lab and get the complete pie. In any case, this is a business opportunity but don't sell yourself short. One more thing, no national lab can legally do the medicare work for $12 per specimen. It's illegal to client bill medicare cases in outpatient setting. It's possible, they are getting some dirt cheap client bill deal on private insurance cases from a national lab, even those hover around $20-25 but remember the national lab is getting full prosfessional on medicare cases which with stains will be around $45-$50 just for professional more if they are billing globally. The GI group will be making a boat load of money out of you, which is OK, as long as they are paying you fair market value.

Thank you mario for your response. This is really informative and you are giving alot of homework to do. I will def. have a lawyer viewer and negotiate with them. I agree it sure is a business opportunity and I know on the long run it will be good. Its gonna take time till I take the research hat off and put the business hat on!

 

[Gene_]

All you really need to do is run the numbers and determine whether this makes good business sense or not. How many slides are there per year and how fast can you read those slides? If you don't like those numbers, then decide what you need to have and make a counter offer. Don't sell yourself short. There's probably a good reason why they are currently looking for a pathologist. Talk to the last few pathologists that they have had to get some insight (if the GI docs don't want to provide this info, that is obviously a major red flag). I would at least negotiate a base salary that is guaranteed and then have a bonus based on productivity/volume.

 

[LADoc00]

For F Sake, just tell them to pay you a flat fee and be done with it. You will do the work on your schedule and fabricate a number that you can live with.

The problem is by doing this you arent building any sort of career or building a practice to take over or anything. Its a pathetic dead end so the dollar amount better buy the best hookers in all the land where you live. And drugs and alcohol. And a Porsche. Gotta have a Porsche.

 

[Zarniwoop]

Doing this kind of work is appealing, and the pay those GI docs gives is at least as good as what you'll get from your fellow pathologists.

However, when you lose this job for any reason (nothing to do with you or your performance), you are totally F-ed.
Unlike doing GI-only work in academia, you will not be able to parlay this experience into anything unless the gods shine down on you and you can land another (or a string) of GI only gigs.
There are FEW jobs in pathology, and you want to risk narrowing your future options by only being eligible for non-academic GI only ones?
You spent far too many years to get where you are now to take that kind of chance. It might pay off, but the risk is huge. IMO, I'd need a killer salary or a terminal illness to want to take a risk like that.

 

[pathstudent]

Accept it and then find some bigger douche to sign it out for 6 per slide.

 

[Unsatisfactory]

Accept it and then find some bigger douche to sign it out for 6 per slide.

This pure greatness. I bow to you. I do think you might negotiate it down to $4.25 though. hahahahaha

 

[2021Doctor]

According to a pathology lab consulting group $10-$15 to the pathologist for an 88305 is now the going rate compared to $25-29 several years ago.

See:
Labor is the largest expense in any business, hence payments to your pathologist should to be reduced to the "new normal" range of $10 to $15/biopsy. For 2013, CPT 88305 PC was increased by 2%. Remember, CAP and ACLA paid for the flawed Mitchell study on utilization. It is time for the "chickens to come home" to roost. Most of IOP contracted pathologists were paid $25 to $29/biopsy in the past. A $10 to $15 cut in pathologist fees will help make the laboratory finances look much better. It will in fact almost cut the payment reduction by 50%. Time to spread the wealth around for your benefit.

http://forums.studentdoctor.net/thr...gists-should-get-10-for-reading-88305.963862/

 

[pathology2020]

Lol dont you just love pathology!

 

[Zarniwoop]

Accept it and then find some bigger douche to sign it out for 6 per slide.

That is a common pathology tactic. I've seen plenty of senior pathologists sit on their asses and get new grads to work for peanuts while they reap the profits.
Most high level derms and GIs work a bit less than their junior associates, they don't rape their own to that extent. If they saw their in house pathologist try that, he or she would be shown the door.
I don't think these GIs and derms have (uniformly) bad intent when they hire pathologists (unlike the clear bad intent by many senior pathologists when they take on junior staff), but I still don't recommend working for the GI's and derms for the inherent risk involved.
Better to be f-ed by your own kind for future employability.

 

[octopusprime]

That is a common pathology tactic. I've seen plenty of senior pathologists sit on their asses and get new grads to work for peanuts while they reap the profits.
Most high level derms and GIs work a bit less than their junior associates, they don't rape their own to that extent. If they saw their in house pathologist try that, he or she would be shown the door.
I don't think these GIs and derms have (uniformly) bad intent when they hire pathologists (unlike the clear bad intent by many senior pathologists when they take on junior staff), but I still don't recommend working for the GI's and derms for the inherent risk involved.
Better to be f-ed by your own kind for future employability.

I don't think there's anything wrong with 'jr associates' coming in at a lower salary level for a few years...no chance they're as productive & knowledgeable as a partner-level pathologist...it's the equivalent of a buy-in, IMO. [though I know several sr pathologists that literally do nothing and still collect partner pay]

And derms/GIs might not have outright 'malicious' intent, but they sure as hell know they're making money off your back NOT as a temporary work-your-way-up-the-totem-pole 'learning curve' kinda way, but because of strong lobbying & legal loopholes.

Every private medical practice makes money off it's employees--physician assistants, NPs, etc--but no other routine professional medical set-up has the same opportunistic relationship that we have with derm & GI [professional colleagues], aside from those that stem from bad decisions.

 

[LADoc00]

Why does everyone pretend like Pathologists are the only financial idiots in the dunce corner?

TRUST ME, we are not. For every GI group that is taking pathologists for a ride, there are pathologists charging medical directorship flat fees and looking at no cases for weeks...other sub specs are crazy busy too and no one is particularly watching the bottom line well.

 

[jupiterianvibe]

I'd get a copy of the contract and payment options. Then i'd take that copy to an attorney with experience in pathology and health fraud law, and see what kind of fraud that constitutes, if any. If it turns out to be a good case, I'd then report it to the authorities. Aren't the awards treble damages? You could stand to gain a lot from exposing this. Be quiet about it though.

If it doesn't turn out to be a good case, I'd try to negotiate as LADoc and others have suggested, but since the initial offer is bad, I would not expect working with them to be a pleasant experience even if you do get a fair deal on paper.

 

[jupiterianvibe]

so I know that alot of pathologist hate this kinda deal, but this group already contracts with a private path lab at this rate and then im sure those path labs pay their employees only a portion of the 12/slide.

How do you know this?

 

[yaah]

Was the job offer from these people? I like how they list the pathologist below the midlevel providers.
http://www.midwestgi.com/about-us

Ever notice how in-office labs are at the top of the wall street journal's medicare billing website? Guess what you see when you put in Nebraska?
http://projects.wsj.com/medicare-billing-2012/#/name=&special=Pathology&city=&state=NE

lol, and her husband is one of the GI docs - look at the bio

Dr. Bernal was born and raised in Yonkers, New York. He received a Bachelor of Science degree from the University of Illinois at Urbana/Champaign. After attending medical school at the University Of Illinois College Of Medicine, he completed his Internal Medicine Residency at the University of Nebraska Medical Center in Omaha, Nebraska, where he later completed his Gastroenterology Fellowship. Dr. Bernal has written a number of abstracts and taken part in a variety of presentations for the American Gastroenterology National Fellows Forum as well as the American College of Physicians, Nebraska Chapter. Dr. Bernal and his wife, who is also a physician, have three children and have been part of the Omaha culture since 1998

 

[Torsed]

I don't know if I'd go to court over 12 dollars, I'd rather have the full professional fee if that is the case.
Sounds like a poor decision.
There is an astonishing lack of fear in these pod lab businesses.

 

[pathstudent]

You know it may not be that bad of a deal. My former resident colleague took a job with Ameripath. She was hospital based but they would send her stuff to sign out from office practices. They secured a big GI account and she said she was signing out an additional 20 GI cases a day along with others in her regional group. She said there was widespread complaining as their pay didn't change. So in effect, they were signing out the cases for 0 per slide.