Physician Office Lab rules

[GI_PathMan02]

Has anyone heard of a physician office lab (POL) that takes specimens in from other non-affiliated referring physicians? Basically, can a physician office lab that is owned by a large GI group receive specimens from a GI doc that is not part of the group and bill for it under the large GI group's tax ID? In other words can a POL act as an independent clinical lab or a reference lab and do work that originates outside it's group?

Intuitively one would think that if you are designated as a POL by CLIA that you work should be limited to your own group's work. One could also make the argument that you are not violating any Stark laws granted the referring lab or provider does not have a financial interest in your group (or is not getting a kickback). I am having trouble finding an answer to this. What do you think?

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[turtle1966]

Has anyone heard of a physician office lab (POL) that takes specimens in from other non-affiliated referring physicians? Basically, can a physician office lab that is owned by a large GI group receive specimens from a GI doc that is not part of the group and bill for it under the large GI group's tax ID? In other words can a POL act as an independent clinical lab or a reference lab and do work that originates outside it's group?

Intuitively one would think that if you are designated as a POL by CLIA that you work should be limited to your own group's work. One could also make the argument that you are not violating any Stark laws granted the referring lab or provider does not have a financial interest in your group (or is not getting a kickback). I am having trouble finding an answer to this. What do you think?

They are doing it.

CLIA and Medicare rules are being ignored as toilet paper by CLIA enforcers in ?certain states. Board certification for directorship in ?certain states is ignored, as an example. Physical location within place of practice requirement is ignored. I see little or no difference between POLs and an independent labs in what they cand do. CAP, in my experience, only regulates/screws pathologists.

 

[GI_PathMan02]

I also get the impression that this is happening. I can't find the specific set of rules and regulations that say that a POL can't take outside work. Is it just a "common knowledge" thing or are there explicit regulations against it that are not regularly enforced?

 

[Med Director New England]

A group of docs taking biopsies can send specimens to any lab they want to for AP testing

 

[DPath2000]

Merica. My old employer explored this. There may have been a restriction as far as a POL functioning as a reference lab and billing for work from referring labs with a 90 modifier. Not sure though.

 

[turtle1966]

I also get the impression that this is happening. I can't find the specific set of rules and regulations that say that a POL can't take outside work. Is it just a "common knowledge" thing or are there explicit regulations against it that are not regularly enforced?

They were like administrative interpretation of CLIA by Medicare. When they were published, pathologists applauded them as rules that would restrict POLs. Then, nothing. Now POLs are competing with commercials labs. Swap of Mohs referrals for biopsy specimens, as an example.

CLIA application/renewal form clearly differentiates between a POL and independent labs.

 

[AZpath]

What you describe is very likely a violation of the Stark law.
To my knowledge POLs are only for physicians & patients associated with the practice.

POLs are part of well defined law and CMS has known rules call safe harbors that permits usage.
It might be a violation of the anti-kickback rule if there is any thing of value exchanged between parties.

CLIA law and regs do not cover of this.
Don't take my word for it, contact a heathcare attorney to be sure.

 

[deleted314957]

AZ, you said it. “ it MIGHT be a violation”. That phrase has been used by the feds
whenever it comes to the issues that concern us. The biggie is little or no remuneration for Part A. The government has clearly demonstrated that they are unwilling to hold people’s feet to the fire unless it is a blatant fraud the will make the general public salivate when hey read about it. Nobody in the general public understands the arcana surrounding our issues. does not really matter anymore
though. not much to salvage from the current dumpster fire.

 

[WEBB PINKERTON]

In my neck of the woods, I have seen urologists force hospitals to send specimens to their POL. I saw a community hospital lose the "town urologist" years ago and that was part of the deal to bring these guys in. All the specimens collected at the clinic had to go to their POL. The path group at the hospital lost a decent volume.

 

[Med Director New England]

no matter where a specimen is processed only a pathologist can do do the Pro interp and only a pathologist can provide medical directorship...the only reason this has become a problem is that paths are so abundant the fair market value for these services has become a race to the bottom. I am hearing now 15 US / 305. I thought 25 was going to be the bottom. In most POLs the path making the per click 305 reads is receiving no additional comp for cliaa oversight / med directorship.

I also dont blame any pathologist for getting a side hustle or primary gig at these prices, esp if they dont have anything better or need the additional comp, but sadly this is now the status quo.

 

[Spikebd]

no matter where a specimen is processed only a pathologist can do do the Pro interp and only a pathologist can provide medical directorship...the only reason this has become a problem is that paths are so abundant the fair market value for these services has become a race to the bottom. I am hearing now 15 US / 305. I thought 25 was going to be the bottom. In most POLs the path making the per click 305 reads is receiving no additional comp for cliaa oversight / med directorship.

I also dont blame any pathologist for getting a side hustle or primary gig at these prices, esp if they dont have anything better or need the additional comp, but sadly this is now the status quo.

15/305? Yuck

 

[AZpath]

In my neck of the woods, I have seen urologists force hospitals to send specimens to their POL. I saw a community hospital lose the "town urologist" years ago and that was part of the deal to bring these guys in. All the specimens collected at the clinic had to go to their POL. The path group at the hospital lost a decent volume.

That would a kickback if the specimen came from the hospital OR

If it comes from their clinic then it can go to their POL

If comes from outside the clinic practice that is illegal

I will skip the “ May be this time “

Of course , most will never get caught unless someone blows the whistle

Urology Pols not very profitable these days unless you do FISH on everyone

 

[y2k_free_radical]

no matter where a specimen is processed only a pathologist can do do the Pro interp and only a pathologist can provide medical directorship...the only reason this has become a problem is that paths are so abundant the fair market value for these services has become a race to the bottom. I am hearing now 15 US / 305. I thought 25 was going to be the bottom. In most POLs the path making the per click 305 reads is receiving no additional comp for cliaa oversight / med directorship.

I also dont blame any pathologist for getting a side hustle or primary gig at these prices, esp if they dont have anything better or need the additional comp, but sadly this is now the status quo.

Sounds about right for my side gigs-if one wants the work one is forced to accept despite THE MASSIVE SHORTAGE OF PATHOLOGISTS

 

[clinicallycorrelated]

no matter where a specimen is processed only a pathologist can do do the Pro interp and only a pathologist can provide medical directorship...the only reason this has become a problem is that paths are so abundant the fair market value for these services has become a race to the bottom. I am hearing now 15 US / 305. I thought 25 was going to be the bottom. In most POLs the path making the per click 305 reads is receiving no additional comp for cliaa oversight / med directorship.

I also dont blame any pathologist for getting a side hustle or primary gig at these prices, esp if they dont have anything better or need the additional comp, but sadly this is now the status quo.

What’s 15US/305 mean?

 

[Rxor49]

What’s 15US/305 mean?

$15 U.S. dollars per CPT code 88305 billed. Essentially the pod lab owner is skimming the majority of the professional component (reimbursement for pathologist's work) off the top, leaving the pathologist with only $15 per biopsy read, yet the above posts are suggesting there are enough desperate pathologists out there willing to accept an arrangement like this.

 

[clinicallycorrelated]

$15 U.S. dollars per CPT code 88305 billed. Essentially the pod lab owner is skimming the majority of the professional component (reimbursement for pathologist's work) off the top, leaving the pathologist with only $15 per biopsy read, yet the above posts are suggesting there are enough desperate pathologists out there willing to accept an arrangement like this.

Wow. That’s sad. How much does is an 88305 worth at 100% value or is it depending on certain factors? Trying to get a sense of what percentage is being taken away. How long does the average 88305 take? To gauge a $/hour

 

[Unty]

Wow. That’s sad. How much does is an 88305 worth at 100% value or is it depending on certain factors? Trying to get a sense of what percentage is being taken away. How long does the average 88305 take? To gauge a $/hour

Careful this guy might be a dermatologist, gastroenterologist or urologist!!!!

 

[clinicallycorrelated]

Careful this guy might be a dermatologist, gastroenterologist or urologist!!!!

Insightful.

 

[deleted314957]

Well, there’s something fishy about him because i had him on “ignore”. he is trolling here.

 

[Dave CX]

$15 U.S. dollars per CPT code 88305 billed. Essentially the pod lab owner is skimming the majority of the professional component (reimbursement for pathologist's work) off the top, leaving the pathologist with only $15 per biopsy read, yet the above posts are suggesting there are enough desperate pathologists out there willing to accept an arrangement like this.

Desperate???? I make a mint with this arrangement, way more than I ever did in my PP hospital practice, and in fewer hrs with WAAAAY less BS

 

[y2k_free_radical]

$15 U.S. dollars per CPT code 88305 billed. Essentially the pod lab owner is skimming the majority of the professional component (reimbursement for pathologist's work) off the top, leaving the pathologist with only $15 per biopsy read, yet the above posts are suggesting there are enough desperate pathologists out there willing to accept an arrangement like this.

I am one who gets about $20 plus per cent immuno charges if any.It is the market place.If there were truly a shortage this practice would disappear.

 

[y2k_free_radical]

Well, there’s something fishy about him because i had him on “ignore”. he is trolling here.

He's our CANADIAN commentator on guns and private practice conditions in the US

 

[clinicallycorrelated]

He's our CANADIAN commentator on guns and private practice conditions in the US

Nobody can tell me what it works out to in $/hour. Lol. Classic

 

[y2k_free_radical]

Nobody can tell me what it works out to in $/hour. Lol. Classic

Depends on the speed and expertise of pathologist and the number and difficulty of the biopsies

 

[Guest8]

Nobody can tell me what it works out to in $/hour. Lol. Classic

No one gets paid by the hour so no one can tell you a specific number for a metric that doesn't exist and no one uses. Classic.

 

[Dave CX]

700$ or so

 

[octopusprime]

$15 U.S. dollars per CPT code 88305 billed. Essentially the pod lab owner is skimming the majority of the professional component (reimbursement for pathologist's work) off the top, leaving the pathologist with only $15 per biopsy read, yet the above posts are suggesting there are enough desperate pathologists out there willing to accept an arrangement like this.

Like DaveCX said--people make good $ doing it, because the market dictates such and there's no incentive to behave differently aside from posterity. This practice will continue until a.) it's not worth the money, b.) it's illegal, or c.) our specialty is in demand enough that it's not a viable option... "a.)" will happen when we've bid down the price so much that only the truly desperate will be the ones taking such gigs, "b.)" will never happen, and "c.)" will only happen if we cut training / limit the outflow from residency programs, which also will never happen.

So while Dave is making a "mint" at $700/hr, that's only by way of his volume & efficiency & practice particulars...when his GI overlords' practice structure changes, or they want to renegotiate, or they find a Dave 2.0 willing to do it for $500/hr, Dave 1.0 will be priced out or minting less coin or moving to the next gig.

 

[y2k_free_radical]

700$ or so

You must do all GI with lots on immunos

 

[Dave CX]

You must do all GI with lots on immunos

No way. I don't do that crap. The only stain is an H.pylori immune and they are only billed if gastritis is diagnosed.

 

[Dave CX]

Like DaveCX said--people make good $ doing it, because the market dictates such and there's no incentive to behave differently aside from posterity. This practice will continue until a.) it's not worth the money, b.) it's illegal, or c.) our specialty is in demand enough that it's not a viable option... "a.)" will happen when we've bid down the price so much that only the truly desperate will be the ones taking such gigs, "b.)" will never happen, and "c.)" will only happen if we cut training / limit the outflow from residency programs, which also will never happen.

So while Dave is making a "mint" at $700/hr, that's only by way of his volume & efficiency & practice particulars...when his GI overlords' practice structure changes, or they want to renegotiate, or they find a Dave 2.0 willing to do it for $500/hr, Dave 1.0 will be priced out or minting less coin or moving to the next gig.

Jealous person. I actually give outstanding service. Don't assume that all these docs are blindly greedy. In fact, the greediest cheapskates in the medical field are pathologists according to my experience.

 

[y2k_free_radical]

No way. I don't do that crap. The only stain is an H.pylori immune and they are only billed if gastritis is diagnosed.

Then i commend your expertise,speed and efficiency.That would equate to close to $1,400,000/year for 40 hours/week for 50 weeks/year. Color me pea green with envy.Do you need an assistant ?????

 

[Thaitanium]

Great let's publicly post how much revenue we are generating so clinicians or future clinicians can pinch us even more!

Even worse CMS will target us for reimbursement cuts.

I would keep numbers on the down low if I were you. Better to keep a low profile imo.

 

[Dave CX]

Then i commend your expertise,speed and efficiency.That would equate to close to $1,400,000/year for 40 hours/week for 50 weeks/year. Color me pea green with envy.Do you need an assistant ?????

Actually yes, I want a partner badly. I am casually looking, but it has to be someone GOOD in GI path.
And I only make half that. I cant work that pace for 8hrs a day.

 

[Dave CX]

Great let's publicly post how much revenue we are generating so clinicians or future clinicians can pinch us even more!

Even worse CMS will target us for reimbursement cuts.

I would keep numbers on the down low if I were you. Better to keep a low profile imo.

Oh please drama Queen. Nobody of any stature is trolling this message board.

 

[Dave CX]

Let me clarify a few things. I sign out an average of 5.5 trays per hour, one empty slot between accessions. I spend 4.5 - 5 hrs a day at the microscope and I am whipped when I am done. I don't work at the merry laconic pace of the usual pathologist. It is concentrated, no coffee, no phone, no surfing the net, no lollygagging intense focus. I need to do this because I also drive 2 hrs a day. I never wait for work, the work is there on my desk before I arrive (usually anyway). The site headings and billing are pre-entered (although occasionally I make modifications). And I have a library of my most common 80 or so diagnoses that can be loaded with two or three key strokes. So I only have to do some typing on maybe 10 percent of specimens.

 

[deleted314957]

Let me clarify a few things. I sign out an average of 5.5 trays per hour, one empty slot between accessions. I spend 4.5 - 5 hrs a day at the microscope and I am whipped when I am done. I don't work at the merry laconic pace of the usual pathologist. It is concentrated, no coffee, no phone, no surfing the net, no lollygagging intense focus. I need to do this because I also drive 2 hrs a day. I never wait for work, the work is there on my desk before I arrive (usually anyway). The site headings and billing are pre-entered (although occasionally I make modifications). And I have a library of my most common 80 or so diagnoses that can be loaded with two or three key strokes. So I only have to do some typing on maybe 10 percent of specimens.

Pretty much like i worked. you can move a lot of glass that way.

 

[octopusprime]

Jealous person. I actually give outstanding service. Don't assume that all these docs are blindly greedy. In fact, the greediest cheapskates in the medical field are pathologists according to my experience.

Never commented on the quality of your service, I'm sure it's excellent, but it's naive to think the GI/derm/GU professions as a whole value the quality of our services over the value at which they can purchase it. Maybe you bring some guru-level swag & the GIs are making so much bank they've invited you to the higher echelons of their pyramid, but it's not sustainable.

Easy to dismiss someone's comments as jealous criticism, but I don't want your job...I make the same coin sans the 2 hr drive and suicide-level straight scope time.

 

[WEBB PINKERTON]

Oh please drama Queen. Nobody of any stature is trolling this message board.

You would be surprised. There have been some prominent people post/monitor this forum in the past, under aliases of course.

 

[WEBB PINKERTON]

Never commented on the quality of your service, I'm sure it's excellent, but it's naive to think the GI/derm/GU professions as a whole value the quality of our services over the value at which they can purchase it. Maybe you bring some guru-level swag & the GIs are making so much bank they've invited you to the higher echelons of their pyramid, but it's not sustainable.

Easy to dismiss someone's comments as jealous criticism, but I don't want your job...I make the same coin sans the 2 hr drive and suicide-level straight scope time.

It will be a much easier job for him once AI takes over...Autonomous car making the trip. Cases pre-screened by AI so all they need is verification.

 

[y2k_free_radical]

Great let's publicly post how much revenue we are generating so clinicians or future clinicians can pinch us even more!

Even worse CMS will target us for reimbursement cuts.

I would keep numbers on the down low if I were you. Better to keep a low profile imo.

If this were the norm there would be less wailing and gnashing of teeth

 

[clinicallycorrelated]

Actually yes, I want a partner badly. I am casually looking, but it has to be someone GOOD in GI path.
And I only make half that. I cant work that pace for 8hrs a day.

I’ll PM you when I graduate.

 

[clinicallycorrelated]

It will be a much easier job for him once AI takes over...Autonomous car making the trip. Cases pre-screened by AI so all they need is verification.

Oh stop it with these A.I. futurology posts. Leave it to Asimov, it’s getting tiring

 

[Dave CX]

Easy to dismiss someone's comments as jealous criticism, but I don't want your job...I make the same coin sans the 2 hr drive and suicide-level straight scope time.

You are a snowflake even by pathologist standards. If looking at slides for 4.5 - 5 hrs qualifies as suicidal, then you should find a different profession.

 

[octopusprime]

You are a snowflake even by pathologist standards. If looking at slides for 4.5 - 5 hrs qualifies as suicidal, then you should find a different profession.

No need to make personal attacks; just saying people make the same coin without making it seem like they're some hot-dog balls-to-the-wall savant. I don't spend 5 straight hours behind the scope because I don't have to--not exactly "bragging rights" if you plow through 25-30 trays in a 5 hr work day + 2 hrs in the car, unless the size of yours is based on some sort of slide/hr metric....I'll take my leisurely 10 minute commute and 7 hr work day (which is probably 4 hrs of actual work and is extremely flexible) and varies from 5 to at most 20 full trays / day and--selling point--still deposits the same check in my bank account. And when both of our income sources go belly-up in 5 years and we're looking for new jobs, I don't want to pigeon hole myself having seen exclusively GI cases.

I know, I know, we have pesky things like occasional autopsies and medical staff meetings, etc, etc, etc...maybe some day I'll get so tired of the extremely laid back hospital-based setup that I'll close up shop and get in bed with some GI/GU docs...maybe you had a bad experience that pushed you in this direction, I get it.

 

[octopusprime]

To an extent, income/salary in path has a direct correlation with how much glass you push...but this correlation is more direct with in-office setups based on volume and 88305s, and less direct with academics [as far as your avg academician is concerned], and it's widely variable in community practice... there are lots of factors that play into overall income: geographic location, collections (both recovery rates & billing costs), insurance reimbursement rates, lab directorship payments, ancillary testing, group dynamics, assets, overhead, PTO...

 

[y2k_free_radical]

No need to make personal attacks; just saying people make the same coin without making it seem like they're some hot-dog balls-to-the-wall savant. I don't spend 5 straight hours behind the scope because I don't have to--not exactly "bragging rights" if you plow through 25-30 trays in a 5 hr work day + 2 hrs in the car, unless the size of yours is based on some sort of slide/hr metric....I'll take my leisurely 10 minute commute and 7 hr work day (which is probably 4 hrs of actual work and is extremely flexible) and varies from 5 to at most 20 full trays / day and--selling point--still deposits the same check in my bank account. And when both of our income sources go belly-up in 5 years and we're looking for new jobs, I don't want to pigeon hole myself having seen exclusively GI cases.

I know, I know, we have pesky things like occasional autopsies and medical staff meetings, etc, etc, etc...maybe some day I'll get so tired of the extremely laid back hospital-based setup that I'll close up shop and get in bed with some GI/GU docs...maybe you had a bad experience that pushed you in this direction, I get it.

Both you and DAVE are in the upper 25 % in income so both of you have very good and even enviable gigs

 

[Dave CX]

N
I know, I know, we have pesky things like occasional autopsies and medical staff meetings, etc, etc, etc...maybe some day I'll get so tired of the extremely laid back hospital-based setup that I'll close up shop and get in bed with some GI/GU docs...maybe you had a bad experience that pushed you in this direction, I get it.

It was a push/pull situation for sure, but those 13 plus years as a community hospital pathologist was a time of immense professional and personal growth and I don't regret a second of it (although I hope to never do it again). I urge any Fellow to not even consider a subspecialty outpatient GI, GU, Derm etc gig until you have done a minimum of 7 - 10 yrs in a hospital setting.

 

[Vicinal]

It was a push/pull situation for sure, but those 13 plus years as a community hospital pathologist was a time of immense professional and personal growth and I don't regret a second of it (although I hope to never do it again). I urge any Fellow to not even consider a subspecialty outpatient GI, GU, Derm etc gig until you have done a minimum of 7 - 10 yrs in a hospital setting.

New grads. This is sage advice. Don’t take shortcuts. Learn in a hospitalist setting for your 10,000 hours before becoming a biopsy only pathologist. You will regret taking a job like that after training because your skills will atrophy.

 

[Torsed]

New grads. This is sage advice. Don’t take shortcuts. Learn in a hospitalist setting for your 10,000 hours before becoming a biopsy only pathologist. You will regret taking a job like that after training because your skills will atrophy.

I absolutely concur.

 

[Unty]

New grads. This is sage advice. Don’t take shortcuts. Learn in a hospitalist setting for your 10,000 hours before becoming a biopsy only pathologist. You will regret taking a job like that after training because your skills will atrophy.

How about all these folks at Quest. My friend commented to me about 50% of the biopsies he sees are normal!!!!

Not sure what their story was but these Quest jobs was one of a few outpatient biopsy jobs they interviewed for. Unless you are invited for a job at a group practice, these jobs may be your only alternative.