Pod Labs vs. Twincrest Labs

[DrMojorisin]

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I was trying to learn about pod labs when I came upon this:

http://www.twincrestgroup.com/PodLabs.html

My impression is that this is a (more) legitimate form of doing the same thing as what pod labs do... shift profits from pathologists to referring specialists.

I really don't know much about the issue though, and I was hoping to get some opinions from more experienced people about the potential scope and impact of the twincrest approach on the working conditions for pathologists.

 

[juddson]

It still sucks for pathologists. The long and short of it is this - the pathologist does not participate in the profits of his services, arguably the sine quo non of a "professional". He is merely an employee, willing to transfer the marginal fruits of his efficiency, competence and expertise to his non-pathologist overlords who know nothing of skills and are otherwise unable to practice without his services. Bad, bad, bad all around.

Justin

 

[TheMightyAngus]

It still sucks for pathologists. The long and short of it is this - the pathologist does not participate in the profits of his services, arguably the sine quo non of a "professional". He is merely an employee, willing to transfer the marginal fruits of his efficiency, competence and expertise to his non-pathologist overlords who know nothing of skills and are otherwise unable to practice without his services. Bad, bad, bad all around.

Justin

So how do pod labs recruit pathologists? Wouldn't most avoid pod labs like the plague?

 

[yaah]

So how do pod labs recruit pathologists? Wouldn't most avoid pod labs like the plague?

They pay well, especially when you are just starting out. There are lots of pathologists out there, maybe for some it is the right situation, I dunno. Doesn't sound like anything I would want to do. The pathologists are vital to the organization, so they will likely be treated well and compensated well, albeit at the "whim" of whoever the boss is. People who do not want the pressure of being a new person and fighting to become a partner, or who want an immediately financial reward, or simply don't have a ton of patience or confidence in their own abilities may jump at these opportunities. Would you answer an ad that said "$350k + per year with unlimited benefits, no call, M-F only?" Some people don't read between the lines.

Everything in this country (not just medicine) is trending towards maximizing profits (although generally only profits for major investors) and minimizing expenses. This is another attempt to do this. However, any medical endeavor that puts patient care secondary to profits and greed is unlikely to have long term success - an example being the outpatient surgery centers like the one where the guy died after having back surgery when they had to call 911 after he started crashing.

The more people take advantage of loopholes or procedural schemes to maximize profits, the more that these schemes will become scrutinized. I think one of the interesting aspects of medicine is seeing where things will go - will medicine become dominated by hedge funds, outside investors, and basically be used as a money making opportunity or will it shift away from that and towards patient care more. You can't really have it both ways, unless you are a gigantic private institution.

We have seen cases that come from outside places where profits are more important. Things such as # of slides, quality of staining, quality of sections, etc, are minimized in comparison to quality labs. It does impact patient care!

In a sense, to say that pathologists "don't participate" in profits at pod labs/condos/whatever is a bit inaccurate, since the pathologist is a key part of the scheme. The profits related to the pathology service won't exist without the pathologist, obviously. As long as there is a supply of pathologists willing to be taken advantage of, however, schemes like this are likely to continue where the pathologist is given less of a say and participation in this business itself.

When medicine becomes strictly a business, people start to suffer. I know I didn't go into medicine strictly for the money. The money is a nice benefit, and I am not going to take less than market value for my services, but I also am not going to compromise patient care for another 5-10%, which unfortunately is what many people are willing to do - and many of these people are the ones making the decisions.

 

[DrMojorisin]

The concern I had was that future pathologists may lose the opportunity to be their own boss (reach partner). I agree about the tendency towards max profits, and would add that it seems to be reducing pathology autonomy and practice ownership. The alternate extreme, socialization of medical care, would likely do the same. How effective do you think private path groups will be at protecting their existence over a 10-30 year span against new business models like Twincrest? Are we witnessing the end of an era? Or is twincrest all hype and the current model for Path services deeply entrenched?

 

[djmd]

How effective do you think private path groups will be at protecting their existence over a 10-30 year span against new business models like Twincrest? Are we witnessing the end of an era? Or is twincrest all hype and the current model for Path services deeply entrenched?

Not very (but they better improve). No. No and not enough.

Actually the first answer is that the will get better or they will get nowhere.

This is not the end of an era. And Twincrest is not more legal that Pod labs (which are technically legal) they just have the letter of the law down and have wedged themselves tightly into it. The would be caught in the same legal snare that with get pod labs, if and when the law is changed/clarified.

They make it sound like it can the the same class has having a local machine for testing PTs or H/H? hardly.

That being said pathology should not be waiting for congress to solve this problem.

We need to do more than entrench. We need active counter measures.

The worst part about Twincrest, on their page somewhere is this:
We like our local pathologist, can we keep using them?
Yes, Twincrest will negotiate a deal with your local pathologists...

What BS. The only negotiation they have is you will get 50% of what you used to get for this, or you will get zero.

Pathology needs to forge relationships with the local groups, and local groups need to know this is stabbing a pathologist in the back. And their favorite 'local pathology group' is not going to accept this.

I'm starting to think that we have to do LA Doc plan where we get into the biopsy & FNA game. We get out our GI and other biopsy docs and we pay them most of what they make, but then WE keep the overhead...

 

[yaah]

The thing is, are pod labs really worse than massive labs like Ameripath or Bostwick or whatever? There really isn't much difference.

I saw a newsletter today hanging around the department about path economics or something. I will have to look again to see what it is called. But the current issue was about podlabs and how podlabs are fighting back against ASCP and others who would deny them. Their arguments include 1) we are actually better for pathologists than ameripath,bostwick,quest, whatever 2) We don't cut corners and we are better for patient care because we are local, there are more direct interactions, etc.

It's all BS, it's all about $$$ anyway. This same article said the reason for podlabs is that urologists and GI docs (with heme onc likely to follow) are losing income via reiumbursements, and so they are trying to make up the difference in creative ways. So they hire a pathologist and make a path lab, and make an extra million dollars a year for the group, which amounts to an extra $75 k per doc after paying the path techs and pathologist. And then the pathologist gets paid well and gets lots of benefits. At least, so goes the sales pitch.

Either way, if pod labs go away then someone else will just try to steal biopsy technical fee money, most likely a mega lab.

I kind of think mega labs are more of a threat than pod labs - that of course assumes that pod labs actually do what they say and provide quality care. That may be a big assumption.

 

[mlw03]

It still sucks for pathologists. The long and short of it is this - the pathologist does not participate in the profits of his services, arguably the sine quo non of a "professional". He is merely an employee, willing to transfer the marginal fruits of his efficiency, competence and expertise to his non-pathologist overlords who know nothing of skills and are otherwise unable to practice without his services. Bad, bad, bad all around.

Justin

is there a business model out there where, instead of being an employee, the pathologist is a partner with the clinicians? for example: pathologist with GI fellowship training joins a group of gastroenterologists, reading all of their biopsies, and for that he's a partner in the group, not just an employee. it doesn't have to be a big power trip or anything sinister - in this model the pathologist is a different, but equally important, part of the team and would get the respect and pay he deserves. everyone could win in this scenario, most importantly the patients as there could likely be quicker signout, possible even on-site frozen sections in a clinic-type setting, and real communication between clinicians and pathologists.

is this type of thing happening anywhere? is it doable? is it good for pathologists? or am i being a bit naive (as i sometimes can be)?

 

[djmd]

is there a business model out there where, instead of being an employee, the pathologist is a partner with the clinicians? for example: pathologist with GI fellowship training joins a group of gastroenterologists, reading all of their biopsies, and for that he's a partner in the group, not just an employee. it doesn't have to be a big power trip or anything sinister - in this model the pathologist is a different, but equally important, part of the team and would get the respect and pay he deserves. everyone could win in this scenario, most importantly the patients as there could likely be quicker signout, possible even on-site frozen sections in a clinic-type setting, and real communication between clinicians and pathologists.

is this type of thing happening anywhere? is it doable? is it good for pathologists? or am i being a bit naive (as i sometimes can be)?

It could exist. Partners are merely people who are owners of a corporation. Pathologist could be minor or even equal voting partners with in a GI or GU group. But why would the GI/GU groups do that? And assuming the partners share income relatively equally...Now you get back that salary you were paying the pathologist, but then you divide the pool by one more share. Assume say 5 partners. And the pathologist was being paid 300k. If the GI partners were seeing more than 350k they just lost money... and to whom? Someone who is apparently something similar to autocell counter /differ.... He doesn't scope anyone, he doesn't see any patients... hell he doesn't even take call or cover for people when the are on vacation...

 

[djmd]

The thing is, are pod labs really worse than massive labs like Ameripath or Bostwick or whatever? There really isn't much difference.

Their arguments include 1) we are actually better for pathologists than ameripath,bostwick,quest, whatever 2) We don't cut corners and we are better for patient care because we are local, there are more direct interactions, etc.

Either way, if pod labs go away then someone else will just try to steal biopsy technical fee money, most likely a mega lab.

I kind of think mega labs are more of a threat than pod labs - that of course assumes that pod labs actually do what they say and provide quality care. That may be a big assumption.

It is true that someone else will try and get that bx money... it is easy and manageable. I don't think that the big labs are as big a threat as PODs and this hybrid pod crap. Firstly, the PODs and the hybrid-pods make money for the groups. The megalabs just save the group money. And while that is similar it is different enough that it makes the PODs hPODS more dangerous. The better for patient care/ better for pathologist is a Faustian deal if ever there was one.

The Megalabs are Walmart pathology... The PODs and the like are the back of a truck, or street side guys in cars. The problem is like I said the Docs MAKE money if they go with the later. Every Bx is cash. Even within the same procedure, but additionally, any BXs you maybe didn't need to do is a double pay out.

Beating Megalabs is about what you get and what the referring physician gets, and a person to talk to is worth something...
The PODs make it seem like you get that AND you get paid for having him there....

 

[yaah]

Good points, I agree with those. I found the journal (pamphlet?) it is called laboratory economics and you can download a sample issue (which is the one I was referring to which talks about podlabs) at www.laboratoryeconomics.com

This same issue talks about how medicare reimbursement for the professional fee has been cut, but reimbursement for the technical fee is increasing. No doubt this plays in.

I think you are right that podlabs are more of an irritant than mega labs. At least mega labs have the pathologist with more power. But at the same time, this pamphlet talks about how the average annual collected revenue per ameripath pathologist is 1.5 million (doubled in the past 7-8 years). Pathologists are getting compensated more based on incentives (but ameripath pathologists do not make even 1/4 of that 1.5 million). To me, that sounds like an employee, not a partner.

I think it's irritating that bean counters and greedy 21st century robber barons are now in health care and making money off of others' work. But such is the way of things. It's not just pathology. It's all about the shareholders and the executive board.

In all of this "pod lab vs mega lab vs private practice" no where does the discussion ever seem to turn to pathologists themselves and what is best for them. It's either about saving money via volume or making money for the clinician (with the pathologist as a willing partner). Somehow I doubt pathologists will stand up to this though. Unlike urologists or gastroenterologists who can theoretically get patients to come to them, pathologists have to depend on other physicians sending their business. It's already a disadvantage.