Private lab take over of management of Hospital lab.

[Torsed]

Many of the system hospital labs in my state (Mississippi), management has been taken over by Quest.

I don't know if my lab is next on the chopping block. Not sure how to even begin to proceed as I have younger pathologists under me that have financial obligations. I don't know if anyone has been in these positions, but I hope if/when it comes for our hospital we can negotiate something financial feasible.

Personally, I feel we are in the black, and the pathology sector has been busier than ever. The admin seems to want to turn over reagent contracts etc for the vendor over to Quest and have them take the FTE's off their hands.

In hospital's that this has happened too, Quest seems to can the senior medical tech (director) and purge the lab and replace with their minions.

I don't know my role, most like me have retained ownership of pathology services and let Quest run the clinical side with some reimbursement. I myself could likely move to another system, but would abandon my junior partner to this take over.

Has anyone experienced this before? Thank you for your opinions and thoughts.

FYI, I am AP/CP and Cytopathology boarded, have been medical director of our hospital lab for 3 years and may be looking for a new job soon.

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[AZpath]

You feel that pathology is in the black? How do you know ?
That is, the hospital must feeling great about path. The must be making money off your activity. This is not necessarily how your CEO or CFO looks at this.



You need to understand the administrations goals. This means a tight relationship with your administration.
Also, as a director a key role in the medical staff leadership helps.

How the money is being made by the hospital lab including pathology (or not)?

I assume that Quest would like to move in their Ameripath operation and take over clinical lab.
You have to understand their sales pitch and how successful they have been in your area.

Does you clinical lab do much outreach ? Is the clinical lab efficient ?
Has your lab managers been able to control costs? Do the pathologist have a plan to help ?

PAMA is changing the clinical lab landscape.
If you understand the entire scope of lab economics you have a better shot at maintain your position.

You don't know your role ( Really) ? Survival.

 

[Torsed]

Thanks AZPath, a few clarifications:

Yes, pathology itself is in the black, I am one of the main physician leaders at the hospital and have as tight of a relationship with the current admin as feasible. As far as the medical staff, they don't really care what happens as long as it doesn't jack up their bottom line, but this you probably know.

The clinical lab is run in a mediocre fashion, the hospital laboratory can't compete with much outreach because the bigger corporate labs (guess who) plant a phlebotomist in any physician office worth it's salt. Further with controlling costs, that almost comical because the hospital is poorly managed: hence the floating of the idea of Quest or another larger reference lab managing the hospital lab. I know admin's goal is to cut period, as many FTE's as they can jettison they will, that is a no brainer. I've given the admin leaders (who transition frequently so its like reinventing the wheel every time) plans and strategies to improve our both our labs outreach and larger hospital footprint, but there are many junior admins who don't get the big picture.

I don't think its a question of if but when this above mentioned transition happens. I am a contractor and my role in dealings with another contractor coming is the question. I was hoping someone with experience dealing with this type of scenario would pitch in their views.

I've already talked to others pathologists that I know who went through this and there were two options: retire or play along. I have an option to go to the competitor hospital which really wasn't an option for the other pathologists playing these games. I like the goal of survival that you mention AZPath, but I don't have to survive on the Titanic, I just need to float to another gig. I am fortunate that I could probably do that, but the younger pathologists I employ I worry for.

It's certainly an odd thing, I was hoping I wouldn't have to deal with it, but I am sure there are others that will follow in this and maybe a thread such as this will help them in the future. Or maybe we can all point and laugh and remember the good old days.

 

[AZpath]

Sorry if I sounded unsympathetic. Your posts have always suggested knowledge and leadership.
I can't help much since I don't know anyone that has seen a clinical lab takeover yet.

The real issue is what kind of damage does Quest typically inflict. Try so see if there is way for you and your folks to hang in there.

Quest's business model is really the question. Part of the cost saving plan may be less part A or they bring in there own pathologist etc.

What are the experiences of pathologists in your area. Did they end up doing a good job? Or did they just cut heads and make a mess?

I employee people that I am loyal to so understand your predicament. If is going to be the titanic than it really does not matter. You might be going down even if you stay.

 

[WEBB PINKERTON]

When you see an agent of Quest, you do what we do...run.

Move on

Thank PAMA. This story is playing out more and more

 

[dukeresident]

Things look bleak outside academia for pathologists.

 

[Thrombus]

Things look bleak outside academia for pathologists.

You are correct sir, however, the academics will have their day at the judgement seat also!

The damn academics have overtrained so many to fill their coffers from the pork that is attached to the residents while they sit on their ass at their desks. Now we can’t even get a job in Mississippi while the hospital conspirators, big corporate crooks, and insurance do nothings cook us til we boil!

Flee Pathology Now!!!!

 

[LADoc00]

Huh, this is a fascinating scenario. I need to know EXACTLY what the arrangement is to comment with any authority.

1.) Is Quest just being used as an outsourced staffing arm for the CLS and Lab Admin director?
2.) Is Quest actually doing the medical directorship of the clin lab itself?
3.) Is your name still on the CLIA license or has that been changed to a Quest Pathologist?

Honestly, if you spun this right, it could be a dream come true. If you played your hand wrong, it could be a catastrophic disaster.

What I would do:
1.) Tell Quest they are responsible for ALL call for clinical lab and anatomic, ALL inspections and ALL onsite admin decision making. They can separately contract with you down the road. Down the road tell them you will charge $50,0000 mo minimum or charge a per hour rate based on your personal availability (which will be very limited).
2.) Tell Quest they are responsible for all anatomic technical functioning including ALL grossing. You will onsite supervise NOTHING. EVER. You will have a courier pick up slides and bring them to your den with eggs, bacon and coffee whilst you sit in your pj's and sign out cases. You will bill solely for your AP pro fees. but you will do nothing else. Literally. Even if the lab is on fire, you whilst not relieve yourself to put said fire out.
3.) You will attend NO meetings at all anywhere unless it is at a bar in Las Vegas and they give you a suite at the Encore. All staff meeting, will be attended to by Quest pathologists with no exceptions.
4.) Most importantly, this agreement will have the maximum no compete with the maximal penalties allowed by law. I believe in MS and other southern states this is near insane levels of automatic damages, we are taking 10-20 million automatically paid to you should Quest attempt to take your AP component revenue.
5.) You should encourage them to take your revenue any chance you get.

Bait them into the trap, get a solid attorney and you will reap a massive whirlwind of cash. With 10 million in capital and even a half competent money man, you should be living forever on a passive income train of 750,000 yr.

 

[Doormat]

Quest recently made a big play to acquire all the pathology and lab medicine services of the large, apex health system in the state of Utah that owns 22 separate hospitals. The quest takeover would be have been a complete takeover. Quest would have put in their own instrumentation and hired their own people. Even the MLSs in the hospital labs would be Quest employees. It came so close to happening that it was terrifying to those even on the outside looking in. I believe ultimately it did not happen because of intervention of the board of directors of the health system and the inability to terminate the arrangement once Quest takes over.

I believe this was triggered when McKinsey & company consulting (think Jeff Skilling at Enron) was hired by the apex health system to streamline and increase profitability.

 

[LADoc00]

Quest recently made a big play to acquire all the pathology and lab medicine services of the large, apex health system in the state of Utah that owns 22 separate hospitals. The quest takeover would be have been a complete takeover. Quest would have put in their own instrumentation and hired their own people. Even the MLSs in the hospital labs would be Quest employees. It came so close to happening that it was terrifying to those even on the outside looking in. I believe ultimately it did not happen because of intervention of the board of directors of the health system and the inability to terminate the arrangement once Quest takes over.

I believe this was triggered when McKinsey & company consulting (think Jeff Skilling at Enron) was hired by the apex health system to streamline and increase profitability.

This is almost too good to be true. This the ultimate Game of Thrones and you are the faceless man, a pitiless assassin able to move through any city unrecognized and take skulls. I can only imagine how many millions you could extract from Quest if they had to pay you to go away. Otherwise you are permanent menace, popping up randomly, filing lawsuit after lawsuit. Waging a guerrilla war behind the scenes. Im gonna be honest, this sounds awesome.

You become the ultimate Quest nemesis, perhaps even take on a secret hero persona like Brown Panther or something.

 

[deleted314957]

QUOTE="LADoc00, post: 20103442, member: 52131"]Huh, this is a fascinating scenario. I need to know EXACTLY what the arrangement is to comment with any authority.

1.) Is Quest just being used as an outsourced staffing arm for the CLS and Lab Admin director?
2.) Is Quest actually doing the medical directorship of the clin lab itself?
3.) Is your name still on the CLIA license or has that been changed to a Quest Pathologist?

Honestly, if you spun this right, it could be a dream come true. If you played your hand wrong, it could be a catastrophic disaster.

What I would do:8
1.) Tell Quest they are responsible for ALL call for clinical lab and anatomic, ALL inspections and ALL onsite admin decision making. They can separately contract with you down the road. Down the road tell them you will charge $50,0000 mo minimum or charge a per hour rate based on your personal availability (which will be very limited).
2.) Tell Quest they are responsible for all anatomic technical functioning including ALL grossing. You will onsite supervise NOTHING. EVER. You will have a courier pick up slides and bring them to your den with eggs, bacon and coffee whilst you sit in your pj's and sign out cases. You will bill solely for your AP pro fees. but you will do nothing else. Literally. Even if the lab is on fire, you whilst not relieve yourself to put said fire out.
3.) You will attend NO meetings at all anywhere unless it is at a bar in Las Vegas and they give you a suite at the Encore. All staff meeting, will be attended to by Quest pathologists with no exceptions.
4.) Most importantly, this agreement will have the maximum no compete with the maximal penalties allowed by law. I believe in MS and other southern states this is near insane levels of automatic damages, we are taking 10-20 million automatically paid to you should Quest attempt to take your AP component revenue.
5.) You should encourage them to take your revenue any chance you get.

Bait them into the trap, get a solid attorney and you will reap a massive whirlwind of cash. With 10 million in capital and even a half competent money man, you should be living forever on a passive income train of 750,000 yr.[/QUOTE]

Hmm. Let’s see. 7 1/2% “no brainer” passive income stream yield $750,000/yr
froma $10,000,000 grub stake. Not without significant risk and no
diminution of principal. I know from experience.

 

[pianoguy05]

I orgasmed reading this. Thank you for that.

Huh, this is a fascinating scenario. I need to know EXACTLY what the arrangement is to comment with any authority.

1.) Is Quest just being used as an outsourced staffing arm for the CLS and Lab Admin director?
2.) Is Quest actually doing the medical directorship of the clin lab itself?
3.) Is your name still on the CLIA license or has that been changed to a Quest Pathologist?

Honestly, if you spun this right, it could be a dream come true. If you played your hand wrong, it could be a catastrophic disaster.

What I would do:
1.) Tell Quest they are responsible for ALL call for clinical lab and anatomic, ALL inspections and ALL onsite admin decision making. They can separately contract with you down the road. Down the road tell them you will charge $50,0000 mo minimum or charge a per hour rate based on your personal availability (which will be very limited).
2.) Tell Quest they are responsible for all anatomic technical functioning including ALL grossing. You will onsite supervise NOTHING. EVER. You will have a courier pick up slides and bring them to your den with eggs, bacon and coffee whilst you sit in your pj's and sign out cases. You will bill solely for your AP pro fees. but you will do nothing else. Literally. Even if the lab is on fire, you whilst not relieve yourself to put said fire out.
3.) You will attend NO meetings at all anywhere unless it is at a bar in Las Vegas and they give you a suite at the Encore. All staff meeting, will be attended to by Quest pathologists with no exceptions.
4.) Most importantly, this agreement will have the maximum no compete with the maximal penalties allowed by law. I believe in MS and other southern states this is near insane levels of automatic damages, we are taking 10-20 million automatically paid to you should Quest attempt to take your AP component revenue.
5.) You should encourage them to take your revenue any chance you get.

Bait them into the trap, get a solid attorney and you will reap a massive whirlwind of cash. With 10 million in capital and even a half competent money man, you should be living forever on a passive income train of 750,000 yr.

 

[AZpath]

Huh, this is a fascinating scenario. I need to know EXACTLY what the arrangement is to comment with any authority.

1.) Is Quest just being used as an outsourced staffing arm for the CLS and Lab Admin director?
2.) Is Quest actually doing the medical directorship of the clin lab itself?
3.) Is your name still on the CLIA license or has that been changed to a Quest Pathologist?

Honestly, if you spun this right, it could be a dream come true. If you played your hand wrong, it could be a catastrophic disaster.

What I would do:
1.) Tell Quest they are responsible for ALL call for clinical lab and anatomic, ALL inspections and ALL onsite admin decision making. They can separately contract with you down the road. Down the road tell them you will charge $50,0000 mo minimum or charge a per hour rate based on your personal availability (which will be very limited).
2.) Tell Quest they are responsible for all anatomic technical functioning including ALL grossing. You will onsite supervise NOTHING. EVER. You will have a courier pick up slides and bring them to your den with eggs, bacon and coffee whilst you sit in your pj's and sign out cases. You will bill solely for your AP pro fees. but you will do nothing else. Literally. Even if the lab is on fire, you whilst not relieve yourself to put said fire out.
3.) You will attend NO meetings at all anywhere unless it is at a bar in Las Vegas and they give you a suite at the Encore. All staff meeting, will be attended to by Quest pathologists with no exceptions.
4.) Most importantly, this agreement will have the maximum no compete with the maximal penalties allowed by law. I believe in MS and other southern states this is near insane levels of automatic damages, we are taking 10-20 million automatically paid to you should Quest attempt to take your AP component revenue.
5.) You should encourage them to take your revenue any chance you get.

Bait them into the trap, get a solid attorney and you will reap a massive whirlwind of cash. With 10 million in capital and even a half competent money man, you should be living forever on a passive income train of 750,000 yr.

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Most small groups have little clout. It would be hard to sucker them into a more favorable deal and not for long.

Ultimately, most of us have 90 to 180 day no penalty termination on our contracts.
It would be easy for enough for Quest to bring in Ameripath and break the contract.

They get rid of the medical director and as many of pathologists as needed.
Often a few pathology will keep there jobs under new terms.

I think state law would have to be usually strong to allow for big damages. The non competes clauses go off once the contract terms out. You might have a contractual interference claim.
Obviously, check with an attorney. That might be a way of keeping there paws off pathology and the part A contract.

 

[y2k_free_radical]

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Most small groups have little clout. It would be hard to sucker them into a more favorable deal and not for long.

Ultimately, most of us have 90 to 180 day no penalty termination on our contracts.
It would be easy for enough for Quest to bring in Ameripath and break the contract.

They get rid of the medical director and as many of pathologists as needed.
Often a few pathology will keep there jobs under new terms.

I think state law would have to be usually strong to allow for big damages. The non competes clauses go off once the contract terms out. You might have a contractual interference claim.
Obviously, check with an attorney. That might be a way of keeping there paws off pathology and the part A contract.

This would be the outcome in most cases i fear, based on having seen the replacement of almost all pathologists who dared to challenge management.

 

[Unty]

Is Quest/Ameripath basically buying all practices? Someone educate me. Eventually will all pathologists be working for large health systems and corporate labs?

 

[LADoc00]

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Most small groups have little clout. It would be hard to sucker them into a more favorable deal and not for long.

Ultimately, most of us have 90 to 180 day no penalty termination on our contracts.
It would be easy for enough for Quest to bring in Ameripath and break the contract.

They get rid of the medical director and as many of pathologists as needed.
Often a few pathology will keep there jobs under new terms.

I think state law would have to be usually strong to allow for big damages. The non competes clauses go off once the contract terms out. You might have a contractual interference claim.
Obviously, check with an attorney. That might be a way of keeping there paws off pathology and the part A contract.

I think people always think they have less clout than they might actually wield. I wouldnt be so sure. Know the law, take responsibility for your "fences" and guard them.

I think many dont appreciate the "tortuous interference" legal doctrine. If you want to become a niche expert on something in law, that is it.

 

[AZpath]

I agree. That would be my strategy if outside party was soliciting business that impacts my contract.
I would be very quick to have my lawyer send a polite "happy to work with you but paws off pathology ".

 

[turtle1966]

I agree. That would be my strategy if outside party was soliciting business that impacts my contract.
I would be very quick to have my lawyer send a polite "happy to work with you but paws off pathology ".

Unless, your contract contains a "no alternative exploration during the contractual period by the Hospital" clause, you will not have a ground against the Hospital. Against your competitor? Not even in your dreams.

I had long warned about the National Labs salivating over in-hospital business, which is many times over the outpatient business size. Yeah, National Labs can do with cheaper FMG pathologists, and not necessarily with the best of the best AMG pathologists. This is why having an oversupply of FMG pathologists will ultimately come back to bite the USG pathologists.

 

[Unty]

Unless, your contract contains a "no alternative exploration during the contractual period by the Hospital" clause, you will not have a ground against the Hospital. Against your competitor? Not even in your dreams.

I had long warned about the National Labs salivating over in-hospital business, which is many times over the outpatient business size. Yeah, National Labs can do with cheaper FMG pathologists, and not necessarily with the best of the best AMG pathologists. This is why having an oversupply of FMG pathologists will ultimately come back to bite the USG pathologists.

Oh here we go again that AMG I'm better than FMG debate.

Tired of all the discrimination on here. Seriously it is turning into that. Most of the attendings that I trained with were all FMGs and were all competent surgical pathologists having many many years of experience. All this FMG and AMG talk is bordering racism and discrimination. Deal with it. Since I've been in pathology, most of the people I trained with and trained under were almost all FMGs or US international grads.

You are putting a stereotyping on FMGs as being cheap and beneath American grads. That is certainly not true and is discrimination. There are bunch of FMGs in other fields. Are all FMGs inferior to you?

I know some American grads and sorry they aren't all great.

I guess some of us have to belittle foreigners to make themselves feel better.

 

[turtle1966]

Oh here we go again that AMG I'm better than FMG debate.

Tired of all the discrimination on here. Seriously it is turning into that. Most of the attendings that I trained with were all FMGs and were all competent surgical pathologists having many many years of experience. All this FMG and AMG talk is bordering racism and discrimination. Deal with it. Since I've been in pathology, most of the people I trained with and trained under were almost all FMGs or US international grads.

You are putting a stereotyping on FMGs as being cheap and beneath American grads. That is certainly not true and is discrimination. There are bunch of FMGs in other fields. Are all FMGs inferior to you?

I know some American grads and sorry they aren't all great.

I guess some of us have to belittle foreigners to make themselves feel better.

I absolutely had no such an intention. My apologies. I was using a "statistical perception" to explain why any oversupply of pathologists is bad.

 

[deleted314957]

Oh here we go again that AMG I'm better than FMG debate.

Tired of all the discrimination on here. Seriously it is turning into that. Most of the attendings that I trained with were all FMGs and were all competent surgical pathologists having many many years of experience. All this FMG and AMG talk is bordering racism and discrimination. Deal with it. Since I've been in pathology, most of the people I trained with and trained under were almost all FMGs or US international grads.

You are putting a stereotyping on FMGs as being cheap and beneath American grads. That is certainly not true and is discrimination. There are bunch of FMGs in other fields. Are all FMGs inferior to you?

I know some American grads and sorry they aren't all great.

I guess some of us have to belittle foreigners to make themselves feel better.

Please, let us not start with the “racism” bit. Bigotry and prejudice may
be more appropriate. But please get off the racism bandwagon.

 

[AZpath]

I don't care what you call it. It is wrong and untrue.

 

[turtle1966]

I don't care what you call it. It is wrong and untrue.

Often, the answers in this Board, to the question "should I enter the field of pathology?" follows the form: "if you are an AMG, not obnoxious... you will be fine."

Would you say that the answer implies something?

 

[AZpath]

Turtle your statement was very very benign.
Too many of the AMG/FMG statements around here are pretty sad. We should be thoughtful to both FMG and AMG colleges.

 

[turtle1966]

Turtle your statement was very very benign.
Too many of the AMG/FMG statements around here are pretty sad. We should be thoughtful to both FMG and AMG colleges.

I agree. Respect IMGs. Remember the Aesop's fable of mighty trapped Lion lion saved by mice. We should work together to ameliorate the oversupply.