Prostate biopsy update.

[pathstudent]

Was at a nye party last night and had a conversation with a urologist and orthopedic surgeon. They were discussing how the Immediate future of medicine will be multi-specialties group specialties (i.e. subspecialty surgeons employing their own hospitalists, anesthesiiologists, etc..,).

The conversation turned to pathology and prostate biopsies. The urologist addressed me and said "I know you are not going to like hearing us but we have a pathologist. We bill for the tc and then pay him a salary which is about 33% of the pc". He said the pathologist was a gu trained guy a couple years out of fellowship and did the work for five different urology groups He then stated that the local branch of ameripath had low balled the insurance companies and contracted for a value that was so low that insurance companies made the urologist's pathologist out of network. So now for the major insurance companies all their prostate biopsies have to go ameripath or they patient will be miffed that they are paying for an out of network pathologist. He said they were going to give it another month or two and then probably fire their pathologist.

I have mixed feelings about this. I am glad the urologist's pathologist is going to get fired. These guys that will work for a fraction of the pc are parriahs. I don't care if he has a new mortgage and kids starting off in grade school. He is a turncoat pathologist, and he is reaping what he sowed. Plus I am glad to see the revenue source for the urologists dry up. It has been a highly unethical uncollegial practice on their part. But the power move by ameripath doesn't bode well for the field as a whole. It is not a system that values quality, service or relationships. It is a sweatshop mentality. So begins 2013.

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[mlw03]

So what's your ideal? I see a lot of your posts bemoaning the current state, but what's the best you would hope for in the modern business of pathology? Presumably you'd like to see the money stay with the pathologist, but how does that occur in the modern healthcare world?

 

[Path or bust]

So what's your ideal? I see a lot of your posts bemoaning the current state, but what's the best you would hope for in the modern business of pathology? Presumably you'd like to see the money stay with the pathologist, but how does that occur in the modern healthcare world?

Stop client billing. Decrease supply. CMS cut of 50% on 88305 TC should help alot. Many of these things have already been discussed in other threads.

 

[mlw03]

Stop client billing. Decrease supply. CMS cut of 50% on 88305 TC should help alot. Many of these things have already been discussed in other threads.

Please explain "client billing" for those of us who aren't in private practice pathology. I am not familiar with this term, so I don't understand it in the context of this discussion.

 

[pathstudent]

Please explain "client billing" for those of us who aren't in private practice pathology. I am not familiar with this term, so I don't understand it in the context of this discussion.

Here is a very good explanation about client billing
http://www.cap.org/apps/cap.portal?...lling.html&_state=maximized&_pageLabel=cntvwr

 

[mlw03]

Here is a very good explanation about client billing
http://www.cap.org/apps/cap.portal?...lling.html&_state=maximized&_pageLabel=cntvwr

Interesting piece. Thank you for sharing. The client billing does seem a bit shady, as presented there, although I imagine there are some "pros" to the practice I'm not seeing. But I think Dr. Wright makes good points about pathologists having to become more like other doctors and less like über-techs to really gain back some professional standing.

 

[Path or bust]

pathologists having to become more like other doctors and less like über-techs to really gain back some professional standing.

Yup, exactly. I wonder if this happens to radiologists?

 

[pathstudent]

So what's your ideal? I see a lot of your posts bemoaning the current state, but what's the best you would hope for in the modern business of pathology? Presumably you'd like to see the money stay with the pathologist, but how does that occur in the modern healthcare world?

That's a good question. I used to think that one day we would get the gi and prostate back, but I could tell by talking to the Urologist last night that these specimens were never coming back to my hospital based practice.

Imagine if you needed a urologist. Can you imagine if your internist was biling for your urologists services and was using the urology group that would do the work for the least possible amount of money. That would be absurd because it would be unethical and illegal, and the urologist wouldn't accept it and you as a patient wouldnt go for it either. But this is how the real world of pathology works.
I would like pathologists to be treated the same as other physicians. That would be a start.

 

[WEBB PINKERTON]

The "turncoats" in pathology sold their practices years ago and threw all of the future generations under the bus.

So now the pathologist gets to work for Ameripath. How is that any better exactly?

So what are you gonna do about managed care contracts?

 

[LADoc00]

Im confused. Ameripath did an end run around everyone and contracted directly with insurance payors? Im not sure how that is even possible. That would be an open and shut anti-competitive business practices case where Im from unless there is a WHOLE LOT MORE to the story.

Realize in California alone, Quest and LabCorpofAmer were ordered to pay over half a BILLION dollars for a scheme even less obviously illegal than that.

If I was a pathologist in that state I would immediately file a lawsuit vs. Ameripath.

 

[pathstudent]

Im confused. Ameripath did an end run around everyone and contracted directly with insurance payors? Im not sure how that is even possible. That would be an open and shut anti-competitive business practices case where Im from unless there is a WHOLE LOT MORE to the story.

Realize in California alone, Quest and LabCorpofAmer were ordered to pay over half a BILLION dollars for a scheme even less obviously illegal than that.

If I was a pathologist in that state I would immediately file a lawsuit vs. Ameripath.

Our group contracts directly with insurance payors. Why couldn't Ameripath?

But there probably is a lot more to the story. I'll have to bring it up the next time I am with one of the Ameripath pathologists that isn't drinking the Ameripath kool-aid and see what I can learn.

 

[LADoc00]

Our group contracts directly with insurance payors. Why couldn't Ameripath?

But there probably is a lot more to the story. I'll have to bring it up the next time I am with one of the Ameripath pathologists that isn't drinking the Ameripath kool-aid and see what I can learn.

Hold it. Yes sure Ameripath can contract directly with insurance payors but it is HIGHLY ILLEGAL to then turnaround and refuse to make in network all the other providers in the area.

Highly illegal. Like I could have the "crappiest attorney in the entire country and still win my case" illegal.

 

[pathstudent]

You are right.

We have contracts with all the insurance companies. As do all the pathology groups in town. So maybe it is just the GU-Urology pathologist who has been kicked out of network.

Maybe the insurnace companies know the self-referal nature of the urology business is increasing their expenses and they are taking the bull by the horns.

Maybe I should call back the urologist and say "hey if you don't want to use Ameripath we'll take the biopsies off your hands". We have experienced insurance companies trying to direct anatonmic pathology before.

 

[LADoc00]

You are right.

We have contracts with all the insurance companies. As do all the pathology groups in town. So maybe it is just the GU-Urology pathologist who has been kicked out of network.

Maybe the insurnace companies know the self-referal nature of the urology business is increasing their expenses and they are taking the bull by the horns.

Maybe I should call back the urologist and say "hey if you don't want to use Ameripath we'll take the biopsies off your hands". We have experienced insurance companies trying to direct anatonmic pathology before.

This also doesnt make any sense to me because Ameripath doesnt have any Urologists so who is actually doing the biopsies then??

Also you cant really kick someone out of a network midstream without cause, that is illegal.

Insurance companies have no ability whatsoever to "take the bull by the horns" in your example. In fact, quite the opposite. If a payor has NO GU service providers in an area, they are actually barred from selling insurance products there OR must pay has the full rate for that provider and give the insured the benefit of a in network provider. This is a common occurrence for derm practices.

If I was at a NYE party where that happened I would:
1.) tell the Urologist to put his drink down and tell me EXACTLY wtf he is blabbering about.
2.) explain to him if necessary where he might be educated on this wonky thing we call business law

 

[pathstudent]

This also doesnt make any sense to me because Ameripath doesnt have any Urologists so who is actually doing the biopsies then??

Also you cant really kick someone out of a network midstream without cause, that is illegal.

Insurance companies have no ability whatsoever to "take the bull by the horns" in your example. In fact, quite the opposite. If a payor has NO GU service providers in an area, they are actually barred from selling insurance products there OR must pay has the full rate for that provider and give the insured the benefit of a in network provider. This is a common occurrence for derm practices.

If I was at a NYE party where that happened I would:
1.) tell the Urologist to put his drink down and tell me EXACTLY wtf he is blabbering about.
2.) explain to him if necessary where he might be educated on this wonky thing we call business law

This is a local private urology group. The urologist clearly was under the impression that he couldn't send his biopsies to his group's pathologist and had to send them to Ameripath. But clearly he doesn't have to. But we have had experience with insurance companies sending letters to clinicians and saying they should send the AP to Quest or Lab Corp or whoever, even though we have a contract with the insurance company to.

Yes insurance companies kick someone out of network. The contracts specify how they can be terminated. I have seen it happen to groups of docs, surgey centers and to hospitals.


But yes. I do think there is more to this.

 

[LADoc00]

You cant be kicked out, you might not renew with an insurance provider due to their crappy terms but insurance companies dont sit around and throw empty beer cans at projected images of docs on Friday TGIFs "kicking people out of network."

I would love it if they did do that, I could retire with all my lawsuit winnings. Where do you live? Maybe I could throw up some sham practice locs with the sole intention of litigating til the cows come home!!

 

[lipomas]

Pathstudent,

Regarding the bolded part of your post, an internist client billing a urologist would not be illegal. If such activity were illegal, it would not be allowed to happen to pathology. But it does.

I think the reason this type of thing doesn't happen is because pathologists are such an easy target, specimens can be mailed (patients cannot), etc etc.

Wrong wrong wrong, don't say it "doesn't happen."

If the internist employed the urologist he could bill for his service. I have seen this happen - internists who are quite entrepreneurial often contract with other specialists to come to their clinic. And they don't always pay them the full rate, which you can justify by saying the hired doc doesn't have to worry as much about adminsitrative stuff.

You people all do realize that clinicians in every specialty serve as employees for which they take reduced compensation from what they bill, don't you? God in heaven there is a poor understanding of medical economics on this forum.

Now, of course, saying that it is unethical that urolgoists among others exploit pathologist is wholly appropriate for this forum and is accurate. And the problem is probably more acute and problematic in pathology than other fields. But don't be ignorant and compare pathology to some idealized version of reality. Compare it to reality.

 

[lipomas]

yep. I referenced it above. Lots of times it's for "part time" work though, like one afternoon a week or something. I don't really know tons of details.

Clinicians do this with radiologists too - especially orthopedists who own their own MRIs and stuff. And urologists employ rad oncs in the same fashion.

 

[pathstudent]

But above you used the word "hired", implying the invited specialist is employed by the internist. Are you saying that they are actually independent specialists who see patients in an internist's office and the internist compensates the specialist at a lower rate, bills for the full amount and pockets the difference?

If so, that would be fairly close to what is happening with pathology client billing but not identical. After all, it is the internist's brick and mortar and office infrastructure the specialist is using, and one could theorize the reduced compensation the specialist gets is "rent" for office space and personnel (which you mentioned).

Obviously with pathology client billing, the referring docs have zero equity invested in the pathology lab and still get to reach into pockets and make money for doing nothing.

And with respect to the ortho and rad onc examples you used, the referring physicians have paid for the MRI and linear accelerator machines and the technicians to run them and the office space to put them in, and a much stronger argument could be made that they are entitled to the technical fee for that.

But again, docs who client bill for path work have spent zero dollars on any lab equipment, real estate, personnel costs, etc.

So those arrangements are close, but in my opinion, are not identical to path client billing.

Thoughts?

Lipomas is simply being contrarian. It doesn't happen in any community I have ever seen. The urologists own their own urologic hospital for christ's sake. They aren't going to an internists office and see patients, performing procedures and let the ruddy internists bill for them.

 

[2121115]

It is key to this discussion to understand that client billing and in office pathology are two different issues.

 

[MOHS_01]

You cant be kicked out, you might not renew with an insurance provider due to their crappy terms but insurance companies dont sit around and throw empty beer cans at projected images of docs on Friday TGIFs "kicking people out of network."

I would love it if they did do that, I could retire with all my lawsuit winnings. Where do you live? Maybe I could throw up some sham practice locs with the sole intention of litigating til the cows come home!!

I imagine the scenario going something like this:

- new player (of a critical mass) enters the market at a "favorable" rate
- prompting plan to send out "updated" fee schedules in accordance to contractual obligation
- choice by provider groups to: a) remain in network at new fee schedule b) terminate in network status or c) attempt a negotiation

Depending upon the specifics of any given market, this is not only a plausible scenario -- it is a likely one. As pathologists y'all are kinda ****ed -- you have little to no direct patient contact, therefore no pissed off patients complaining to their HR departments and, thus, no pissed off HR departments applying pressure for conflict resolution.

Pretty ****ty environment that some specialties have to work within. We have our own battles, but the structural headwinds y'all face would be tough to overcome (or even work around without selling your souls to some hospital / megagroup / specialty provider group devil).

 

[yaah]

Lipomas is simply being contrarian. It doesn't happen in any community I have ever seen. The urologists own their own urologic hospital for christ's sake. They aren't going to an internists office and see patients, performing procedures and let the ruddy internists bill for them.

I have heard of this happening too - I know next to nothing about it though, just that an internist-owned clinic hires specialists to come and see patients there. I don't know the compensation scheme though.

 

[pathstudent]

I have heard of this happening too - I know next to nothing about it though, just that an internist-owned clinic hires specialists to come and see patients there. I don't know the compensation scheme though.

You are another contrarian too. Yes I am sure it is rampant where you live. Urologists coming to perform biopsies and do procedures, gi docs coming to do endoscopy, derm guys coming to do skin biopsies and examinations, and letting the Internest keep 75% of the pc and 100% of the facility fee. It is no different than pathology, right?

I am sure the derm forums are full of gripes about how their most common and lucrative practices are being billed for by family practice docs with them receiving less than 50% on the dollar.

 

[yaah]

You are another contrarian too. Yes I am sure it is rampant where you live. Urologists coming to perform biopsies and do procedures, gi docs coming to do endoscopy, derm guys coming to do skin biopsies and examinations, and letting the Internest keep 75% of the pc and 100% of the facility fee. It is no different than pathology, right?

I am sure the derm forums are full of gripes about how their most common and lucrative practices are being billed for by family practice docs with them receiving less than 50% on the dollar.

All I said was that I have heard of it happening. Nowhere did I say it was widespread. Why don't you stop reading into things or putting words into others' mouths. This forum is way too full already of people who only see what they want to see, and those who refuse to ever consider another opinion.

 

[ttl2]

Glad to hear that. I know of pathologists who are even 'servicing' the GI/GU docs for 10-14% of their PC!

 

[LADoc00]

Glad to hear that. I know of pathologists who are even 'servicing' the GI/GU docs for 10-14% of their PC!

10% of Medicare?
Wha?! No way, that is like 3-4 bucks a slide. No one on Earth, even in India or rural China could swing that.

 

[vistaril]

10% of Medicare?
Wha?! No way, that is like 3-4 bucks a slide. No one on Earth, even in India or rural China could swing that.

people in at least one community are reading them for 11-12 bucks a slide(and that has the potential to always be negotiated down)

 

[icpshootyz]

Again, thanks for the Psychiatry input, vistaril. Always appreciated.

 

[vistaril]

Again, thanks for the Psychiatry input, vistaril. Always appreciated.

you're welcome. Hey if your wife is a psychiatrist and she tells you things relevant to her field and you want to post it over in psych...go for it. would be very welcome.

 

[icpshootyz]

Except your wife isn't a pathologist. She's a GI doc looking to screw pathologists out of their earnings for her own benefit in a glorified kickback scheme. Congrats.

 

[vistaril]

Except your wife isn't a pathologist. She's a GI doc looking to screw pathologists out of their earnings for her own benefit in a glorified kickback scheme. Congrats.

those who are strong and have leverage dominate those who are weak and don't.....in every aspect.

I've said it before- the essential problem is that the cms reimbursement for these slides seems to be inflated. Seeing how it is 'extra' money anyways above the value of the service, it may as well go to the GI.....just my opinion of course.

If the pc went down to what it probably should be in the first place for these slides(and the tc kept falling), then GI wouldnt have any interest in doing it because it wouldnt be feasible.

 

[pathstudent]

those who are strong and have leverage dominate those who are weak and don't.....in every aspect.

I've said it before- the essential problem is that the cms reimbursement for these slides seems to be inflated. Seeing how it is 'extra' money anyways above the value of the service, it may as well go to the GI.....just my opinion of course.

If the pc went down to what it probably should be in the first place for these slides(and the tc kept falling), then GI wouldnt have any interest in doing it because it wouldnt be feasible.

Wrong wrong wrong. Imagine if fam practice docs required 75% of gastroenterologists reimbursement in order to refer thei patient.

Would that mean that gi docs were paid too much?

No. That doesn't happens because that would be so blatantly unethical and illegal. For reason it is allowed to go on with pathology referral. Hopefully one day it will stop.

But I don't think you will understand that and you are nothing but a megatroll.

 

[vistaril]

Wrong wrong wrong. Imagine if fam practice docs required 75% of gastroenterologists reimbursement in order to refer thei patient.

Would that mean that gi docs were paid too much?
.

you apparently missed what I wrote about leverage and who has it. In the gi/fam doc example, the fam doc has no leverage. If anything, the gi doc has it iver the family doc. Fam docs don't want to tick GI's off or they won't schedule their nonurgent patients soon, the pt will get upset, and then find another family doc who can get them into specialists when needed sooner.

In the case of pathologists, if a small path group is upset at a GI or uro group, the GI or uro group will just send the tissue to quest or whatever. The patients don't mind either way. You guys know that.

 

[icpshootyz]

you apparently missed what I wrote about leverage and who has it. In the gi/fam doc example, the fam doc has no leverage. If anything, the gi doc has it iver the family doc. Fam docs don't want to tick GI's off or they won't schedule their nonurgent patients soon, the pt will get upset, and then find another family doc who can get them into specialists when needed sooner.

In the case of pathologists, if a small path group is upset at a GI or uro group, the GI or uro group will just send the tissue to quest or whatever. The patients don't mind either way. You guys know that.

BS and you know it. The GI doc has leverage over the Family doc? What world do you live in? Unless you live in rural Podunk USA, if one GI group won't see your patients fast enough, you simply refer to a different GI group. GI depends on internists and general practitioners for their business, not the other way around. There's GI docs on just about every corner around here, from academic centers to private offices. Dime a dozen.

 

[2121115]

Just because someone will do something for less, doesn't mean that the service is overvalued. You think if colonoscopies got cut 30% that GI docs would quit doing them? Does that mean they are overvalued? LOL. Everything in medicine gets reimbursement cut all the time and docs keep doing all of them. By that logic all of medicine is overvalued.

 

[vistaril]

BS and you know it. The GI doc has leverage over the Family doc? What world do you live in? Unless you live in rural Podunk USA, if one GI group won't see your patients fast enough, you simply refer to a different GI group. GI depends on internists and general practitioners for their business, not the other way around. There's GI docs on just about every corner around here, from academic centers to private offices. Dime a dozen.

1) There is a big middle ground between 'rural podunk USA' and LA/NYC/Chicago/etc. The reality is that most americans live somewhere in that middle ground. And the reality is that in many of those places some specialists are in somewhat more demand(vs supply) than others. GI isn't derm or anything in this regard, but the supply is usually tight enough that family docs and pcps dont have enough leverage to get anything out of it(but their pt seen)

2) The market proves I am right. Do you really think there is something inherently greedy/evil/whatever about uro/derm/GI that general internists dont have? Of course not.....

 

[icpshootyz]

2) The market proves I am right. Do you really think there is something inherently greedy/evil/whatever about uro/derm/GI that general internists dont have? Of course not.....

If you can't see the greed in billing for PATHOLOGIST services at full reimbursement (PC around $32) and then only paying the PATHOLOGIST a fraction of that ($9-11) yet KEEPING THE REST, even though you provided zero absolutely nil of that service, then sorry your ethics are so far gone we can't help you. The only reason whatsoever that you're even in here arguing for this is that your fiance is going to profit by it, and indirectly you are. If you're so concerned that pathology is being overpaid, you'd think you'd be pushing her to return that money to Medicare and save the taxpayers money, no? Nah, instead you're gonna buy yourself a nicer car or a vacation home, right? Sorry, you and her have NO ethics. The market? Sure, you sound like a big proponent. Guess I'll use my AMA vote to push for psychologists and psych NP's to get full prescribing rights and independent practices, since that would be better for the free market.

 

[pathstudent]

Vistaril once again reinforces that psychaitrists are more off than their patients.

What kind of doc goes out of their way to antagonize another specialty? What's the gain?

 

[Enkidu]

The market proves I am right. Do you really think there is something inherently greedy/evil/whatever about uro/derm/GI that general internists dont have? Of course not.....

Well - there *is* something greedy/evil/whatever about profiting off of ordering tests and making referrals. You can't seriously be disputing this.

These market based arguments that you're making are absurd. I mean - physicians might do pretty well to run their own in-office pharmacies too and make 75% off of every prescription. Clearly they have the "market leverage", but that leads to ridiculous abuse.

But yeah, maybe a lot of physicians would be tempted to act unethically - because they can make a lot of money doing it. The problem is that it ultimately harms their patients. Well, if you're willing to harm your patients in order to make extra money, then there are probably plenty of opportunities for you, but I probably wouldn't defend the practice on an internet forum.

 

[Enkidu]

If you can't see the greed in billing for PATHOLOGIST services at full reimbursement (PC around $32) and then only paying the PATHOLOGIST a fraction of that ($9-11) yet KEEPING THE REST, even though you provided zero absolutely nil of that service, then sorry your ethics are so far gone we can't help you. The only reason whatsoever that you're even in here arguing for this is that your fiance is going to profit by it, and indirectly you are. If you're so concerned that pathology is being overpaid, you'd think you'd be pushing her to return that money to Medicare and save the taxpayers money, no? Nah, instead you're gonna buy yourself a nicer car or a vacation home, right? Sorry, you and her have NO ethics. The market? Sure, you sound like a big proponent. Guess I'll use my AMA vote to push for psychologists and psych NP's to get full prescribing rights and independent practices, since that would be better for the free market.

But suppose an MBA bought a lab and hired a bunch of pathologist and paid them next to nothing - as long as he didn't have any impact on clinical decision making, then it doesn't seem unethical. And then suppose that instead of an MBA, it was a GI doc - that seems fine too. (I mean - it sucks to not pay your employees well, but that's more-or-less business, isn't it?). But once the GI doc says that only *his* personal specimens and those of the others in his practice will be processed in the lab and that profit from that work would go directly to the the only allowed referral source, which is himself... Then *that* is an incredibly unethical setup.

I mean, otherwise it is just an issue of capital, right? If some non-pathologist doucher owns a pathology practice and gets all of the profit from it, the value of the practice would at least be calculable from the profit of the practice and he would presumably be willing to sell it to the pathologist for the right price- but once it is married to a specific GI practice then the value can't be determined because the the demand for pathology services goes through the roof since the GI guys themselves can simply send more, if they want. That's not a market situation at all - no amount of "free market leverage" or whatever can justify it, because *that* is not a functioning market - so it should be illegal.

 

[vistaril]

Well - there *is* something greedy/evil/whatever about profiting off of ordering tests and making referrals. You can't seriously be disputing this.

These market based arguments that you're making are absurd. I mean - physicians might do pretty well to run their own in-office pharmacies too and make 75% off of every prescription.

ummm....if this was a viable practice model they would. But it isn't except in certain situations(illegal pill mills and occasional late hours urgent clinic clinics)......

 

[Enkidu]

ummm....if this was a viable practice model they would. But it isn't except in certain situations(illegal pill mills and occasional late hours urgent clinic clinics)......

Um - that was my point. It's unethical and harms patients - so illegal. Self referring to your own pathology lab is the same and should also be illegal.

 

[vistaril]

Um - that was my point. It's unethical and harms patients - so illegal. Self referring to your own pathology lab is the same and should also be illegal.

no, you dont see 'in house pharmacies' at most physician practices not because it is unethical and harms patients but rather because it is not efficient and a viable business model. If it was, you would.

 

[malchik]

It is illegal because it isn't a viable practice model?

 

[vistaril]

It is illegal because it isn't a viable practice model?

not an expert on these laws, but I do know of pharmacies attached to/inside clinics in some cases that fill prescriptions on site for the drugs prescribed at the practice....

 

[Enkidu]

And the physicians profit off of the drugs that they prescribe? If this isn't illegal, then it's certainly unethical.

 

[icpshootyz]

It's illegal.

 

[Path or bust]

no, you dont see 'in house pharmacies' at most physician practices not because it is unethical and harms patients but rather because it is not efficient and a viable business model. If it was, you would.

In Texas, if its not a rural area of less than 3000 people, its illegal and you go to prison. Keep walking that fine line and you will find yourself there.

 

[LADoc00]

File this under "random crap that is illegal for no reason" and then tell us why Kaiser Permenante can vertically integrate to not only have employed MDs, Chiropractors etc but also have pharmacies and optical retail shops in house?

That is the U.S. in a nutshell if you are a Stanford, Crocker, Hopkins, Morgan, Rockefeller or Doheny (and consequently Henry Kaiser), the laws dont apply because you are "too big to fail" or some crap.

What a load!!

 

[TMZ2007]

There are pharmacies staffed by med school employees in several of the new outpt clinic buildings on our campus. The med school docs encourage all the patients to utilize them, mainly because they are the cheapest pharmacy in town. This is illegal? Or is the restriction only against privately owned physician offices owning pharmacies...?