Prostate biopsy update.

[Enkidu]

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!!

Um - I think it's illegal for a good reason. If the patient is being directed to fill their prescription at an in-house pharmacy, and the profits from the pharmacy go back to the physician, they will be motivated to prescribe more expensive drugs and more of them. It's exactly the same as having an in-house pathology lab.

There can be an in-house pharmacy and whatever else - that's not a problem. It's only a problem when the profits from the pharmacy go back to the physician in any way. If the same company is paying both the physician and running the pharmacy, that should be fine as long as the physician isn't getting a bonus for prescribing particular "profitable" drugs.

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[Enkidu]

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...?

I don't think that the med school docs have a financial interest in this pharmacy any more than they have a financial interest in sending more biopsies to their own pathology department. These situations are only problematic if the university itself were providing bonuses to urologists for sending more specimens (or more containers) to pathology in order to increase its profits. I don't think that this happens.

 

[vistaril]

It's illegal.

Just looked it up and in a lot of states it isn't. In a few states it is illegal with a few exceptions.

 

[icpshootyz]

It's illegal in mine, and it's illegal in many. If that doesn't make you think twice about the ethics of it, so be it. But your ethics sound a little lacking from your posts on here anyway, so I doubt it's keeping you up at night. Or your fiance.

 

[vistaril]

It's illegal in mine, and it's illegal in many. If that doesn't make you think twice about the ethics of it, so be it. But your ethics sound a little lacking from your posts on here anyway, so I doubt it's keeping you up at night. Or your fiance.

no...I seriously dout providing *IN OFFICE* coordinated services vs sending it off to a lab 2000 miles away is keeping her up at night.

 

[icpshootyz]

Ah yes, I forgot. And what pathology services does your gastroenterologist fiance provide, hmm? I missed where you explained her pathology training, experience, and ability to provide diagnostic pathology services. Oh wait, that's right, she doesn't. She is just being hired by a GI practice that keeps a large portion of the pathology professional component for the clinicians, who already are reimbursed for the patient visit, the biopsy procedure, and the technical pathology service component. Silly me, she sounds SOOOOO ethical.

"Coordinated services" my rear. It has zero to do with improving patient care and EVERYTHING to do with $$$$$. Go blow smoke up someone else's rearend.

 

[Enkidu]

no...I seriously dout providing *IN OFFICE* coordinated services vs sending it off to a lab 2000 miles away is keeping her up at night.

Well - I suppose that if the *IN OFFICE* services that her practice provides are very valuable, then they should result in improved patient outcomes and/or lower cost.

If GI practices perform similarly to urology practices, then I'd guess that the opposite is the case. Probably your fiancee's practice performs more biopsies than necessary, for which patients pay for financially as well as in having a higher risk of complications.

But - on the bright side, what's bad for the patient is good for your fiance, apparently the scheme nets her $85,000 per year.

 

[Kunu]

You all do realize that instead of railing on this shrink guy because his sig-other hired a scab that if pathologists would take control of the profession and stop overproducing Paths and ones in established practices behaved fair, benevolent and humane to recent trainees instead of the selfish diks that they are then this wouldnt happen, right?

 

[icpshootyz]

Sure, path needs to reduce the number of trainees being pumped out. That has zero to do with the ethics of clinicians billing for pathology services, or whether the practice should be legislated out of existence.

 

[WEBB PINKERTON]

You all do realize that instead of railing on this shrink guy because his sig-other hired a scab that if pathologists would take control of the profession and stop overproducing Paths and ones in established practices behaved fair, benevolent and humane to recent trainees instead of the selfish diks that they are then this wouldnt happen, right?

The pathologists of the past were greedy cowards. The "establishment" threw the future generation of pathologists under the bus years ago by selling out when the going got rough.

 

[Enkidu]

The pathologists of the past were greedy cowards. The "establishment" threw the future generation of pathologists under the bus years ago by selling out when the going got rough.

I dunno - I guess you could say "hate the game, not the player".

But is there maybe some ethical imperative here? By "selling out" the way that they did, did the pathologists of the past somehow compromise current patient care?

 

[deleted314957]

The pathologists of the past were greedy cowards. The "establishment" threw the future generation of pathologists under the bus years ago by selling out when the going got rough.

Greedy? How about smart business people (who really didn't care about cutting YOU in on the business they established and grew.) You'd rather glom onto someone else's 20-30 years of labor and be be given the pie because they hired you and let the founders retire with a gold watch. You got a big chip Webb. Seems you don't like entrepenures

And "cowards" doesn't make sense. Did you just use it to complete the cliche of "greedy cowards"?

 

[pathstudent]

Greedy? How about smart business people (who really didn't care about cutting YOU in on the business they established and grew.) You'd rather glom onto someone else's 20-30 years of labor and be be given the pie because they hired you and let the founders retire with a gold watch. You got a big chip Webb. Seems you don't like entrepenures

And "cowards" doesn't make sense. Did you just use it to complete the cliche of "greedy cowards"?

I completely agree with mikesheree. I used to think like Webb Pinkerton but now I see that is how businesses are run. You start one and maybe it is successful and maybe it is not. Maybe you sell it or maybe you don't. And who is mikesheree supposed to think about, setting up his own wife, kids and grandkids or setting up webbpinkerton? Hate the game, not the playa.

 

[2121115]

Greedy? How about smart business people (who really didn't care about cutting YOU in on the business they established and grew.) You'd rather glom onto someone else's 20-30 years of labor and be be given the pie because they hired you and let the founders retire with a gold watch.

100% agree.

 

[lipomas]

"illegal" is a relative term anyway. It's only illegal if you get caught and punished. It is not illegal if you get a congressman to write a vague law that you can get by with shady tactics, and it isn't illegal if you get the congressman to write in exceptions to the law that apply to you.