Sordid details surrounding insourcing of AP by GI groups

[Doormat]

Look what I read today....

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[KeratinPearls]

50% of Medicare PC rates!?!

We got a SHORTAGE OF PATHOLOGISTS everyone! Lmao.

 

[Spikebd]

Look what I read today....

View attachment 354777

GI groups taking tips from academic path departments on how to scam paths out of money

 

[cmz]

I've seen worse.

 

[WEBB PINKERTON]

In-office labs have a bleak future. The businesses setting these up are getting desperate.

 

[Dave CX]

There is no way a 7 person group could legitimately produce 11k 305's. 5k tops.

 

[cmz]

There is no way a 7 person group could legitimately produce 11k 305's. 5k tops.

There's a group where I practice that seems to have a biopsy protocol for their EGD as follows:
1) Proximal esophagus;
2) Distal esophagus;
3) Gastric body;
4) Gastric fundus;
5) Gastric angularis;
6) Gastric antrum;
7) Duodenum, 2nd portion;
8) Duodenum, bulb.

Each esophagus gets Ab/PAS. Every GI bx gets Ab/PAS + HP IHC. Every duodenum bx gets CD3 and Ab/PAS.

I have a hard time finding intraepithelial lymphocytes on my duodenums, so should I start doing CD3 on every biopsy? Also, I don't want to miss the "subtle" gastric IM or "subtle" duodenal gastric foveolar metaplasia.... maybe I'll start doing Ab/PAS on every biopsy as well.

The colonoscopy specimens are pretty intense as well. Normally, you might think of a bunch of random right and left colon biopsies to rule out collagenous/lymphocytic colitis... why submit two jars when you can break things into quadrants or into smaller sectors?

This is not a common scenario and this group produces 300-400 88305s/day, on average. That's 6-8K 88305's per month. Please keep in mind this is a 7-8 person GI group at the moment. How long until the feds pinch these guys? I know it takes YEARS to build a case...

 

[Dave CX]

There's a group where I practice that seems to have a biopsy protocol for their EGD as follows:
1) Proximal esophagus;
2) Distal esophagus;
3) Gastric body;
4) Gastric fundus;
5) Gastric angularis;
6) Gastric antrum;
7) Duodenum, 2nd portion;
8) Duodenum, bulb.

Each esophagus gets Ab/PAS. Every GI bx gets Ab/PAS + HP IHC. Every duodenum bx gets CD3 and Ab/PAS.

I have a hard time finding intraepithelial lymphocytes on my duodenums, so should I start doing CD3 on every biopsy? Also, I don't want to miss the "subtle" gastric IM or "subtle" duodenal gastric foveolar metaplasia.... maybe I'll start doing Ab/PAS on every biopsy as well.

The colonoscopy specimens are pretty intense as well. Normally, you might think of a bunch of random right and left colon biopsies to rule out collagenous/lymphocytic colitis... why submit two jars when you can break things into quadrants or into smaller sectors?

This is not a common scenario and this group produces 300-400 88305s/day, on average. That's 6-8K 88305's per month. Please keep in mind this is a 7-8 person GI group at the moment. How long until the feds pinch these guys? I know it takes YEARS to build a case...

Thats disgusting.

 

[cmz]

Thats disgusting.

The GI has a TC-only lab. They send their slides to another path group ~300 miles away. How does one maintain a 24-48 hour TAT when you cannot technically have up-front stains ordered? I always question how such a group can read the H&E and get their HP, Ab/PAS, CD3 special stains in a timely manner. It must all be sent at the same time. The GI group seems to understand how to "maximize" billing. The path group they refer to also understands how to maximize billing but it is not doing anything to push back and say, "Hey some of these stains aren't medically necessary." In my eyes, two bad actors...

 

[deleted314957]

Paths “pushing back” is like a plaintiff’s attorney recommending mediation.