Tc bloodbath!

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Have you been under a rock?

This from CAP sorry for bad formatting, but every pathologists should do this. Even ones in training or ones that are completely detached from the business of pathology. Gutting the field is not good for anybody.

July 30, 2013
Your Immediate Action Needed
Fight CMS’ Proposal to Make Drastic Cuts to the Physician Fee Schedule in 2014
As you are well aware, the Centers for Medicare and Medicaid Services (CMS) recently proposed to radically cut the technical component (TC) and global payments for many anatomic pathology services by over 50% and as much as 80% for certain codes. If CMS finalizes this proposal, it will have devastating results. A 60 day comment period is underway. Our collective voice must be heard to prevent CMS from moving forward.
See the potential impact on your practice by reviewing the impact table.
The CAP is vigorously opposing these proposed payment cuts. Our efforts are focused on three tracks, regulatory, legal, and political. Your help is needed to succeed in our political advocacy efforts. Every Member of Congress must hear from you and your colleagues. Action is needed NOW to prevent these cuts from taking effect.
There are two vital actions you must take today:
1. Email your Member of Congress (sample text below). Tell him or her that you are OPPOSED to the pathology cuts in CMS’ 2014 Physician Fee Schedule proposed rule. Congress must stop CMS from finalizing this misguided policy, which will threaten patients’ access to pathology services and eliminate jobs for healthcare workers. Take action!
2. File comments with CMS (sample text below). A sixty-day comment period on the proposed rule is underway. You must take action and provide your comments to CMS before the September 6 deadline. Tell CMS about the impact these cuts will have on your patients and your practice. To submit comments:
a. Go to www.Regulations.gov
b. Go to search and type in “RIN: 0938-AR56”
c. Click on the “Comment Now” button to write your comment.
Sample Text
Email to Member of Congress:
As a constituent and practicing pathologist, I am strongly opposed to the pathology payment cuts in the 2014 Medicare Physician Fee Schedule proposed rule. CMS proposes to drastically cut the technical component (TC) and global payments for many critical anatomic services by over 50% and some codes as much as 80%. These cuts will have a devastating impact on the practice of pathology, which ensures that millions of Medicare patients get the right diagnosis. Further, these drastic cuts will threaten patients’ access to pathology services and could eliminate jobs for healthcare workers.
Congress must make CMS withdraw this proposal, which is severely flawed. Current law requires physician fee schedule values to be resource based. By linking physician payment to the payments for hospital outpatient departments, CMS’ proposal violates Medicare law. Further, the cuts would reduce reimbursement below the cost of the components used perform the service. No one can stay in business if their costs exceed their revenue.
As your constituent I am asking you to contact CMS immediately and demand the proposed rule be halted. Congress must stop CMS from moving forward with the proposed pathology cuts.
Sample Text for CMS Comments:
As a practicing pathologist, I am strongly opposed to the drastic cuts for pathology services included in this proposed rule. The cuts will have a devastating impact on the practice of pathology, which ensures that millions of Medicare patients get the right diagnoses.
The proposal fails to account for the resource costs associated with specific physician service codes. Current law requires physician fee schedule payments to be resource based. By linking payment to physicians to payments for hospital outpatient departments, the proposed rule violates Medicare law.
Further, the proposal would reduce reimbursement below the cost of the components used to perform many pathology services. No physician practice can stay in business if their costs exceed their revenue.
The existing AMA-RUC process is the proper way to value physician service codes. It has shown itself to be accurate and fair, and has been thoroughly vetted over many years. CMS should withdraw the proposed rule’s cuts to pathology services.
Stay Informed!
Watch for additional alerts and updates from the CAP.
Register now for an exclusive CAP webinar on proposed 2014 PFS: Understanding the 2014 Proposed Medicare Physician Fee Schedule scheduled for Wednesday, August 7, 2013 at 3:00 - 4:30 PM Eastern Time.
2014 Proposed Rule Resource Center
Details on the proposed Medicare physician fee schedule
If you have any questions, please contact Laura Brigandi at (202) 354-7128 or [email protected].
________________________________________
 
Have you been under a rock?

This from CAP sorry for bad formatting, but every pathologists should do this. Even ones in training or ones that are completely detached from the business of pathology. Gutting the field is not good for anybody.

July 30, 2013
Your Immediate Action Needed
Fight CMS' Proposal to Make Drastic Cuts to the Physician Fee Schedule in 2014
As you are well aware, the Centers for Medicare and Medicaid Services (CMS) recently proposed to radically cut the technical component (TC) and global payments for many anatomic pathology services by over 50% and as much as 80% for certain codes. If CMS finalizes this proposal, it will have devastating results. A 60 day comment period is underway. Our collective voice must be heard to prevent CMS from moving forward.
See the potential impact on your practice by reviewing the impact table.
The CAP is vigorously opposing these proposed payment cuts. Our efforts are focused on three tracks, regulatory, legal, and political. Your help is needed to succeed in our political advocacy efforts. Every Member of Congress must hear from you and your colleagues. Action is needed NOW to prevent these cuts from taking effect.
There are two vital actions you must take today:
1. Email your Member of Congress (sample text below). Tell him or her that you are OPPOSED to the pathology cuts in CMS' 2014 Physician Fee Schedule proposed rule. Congress must stop CMS from finalizing this misguided policy, which will threaten patients' access to pathology services and eliminate jobs for healthcare workers. Take action!
2. File comments with CMS (sample text below). A sixty-day comment period on the proposed rule is underway. You must take action and provide your comments to CMS before the September 6 deadline. Tell CMS about the impact these cuts will have on your patients and your practice. To submit comments:
a. Go to www.Regulations.gov
b. Go to search and type in "RIN: 0938-AR56"
c. Click on the "Comment Now" button to write your comment.
Sample Text
Email to Member of Congress:
As a constituent and practicing pathologist, I am strongly opposed to the pathology payment cuts in the 2014 Medicare Physician Fee Schedule proposed rule. CMS proposes to drastically cut the technical component (TC) and global payments for many critical anatomic services by over 50% and some codes as much as 80%. These cuts will have a devastating impact on the practice of pathology, which ensures that millions of Medicare patients get the right diagnosis. Further, these drastic cuts will threaten patients' access to pathology services and could eliminate jobs for healthcare workers.
Congress must make CMS withdraw this proposal, which is severely flawed. Current law requires physician fee schedule values to be resource based. By linking physician payment to the payments for hospital outpatient departments, CMS' proposal violates Medicare law. Further, the cuts would reduce reimbursement below the cost of the components used perform the service. No one can stay in business if their costs exceed their revenue.
As your constituent I am asking you to contact CMS immediately and demand the proposed rule be halted. Congress must stop CMS from moving forward with the proposed pathology cuts.
Sample Text for CMS Comments:
As a practicing pathologist, I am strongly opposed to the drastic cuts for pathology services included in this proposed rule. The cuts will have a devastating impact on the practice of pathology, which ensures that millions of Medicare patients get the right diagnoses.
The proposal fails to account for the resource costs associated with specific physician service codes. Current law requires physician fee schedule payments to be resource based. By linking payment to physicians to payments for hospital outpatient departments, the proposed rule violates Medicare law.
Further, the proposal would reduce reimbursement below the cost of the components used to perform many pathology services. No physician practice can stay in business if their costs exceed their revenue.
The existing AMA-RUC process is the proper way to value physician service codes. It has shown itself to be accurate and fair, and has been thoroughly vetted over many years. CMS should withdraw the proposed rule's cuts to pathology services.
Stay Informed!
Watch for additional alerts and updates from the CAP.
Register now for an exclusive CAP webinar on proposed 2014 PFS: Understanding the 2014 Proposed Medicare Physician Fee Schedule scheduled for Wednesday, August 7, 2013 at 3:00 - 4:30 PM Eastern Time.
2014 Proposed Rule Resource Center
Details on the proposed Medicare physician fee schedule
If you have any questions, please contact Laura Brigandi at (202) 354-7128 or [email protected].
________________________________________


I havent been under a rock but I have been stoned. Pathologists are groovy. 🙄

That was the first time I saw the complete list. I knew some were going to get slashed but had no clue this many codes were deemed misvalued. CAP must have just put that up on their front page. Those cuts would be game over for many places. No doubt about it. Who the hell can do work for rates that low? Quest, labcorp maybe.

Obama and the other stupid liberals acted like the 2 percent cut for the sequestor was going to kill off a lot of government jobs. I guess they dont give a **** what 50 percent+ cuts will do to the lab industry. Better get used to 1 month turnaround times and zero innovation from the few labs that survive.

If you want to save this field, you better fight like hell. I noticed CAP has a webinar about the cuts august 7th. Didnt they pretty much tell everyone in last year's webinar to accept the 52% cut and be ready for more 88305 cuts in the future? I hope they put the bong down and show some more fight this time. Damn hippies.
 
This is a train wreck. My sympathy really goes out to all my colleagues. They have screwed you folks.
I am largely a product of good timing, having been part of the "glory days". But i am also closer to my physical demise than most of you so i hope the future for you all can change and is not a total fuc**ing
 
Wow, I didnt realize so many codes were getting slashed this severely.



http://www.cap.org/apps/docs/advocacy/2014_proposed_rule_impact_chart_per_code.xlsx

All of this makes me wonder what the end game is. Clearly TC is an irreparable losing business now. It is easy to sit back and say, "Well, we still have our PC," but unless you are in a large community hospital, hospital system or an academic center, having relative control over the specimen processing (whether that consists of a pathologist owned independent lab or a small to medium sized hospital owned lab) gave most private practice pathologists a sense of security. What happens now when the independent labs have to shutter their doors and the small to medium sized hospitals realize that they are now losing significant money doing anatomic pathology TC and decide to bail? Are we headed towards massive consolidation of private practices and the TC being performed at large reference labs, academic centers and uber large private labs?

It seems evident to me that super large practices with large independent labs now will go after all of the small to medium practices in order to capture the PC with the promise of taking the TC off of these small to medium sized hospitals' books. These larger labs can scale up the TC if only to capture additional PC.

I have no idea where this ends but I can envision massive consolidation of hospitals into ever larger "systems" with subsequent consolidation of small to medium sized pathology practices into super large practices (and their associated labs) having exclusive contracts for entire hospital systems.

Our profession will survive, but it will bear little resemblance to its current state. In ten years, who in pathology will emerge from the embers the survivor? Someone always uses these massive shifts in the landscape to thrive above the rest.
 
This is a train wreck. My sympathy really goes out to all my colleagues. They have screwed you folks.
I am largely a product of good timing, having been part of the "glory days". But i am also closer to my physical demise than most of you so i hope the future for you all can change and is not a total fuc**ing

Thanks mike. You are who many of us wanted to be. I assumed this would happen but thought it would be gradual. But instead it is the guillotine. And this is all part of Obama and Obamacare and ACOs haven't really even happens yet. We have lost out TC. ACoS will destroy our PC.

Listen people. Don't go into pathology. No matter how much you love it. gointo subspecialty surgery if you can hack it. Go into primary care.
 
Wow we are getting corncobbed in cytology and FISH. For the 88307 and 88309 put a minimal amount of sections through to save on costs.
 
This is how Obamunism works.

When I was little I remembered learning about how the commies in the eastern block resulted in breadlines with the entire working class ending up poor but promised that they will be taken care of.

Similarly, we are pretty much turning into a communist state here. Prices are being fixed and ridiculous false promises are being made, cities are becoming bankrupt, and Washington DC thrives. Pretty much every non-politically connected career path is being destroyed.

Soon many of us will be run out of business except for the politically connected large university system who is subsidized by free labor (residents) or the corporate cronies Quests and Labcorps. The feds control the costs, there is no way out thanks to the commoditization of the field (allowed by the flooding of laborers/overtraining of residents), and the race to the bottom continues full steam ahead.

The economy is one huge joke. Part time jobs abound, the average "work" week is 32 hours?:laugh::laugh::laugh: The average take home pay is below a decent standard of living. This country is screwed. Krushchev was right.😡😡😡
 
Wow we are getting corncobbed in cytology and FISH. For the 88307 and 88309 put a minimal amount of sections through to save on costs.

An 88305 reimburses like 35 for one block.

A lumpectomy will now reimburse 60 for what is sometimes up to 100 blocks, which means the pathologists processing the case will be paying huge money out of their pockets and who would bother doing that. Thanks a lot obamacare. Obamacare is ****ing the breast cancer women of america.

My business is breast cancer heavy. I will lose money on lumpectomies and lose money on testing for her2 and hormone receptor status, which is obligatory. I have no options. If these cuts stick I will rue the day I chose pathology even though I love the work.

I will have to pay over 100 dollars out of my own pocket to perform a her-2 test. Either I give up the business entirely or I give up control of the specimen.
 
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An 88305 reimburses like 35 for one block.

A lumpectomy will now reimburse 60 for what is sometimes up to 100 blocks, which means the pathologists processing the case will be paying huge money out of their pockets and who would bother doing that. Thanks a lot obamacare. Obamacare is ****ing the breast cancer women of america.

My business is breast cancer heavy. I will lose money on lumpectomies and lose money on testing for her2 and hormone receptor status, which is obligatory. I have no options. I roux the day I chose pathology even though I love the work.

When I sat down and figured it out back in 2008, I figured it costs $7 to turn a piece of tissue into a slide, including the cassette, formalin, processing reagents, paraffin, slide, H&E reagents, glue, coverslip, folder and paper for the report. That is not including electricity, tech time, buying the processor or stainer. I imagine with inflation it costs more now. If you put through more than 5 blocks on an 88305, you lose. If you put through more than 8 on an 88307, you lose.

I do not understand the prostate core scoring. Is the 21-40 the number of cores?
 
When I sat down and figured it out back in 2008, I figured it costs $7 to turn a piece of tissue into a slide, including the cassette, formalin, processing reagents, paraffin, slide, H&E reagents, glue, coverslip, folder and paper for the report. That is not including electricity, tech time, buying the processor or stainer. I imagine with inflation it costs more now. If you put through more than 5 blocks on an 88305, you lose. If you put through more than 8 on an 88307, you lose.

I do not understand the prostate core scoring. Is the 21-40 the number of cores?

Well you figured wrong, because techs need salaries and benefits. There are so many costs you have no clue about such as service contracts and a 100 other things I could list.

Then your billing company takes 8-12%, if you get paid at all, as self pay patients don't pay and many times the insurance companies will try paying you 50% on what they are supposed to and hope you don't notice.

You know nothing.

So you really have no clue about what it costs to produce a slide.
 
Well you figured wrong, because techs need salaries and benefits. There are so many costs you have no clue about such as service contracts and a 100 other things I could list.

Then your billing company takes 8-12%, if you get paid at all, as self pay patients don't pay and many times the insurance companies will try paying you 50% on what they are supposed to and hope you don't notice.

You know nothing.

So you really have no clue about what it costs to produce a slide.

Don't forget rent, insurance, 401k, space for break room, cleaning service, disposal service (stericycle, etc)

The large contingent that does not pay is also huge.

This is an outrage. For us, we will get killed by the IHC reductions. That will hurt the most. IHC includes all the above plus validations (which the idiots at CAP are now trying to impose even more), control tissue, ridiculous antibody costs, machine prices, service on the machines, IT, etc.
 
Don't forget rent, insurance, 401k, space for break room, cleaning service, disposal service (stericycle, etc)

The large contingent that does not pay is also huge.

This is an outrage. For us, we will get killed by the IHC reductions. That will hurt the most. IHC includes all the above plus validations (which the idiots at CAP are now trying to impose even more), control tissue, ridiculous antibody costs, machine prices, service on the machines, IT, etc.

I was looking at buying a pathology lab.

How can anyone invest in pathology in this environment?


A lot of small pathology labs will close. They are trying to kill off the in office labs but will end up killing them all except hospitals and large commercials.

We may find no lab that will take a FISH test for a MC patient.
I own some stock in Neogenomics. They said their FISH cost is 50% of purposed rate on their conference call.

MC says they have accurate data on the cost of these tests through audited hospital expenses. They are full of it!

For those that think this good news because it will help kill IOP. Think again.

If your hospital has a good outreach pathology this will kill their already tight margins.

Over the mid to long term this can't be good part A payments .
CEOs and lab administrators don't like to pay us if they losing money in the lab.

Az
 
Reading through the charts, I was hoping to find something to allow me to temper these doom and gloom pronouncements.

I'm afraid I can't. :/

From what I can tell, the professional component is compensating for inflation (though likely not completely). But many pathologists supplement their income via a cut of laboratory profits (or part of their salary is funded through such). Not only will those funds become potentially non-existent, but I would not be surprised if groups and hospitals have to dig into the professional component portions of the reimbursement in order to fully cover their technical expenses.

I'm by no means deep into the system to know the details, but I do know several lab managers that are freaking out at the moment. 🙁
 
I was looking at buying a pathology lab.

How can anyone invest in pathology in this environment?


A lot of small pathology labs will close. They are trying to kill off the in office labs but will end up killing them all except hospitals and large commercials.

We may find no lab that will take a FISH test for a MC patient.
I own some stock in Neogenomics. They said their FISH cost is 50% of purposed rate on their conference call.

MC says they have accurate data on the cost of these tests through audited hospital expenses. They are full of it!

For those that think this good news because it will help kill IOP. Think again.

If your hospital has a good outreach pathology this will kill their already tight margins.

Over the mid to long term this can't be good part A payments .
CEOs and lab administrators don't like to pay us if they losing money in the lab.

Az

Neogenomics CEO sounds pretty concerned.

http://www.regulations.gov/#!documentDetail;D=CMS-2013-0155-0454
 
He makes some good points.

Yes he does. Patients will be harmed, labs will go under, innovation will grind to a halt.

I didnt realize only 5 percent of FISH was being done in hospital labs. Learned a lot from reading his letter.
 
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