That's exactly how it is already in third world countries. In Mexico, a lot of practices just hand the biopsy to you in a little jar or whatever container you provide and then its up to you to take it to a pathologist. The pathologist will do simple H&E at a fixed rate, for cash, and then if said pathologist has access to IHC or other testing they'll quote you what it's going to cost to get a definitive answer - and you pay upfront. If you don't pay it, they'll probably refer you to the state run hospital system where you may get your answer as you're being admitted to hospice care.
Since I'm on the border, my private lab receives a lot of "consults" from Mexico akin to what you just described. These are typically uninsured US citizens that decided to go to Mexico for their healthcare needs. I guess the surgery is cheaper. In the unfortunate event that a cancer diagnosis is made, they are quick to realize that their best option for treatment is here in the US, but in order to get that, they need that cancer diagnosis to come from a US lab. Once they have the official diagnosis they can apply for Medicaid benefits and get treatment.
Our lab charges a flat rate of $200 for the read and an additional sum for doing ancillaries (e.g. breast panel for ER, PR, HER2 and Ki-67) if necessary. I guess this is akin to billing out an 88321/88325. We charge the same flat rate if given an unprocessed biopsy. Our lab let's the patient know up front that if additional testing is needed ... we need to see another money order before moving forward. It's a hassle sometimes, but it's better than not getting paid. We do enough charity to last a 100 lifetimes down here, so we have to get creative if we are going to make a living. It pays more than 100% MCR.
As a long aside in dealing with these types of cases, I did encounter one of the most egregious diagnostic errors from a pathology group in Mexico that rendered a breast cancer diagnosis on a 20-something year old woman. I think everyone here in practice has come across a young person and diagnosed them with cancer. It's not uncommon for us in my neck of the woods to see colon cancer or breast cancer in a 20-something year old. I was alarmed to be getting this particular biopsy to read, but it didn't surprise me. When I saw the case, it was an almost instantaneous diagnosis of "sclerosing adenosis." I didn't believe my eyes when I read the report (which is in Spanish btw) and the pathologist made an elegant diagnosis of invasive ductal carcinoma. I felt inclined to perform IHC to prove that this was a B9 lesion but the case did not come with blocks (we usually receive these as well). The report also came with breast biomarkers (not surprising, but the "tumor" was ER(+), PR(+) and HER-2(-) with a low Ki-67 proliferation fraction). I had my partner call the patient (who spoke mostly Spanish) and explain the situation to her. We wanted to request the original biopsy blocks in order to do a couple more IHC but the lab told the patient that the blocks are "missing" but they have the mastectomy and axillary dissection slides and could send those. Wait. What??
We received six trays of H&Es for this patient's radical mastectomy specimen with axillary dissection. I guess it's a red flag to have 80+ blocks with multiple levels on a typical mastectomy case, right? Oddly enough, the pathology report (read by the same pathologist) regurgitated the exact same findings as the original biopsy. Good news was that the margins were all negative and so were the 10 lymph nodes.
The cover-up of all cover-ups occurred. Obviously, someone was looking for something that wasn't there to begin with and it was at this point when we asked the patient to meet with us face to face and we told her that there's no cancer in the original biopsy and there's no cancer in the mastectomy specimen. The patient brought her mother with her and all her mother could say over and over was, "Thank God you don't have cancer anymore!!" You've just witnessed a miracle. The patient had a different expression on her face -- how would you react if you were permanently disfigured and had 10 axillary LN removed?
This isn't the first time that I've encountered something like this in the area I practice. Obviously, this kind of thing should end up in litigation, but I am surprised to find that the patient's where I practice will have a completely different attitude than what I would expect.
