Up front stains

[Zarniwoop]

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Years ago it was commonplace to see labs do up front Alcian Blue / PAS's, H pylori IHC, among others.

I thought there was a crackdown on this, so I very rarely see it today, but I still do see an occasional lab performing these stains universally up front.

How are these labs still making this easy extra money, when most everyone else stopped? Does it have something to do with the payor mix?

 

[ChicagoPath]

It still happens and is common. Go check out Reddit. It’s a topic of discussion over there.

Whenever there’s an opportunity for someone to increase their revenue, people will exploit that opportunity and continue to do it until they get caught. Just like those gastroenterologists that hire pathologists for their labs and the number of biopsies go up or they hire histotechs to cut blocks in their lab to capture the TC.

In office labs are a joke and should have never been made legal. In office labs just allowed urologists, dermatologists and gastroenterologists the opportunity to exploit pathologists. Gastros not only make money on path but also anesthesia.

Pathology lost the war with in office labs many years ago.

When you give someone/anyone an opportunity to exploit the system, the bad actors will do so.

I remember reading somewhere that these labs were supposed to improve patient care. On the contrary, in office labs don’t help patient care at all. You still call the clinician as you would if the specimens were sent to the pathologist.

Gastroenterology Practice Agrees to Pay $4.75M to Settle Allegations of Kickbacks and Unnecessary Medical Testing Services

Atlanta Gastroenterology Associates located in Atlanta, Georgia, has agreed to pay $4.75 million to resolve allegations that it violated the False Claims Act by receiving kickbacks in exchange for referrals of gastrointestinal pathology services and by performing certain gastrointestinal...

www.justice.gov

 

[Guest8]

We had stopped upfront H pylori years ago but recently re-instituted it. I was personally opposed, but it seemed like I was the only one not ordering it on every gastric biopsy anyway. Nothing else happens up front except on certain SLNBx cases w/ keratins, etc.

 

[Zarniwoop]

It had seemed to me that the end of upfront staining occurred somewhat simultaneously across groups.
Was this a kneejerk response by a majority of practices to an announced crackdown that never really happened, if some labs are continuing the practice?

Also, the excessive use of upfront stains might have been most egregious in in-office labs. However, I do remember plenty of community hospitals and even academic practices doing it as well.

 

[mike-sheree]

This has been an issue since before I retired in 2013. If someone is determined to do them, it is really not that big a deal. It just requires a little more verbosity in the report, an addendum, and a one day delay for the final results.

 

[cmz]

APS lab contracts with several local GI groups in my area and they all do up-front stains. The in-house lab gets to bill TC for Thiazine blue for HP. APS then does HP IHC on top of that at their lab and bills globally for that stain. I think if the US Govt cast a wider net they could make that $4.75M look like chump change. They need to completely audit APS.

 

[mike-sheree]

APS lab contracts with several local GI groups in my area and they all do up-front stains. The in-house lab gets to bill TC for Thiazine blue for HP. APS then does HP IHC on top of that at their lab and bills globally for that stain. I think if the US Govt cast a wider net they could make that $4.75M look like chump change. They need to completely audit APS.

Hey, if you’ve got some facts, there may be significant whistleblower bucks to be made. Doing a helico stain up front on “all” (of very dubious utility) followed by a helico immuno on all is pretty eye watering. And I certainly was no “anti-stain “ crusader.

 

[cmz]

Hey, if you’ve got some facts, there may be significant whistleblower bucks to be made. Doing a helico stain up front on “all” (of very dubious utility) followed by a helico immuno on all is pretty eye watering. And I certainly was no “anti-stain “ crusader.

I caught these specific cases at one of the hospitals I had a contract with, an exclusive contract btw. We caught a group of GI basically taking their biopsies from endoscopy and circumventing our histology lab. The GI personally drove them to their in-house histology lab at their endo suite for processing. I read these reports and found some alarming features: Thiazine blue performed on and reported out on ALL gastric biopsies that were ALL followed up by "confirmatory" HP IHC.

I should post APS' medical disclaimer for their use of special stains and it's frankly amusing. Alcian blue/PAS is performed on every GI to rule out "subtle IM" etc. Regardless, you can't do a Thiazine blue up-front and send the case out to another lab in another state and then decide you need to also bill for HP IHC.

 

[mike-sheree]

If you’ve got the flak cover, give it a shot. These bastards screw “us” all. 1st stop could be a “ whistle blower” atty but they WILL take a cut of the collection.