Urologists- The Ugly Truth About Their Corrupt Profession And Pathologists who..

[pathstudent]

I was riding my bike this weekend and stopped at my neighbor's garage sale. The wife chatted me up and found out I was a pathologist. She called her husband over who was boisterous lawyer and had recently had a prostate biopsy. He asked me how much I would charge for a prostate biopsy. I explained to him that it is clinically sufficient to simply biopsy the prostate left and right and that the total pathology bill should be no more than in the range of 250-300 dollars with about 65% of that going to the processing facility and 35% to the pathologist. Well he received a bill for 2500 (high deductible) as they did a 12 sector biopsy due to having a PSA barely above age normal range. All his biopsies were benign. He said he looked up the pathologist on the internet and the pathologist worked 2000 miles away and went to medical school in Guadalajara Mexico. I explained to him that the urologist was profiteering off the pathology and likely paid the pathologist 2000 miles away a small fraction of the 2500 and pocketed the rest for himself. I explained to him how pathology specimens are billed per container and by breaking it up into 12 containers the urologist was racking up the bill 6x over what was necessary for clinical decision making. I told him to go negotiate with the urologist about the pathology bill because that is what he was doing to the pathologist. He was absolutely livid. I also referred him to the NYT articles about the BS around PSA values and the overtreatment of prostate disease.

See this is what our profession has come to. We split fees and grovel over a pittance of pay while urologists make serious cash over a service they don't provide. Yes it harms us. But ultimately it screws patients and insurance companies (which gets passed onto us via premiums).

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[Thaitanium]

I was riding my bike this weekend and stopped at my neighbor's garage sale. The wife chatted me up and found out I was a pathologist. She called her husband over who was boisterous lawyer and had recently had a prostate biopsy. He asked me how much I would charge for a prostate biopsy. I explained to him that it is clinically sufficient to simply biopsy the prostate left and right and that the total pathology bill should be no more than in the range of 250-300 dollars with about 65% of that going to the processing facility and 35% to the pathologist. Well he received a bill for 2500 (high deductible) as they did a 12 sector biopsy due to having a PSA barely above age normal range. All his biopsies were benign. He said he looked up the pathologist on the internet and the pathologist worked 2000 miles away and went to medical school in Guadalajara Mexico. I explained to him that the urologist was profiteering off the pathology and likely paid the pathologist 2000 miles away a small fraction of the 2500 and pocketed the rest for himself. I explained to him how pathology specimens are billed per container and by breaking it up into 12 containers the urologist was racking up the bill 6x over what was necessary for clinical decision making. I told him to go negotiate with the urologist about the pathology bill because that is what he was doing to the pathologist. He was absolutely livid. I also referred him to the NYT articles about the BS around PSA values and the overtreatment of prostate disease.

See this is what our profession has come to. We split fees and grovel over a pittance of pay while urologists make serious cash over a service they don't provide. Yes it harms us. But ultimately it screws patients and insurance companies (which gets passed onto us via premiums).

How does that work? You as a clinician would send a biopsy 2000 miles away versus your local pathologist for more $$$$? Or are the slides made at the in office lab and sent to the pathologist 2000 miles away? If only patients knew what was going on!!!

 

[Enkidu]

Can a patient sue his urologist over this sort of thing? Maybe if this keeps happening to lawyers the problem will go away?

 

[pathstudent]

How does that work? You as a clinician would send a biopsy 2000 miles away versus your local pathologist for more $$$$? Or are the slides made at the in office lab and sent to the pathologist 2000 miles away? If only patients knew what was going on!!!

Right and given that the urologist profits probably 1000-1500 of pathology services who knows if the biopsy was really indicated. The lawyer is paying 2500 with probably 1500 going to a urologist for a pathologist spending 5 minutes looking at benign prostate biopsies. Urology had been corrupted by the greed bug.

 

[mlw03]

See this is what our profession has come to. We split fees and grovel over a pittance of pay while urologists make serious cash over a service they don't provide. Yes it harms us. But ultimately it screws patients and insurance companies (which gets passed onto us via premiums).

Why is it that in a free market insurance companies are willing to pay for overbiopsy-ing a prostate, but not for nutritional counseling for an overweight (but not yet obese or DM2) 42 year old with a BMI of 27? I know this isn't really a pathology issue, but it just baffles my mind (and i'm married to a dietitian).

i'd also be curious to know if all 12 of those prostate cores got a triple stain, and how common that is in pod lab pathology practice. as much as i hated the gu person where i trained (and i truly hated that nasty little shrew), she at least reserved the triple stain for the more challenging cases and didn't routinely order it just to rack up the bill. although a small irony would be that part of the reason i was told some pathologists do IHC on all prostate biopsies is because of sue-happy lawyers who will go back and stain the block on "negative" biopsies if a patient ends up with prostate carcinoma 5 years down the road.

 

[scienceguy19]

That's ridiculous... that's like a family medicine doctor ordering a CT scan and X-ray for a patient, charging the patient for the imaging, and collecting 80% of the radiology fee and giving the remaining 20% to the radiologist. I'm sure radiologists would say that it's bulls*. Why should us pathologists put up with that? As pathologists, we really need to make ourselves known and start seeing patients directly in order to stop urologists and gastroenterologists from stealing from us.

Right and given that the urologist profits probably 1000-1500 of pathology services who knows if the biopsy was really indicated. The lawyer is paying 2500 with probably 1500 going to a urologist for a pathologist spending 5 minutes looking at benign prostate biopsies. Urology had been corrupted by the greed bug.

 

[2121115]

That's ridiculous... that's like a family medicine doctor ordering a CT scan and X-ray for a patient, charging the patient for the imaging, and collecting 80% of the radiology fee and giving the remaining 20% to the radiologist. I'm sure radiologists would say that it's bulls*. Why should us pathologists put up with that? As pathologists, we really need to make ourselves known and start seeing patients directly in order to stop urologists and gastroenterologists from stealing from us.

How exactly does seeing patients directly fix any of that?

 

[yaah]

That's ridiculous... that's like a family medicine doctor ordering a CT scan and X-ray for a patient, charging the patient for the imaging, and collecting 80% of the radiology fee and giving the remaining 20% to the radiologist. I'm sure radiologists would say that it's bulls*. Why should us pathologists put up with that? As pathologists, we really need to make ourselves known and start seeing patients directly in order to stop urologists and gastroenterologists from stealing from us.

Except for the fact that it does happen to radiologists. Lots of clinicians own imaging centers. Orthopedics are frequently among them.

 

[pathstudent]

Can a patient sue his urologist over this sort of thing? Maybe if this keeps happening to lawyers the problem will go away?

There is really nothing you could sue for. But if awareness increases it could force a change in laws at the state or national level. Some states do attempt to restrict this extremely unethical behavior. It is really disgusting behavior on the part of our physician colleagues and it is unfortunate that so many pathologists are willing to crawl into the slime pit with them. No gastroenterologist urologist or pathologist would want their personal healthcare to be straddled with so many conflicts of interest and unethical behavior yet we have let it flourish. Our colleagues have been bitten by the greed bug and we have been bitten by the fear bug.

 

[sirenomelia]

You were not actually involved in this case and you have 0 facts to base your inflammatory opinion and go on inciting some random guy at a garage sale, least alone a d'bag lawyer, that he was being bilked by a clinician it sounds you don't even know. Maybe the guy is scamming, maybe he's not. I see multisector prostate biopsies every week that demonstrate cancer in one fragment and then not in another from the same side and if I'm examining and being held accountable for each fragment then they should be billed separately. If you have a professional concern with how this doctor practices maybe you should contact him and speak with him yourself rather than rouse up trouble for a fellow physician by fretting up a lawyer-patient with whom you have no professional relationship and nothing to gain by butting into someone elses business.

 

[pathstudent]

You were not actually involved in this case and you have 0 facts to base your inflammatory opinion and go on inciting some random guy at a garage sale, least alone a d'bag lawyer, that he was being bilked by a clinician it sounds you don't even know. Maybe the guy is scamming, maybe he's not. I see multisector prostate biopsies every week that demonstrate cancer in one fragment and then not in another from the same side and if I'm examining and being held accountable for each fragment then they should be billed separately. If you have a professional concern with how this doctor practices maybe you should contact him and speak with him yourself rather than rouse up trouble for a fellow physician by fretting up a lawyer-patient with whom you have no professional relationship and nothing to gain by butting into someone elses business.

Let's keep things separate here. I am not aware of any literature that says morbidity and mortality are different whether the prostate is simply biopsied left and right vs 12 or more sectors. Nor am I aware of literature that says how the patient should be managed whether there is cancer in only one biospy from sector X vs one biopsy from sector y. But I do know that it increases the cost at least 6 fold and increases the profit to the urologist by 6 fold.

But that is not the main point my main point is to give an example of the monkey business going on in our profession. I do believe this neighbor when he said that the pathology report was signed out in a lab 2000 miles a way and I do believe him when he says he looked this pathologist up and the pathologist went to med school in Guadalajara. I do believe that such odd patterns of referal are dictated by greed and the willingness of pathologist to split fees. Which leads me to believe that perhaps the PC on an 88305 is too high if pathologists are willing to play ball and split fees with urologists and gastroenterologists.

If you went to a doctor and he referred you to a specialist, would you feel comfortable with that if you knew the referring doctor was billing for the specialist's services and profiteering off the referral by paying the specialist less than the going fee? Would you question how this conflict of interest might be affecting the decision making of the referring doctor? Will this type of thing is rampant in pathology.

Meeting this neighbor personalized the nature of these abusive practices.

 

[WEBB PINKERTON]

I just talked with someone at a nearby hospital that recently lost the town urologist. Now the hospital is negotiating with a group of urologists that say its a "deal breaker" if the biopsies dont go to their in-office lab.

Looks like they have a pretty nice website.

http://metropolitanurology.com/

It's sad watching Pathology continue going into the gutter. Pretty soon it will be like Optometrist. People will go into the field with low expectations for what a good job is.

 

[sirenomelia]

I'm as much against fraud as anyone and I think pathologists that sell out and function within a clinician's office are scabs that hurt our profession and probably perform sub-standard overall. I sympathize with these pathologists as they likely are scrounging for employment and have to resort to this work to make a living. It likely wouldnt come to this if asshat established pathologists would treat newcommers as colleagues and not assembly line lackeys and keep partnerships and profits to themselves. But laypeople lump all doctors together and dont pay attention to fine details about the economics of how we do our job. Regardless we should all maintain professionalism and this topic should be kept and discussed and dealt with amongst physicians. Its not good for anyone to pit a patient against their doctor.

 

[path24]

Pathologists are a dime a dozen....why shouldn't we be exploited? The obvious oversupply keeps killing us. Places beg for urologists...no one, I repeat no one begs for a pathologist. This will never change until we start cutting programs. There is no shortage of pathologists and a shortage will never come. Thanks to ascp, cap, uscap, acgme, academic programs wanting their handouts and labor.

Med students become a pathologist and become your classmates pawn! You will bow/beg for their specimens.

 

[KluverB]

Pathologists are a dime a dozen....why shouldn't we be exploited? The obvious oversupply keeps killing us. Places beg for urologists...no one, I repeat no one begs for a pathologist. This will never change until we start cutting programs. There is no shortage of pathologists and a shortage will never come. Thanks to ascp, cap, uscap, acgme, academic programs wanting their handouts and labor.....

It starts with residents whining about all the grossing they have to do... then ACGME has to restrict work hours... then more residents need to be hired... then there is an oversupply... voila.

 

[Torsed]

With regard to the attorney's prostate in question, I can only surmise that there was not as high of clinical suspicion to warrant multiple sector biopsies or he just had markedly prominent nodules on U/S. I am sure the urologist will enjoy having an irate patient return to him after the conversation in the garage.

I have numerous examples of prostate adenocarcinoma being present in one or two fragments of the 12 core biopsies. Hasn't everyone?

I fear if this is a result of POD type set up, then these establishments are most likely here to stay unless the law makers get rid of the silly exception that makes anatomic services exempt from Stark Laws.

I would be wary of criticizing a graduate of Guadralajara. Juan Rosai is from Argentina and Dr. Fu is from Taiwan, but I would be hesitant to joke about them being foreign.

 

[2121115]

Actually, the "2000 miles away" POD lab is not legal anymore. A clinician cannot have ownership in a true POD lab (so named because it was literally a POD - similar to the moving company - in a non-descript warehouse in another state) where a group of clinicians would hire one tech would go around to each POD and make the slides and one pathologist would show up and go around to all of the PODs and read their slides while the urologists raked in the TC and part of the PC with absent/low/consolidated overhead. This model was shut down by CMS.

The issue now, rather, is "in office" labs, which are not true POD labs but are mis-called so because they contribute to the same problem. This is where a clinician essentially does the same thing as a POD lab but it is in their office (back room with scope) and a pathologist comes to the office to read the slides. As long as this operation takes place in the office of the clinician then it is protected under the IOASE (in office ancillary services exception) of the Stark law and it is legal. This is currently what is truly driving over-utilization of the 88305, since clinicians are taking the TC and, in many cases, part of the PC - thus, driving up the number of biopsies. As is often stated in CAP STATline publications, CAP has repeatedly lobbied to remove anatomic pathology from this loophole, but the political fall out from the other specialty societies, who benefit greatly from it, would be tremendous and so CMS has backed off from doing so.

The other situation often mis-called a "POD lab" is a referral lab which comes into a community and undercuts the local pathology group for the clinicians' biopsies by taking less than the PC and/or giving kickbacks (some of which are protected by law, like providing clinician office EMR systems). Places that would fall under this umbrella would be Caris, OUR lab, Bostwick, etc.

All that is just to make sure we are all talking about the same thing and using the same terminology.

 

[pathstudent]

Actually, the "2000 miles away" POD lab is not legal anymore. A clinician cannot have ownership in a true POD lab (so named because it was literally a POD - similar to the moving company - in a non-descript warehouse in another state) where a group of clinicians would hire one tech would go around to each POD and make the slides and one pathologist would show up and go around to all of the PODs and read their slides while the urologists raked in the TC and part of the PC with absent/low/consolidated overhead. This model was shut down by CMS.

.

I agree with about CMS but private insurance does not have to follow the Stark Laws. Therefore these fee splitting arrangements are still flourish. Some GI groups own their own GI path lab but they can only send their non-medicare biopsies to it.

 

[deleted314957]

I agree with about CMS but private insurance does not have to follow the Stark Laws. Therefore these fee splitting arrangements are still flourish. Some GI groups own their own GI path lab but they can only send their non-medicare biopsies to it.

equally, or more disgusting, is the 12 part ( or saturation ) bx on an 80'ish guy with hx of "elevated PSA". I see it too often ( and once is too often).

 

[mlw03]

equally, or more disgusting, is the 12 part ( or saturation ) bx on an 80'ish guy with hx of "elevated PSA". I see it too often ( and once is too often).

I agree with you, but indulge me for a moment. The best way to prevent this would be to not pay the urologist for it, right? But are we willing to give that kind of control to an insurance company? It's a slippery slope I think. Yes, your scenario is obscene, but what about screening mammograms for 50 year old women? In theory, we want doctors making decisions and doing so with their patients in mind, not their wallets. I just don't know how to make that happen.

 

[KCShaw]

Pretty much every system which addresses one problem opens the door to others.

Give every physician a salary based on degrees, certification, experience, and whether they're full time -- lose motivation to excel, market, all the benefits of privatization (like money, frankly, but also control).

Base income on patient outcomes -- old, high risk, and complicated patients become all the more like outcasts, and possibly overspending for aggressive measures or diagnostic modalities.

Base income on whatever you can get in a free market (or, well, semi-free, given medicare & insurance companies -- but it probably would apply even if patients weren't directed by insurance) -- competition for numbers and billing loopholes override the goals of patient care.

It's the way of things. Some people will always have other things in mind (usually financial), even if others are doing the best they can to make the system an ideal one.

 

[Euchromatin]

I always thought that the "in-office" labs using that onsite ancillary testing loophole in Stark were the "POD" labs - I thought POD was an acronym for "point of delivery" testing...?

 

[2121115]

I always thought that the "in-office" labs using that onsite ancillary testing loophole in Stark were the "POD" labs - I thought POD was an acronym for "point of delivery" testing...?

Never thought about the acronym like that; however, they were called POD labs because they were actually in a POD.

 

[lipomas]

The Urology profession is not corrupt. Within the field there are corrupt practitioners. Within pathology there are also corrupt practitioners. Like those who are in a partnership group and limit partnership to only a couple of people in a larger group. Or those who sell the group out from everyone else.

 

[WEBB PINKERTON]

Probably more pathologists in prison right now than urologists. I've seen a fair number of pathologists in Florida go down for medicare fraud. It really sucks we are being put in this position fighting over the same nickels. Maybe that will create the shortage we are all praying for. Cell blocks to Cell blocks. Hopefully they wont let any inmates start prison labs that uncut us.

 

[2121115]

Cell blocks to Cell blocks.

Ok, this made me LOL.

 

[LADoc00]

Probably more pathologists in prison right now than urologists. I've seen a fair number of pathologists in Florida go down for medicare fraud. It really sucks we are being put in this position fighting over the same nickels. Maybe that will create the shortage we are all praying for. Cell blocks to Cell blocks. Hopefully they wont let any inmates start prison labs that uncut us.

My last tally showed that there were more Urologists in prison for fraud than Pathologists actually.

Oddly, I recently looked this up and then asked a firm to do the leg work to confirm.

If there is something going on in Florida I would really like to know it.

What is the nature of the Pathology fraud charges? Post here or pm me.

 

[gungho]

My last tally showed that there were more Urologists in prison for fraud than Pathologists actually.

Oddly, I recently looked this up and then asked a firm to do the leg work to confirm.

If there is something going on in Florida I would really like to know it.

What is the nature of the Pathology fraud charges? Post here or pm me.

 

[pathstudent]

I know the title of this thread is kind of inflammatory but imagine if your doctor referred you to a cardiothoracic surgeon because that surgeon was willing to split his fee so you doctor could profiteer from his referral?

It raises mulitple ethical issues. A) Do you even need a referral? B) Are you simply getting referred to the guy that will split his fee the most vs being referred to the most competent local doc in your doc's opinion?

Well this is the nonsense that is widespread in pathology particularly with urologists and gastroenetrologists. It is a shame that pathologists will even play ball because surely they wouldn't want their own care conducted that way.

 

[LADoc00]

I know the title of this thread is kind of inflammatory but imagine if your doctor referred you to a cardiothoracic surgeon because that surgeon was willing to split his fee so you doctor could profiteer from his referral?

It raises mulitple ethical issues. A) Do you even need a referral? B) Are you simply getting referred to the guy that will split his fee the most vs being referred to the most competent local doc in your doc's opinion?

Well this is the nonsense that is widespread in pathology particularly with urologists and gastroenetrologists. It is a shame that pathologists will even play ball because surely they wouldn't want their own care conducted that way.

Your very misguided on the real world. This sort of fee splitting is par.

Imagine a mutli-speciality physician group like an IPA or Kaiser or an ACO. Dr. X refers patients to Dr. Y because, well among other things, what is good financially for Dr. Y is good for Dr. X.

Its not direct 1:1 profit, but the same crap just indirectly.

Doctors will soon NEVER have an incentive to refer purely because they think their colleague is the best one for the job. Of course this doesnt even happen now in most cases.

If you want crazy, look at Ortho devices where the surgeon owns the Ortho device company or is the wholesaler.

Regardless even in a Nationalized Healthcare System like Britian or Germany there are plenty of such abuses, albiet of a slightly different flavor.

Youre spastic med student concern is misplaced.

 

[pathstudent]

I disagree. How is it beneficial for pathologists to be willing to sign out a biopsy for the least amount of money and the urologist keeping the rest. Trust me a urologist would never give the family practice doctor80% of his fee just to get a patient.

Your very misguided on the real world. This sort of fee splitting is par.

Imagine a mutli-speciality physician group like an IPA or Kaiser or an ACO. Dr. X refers patients to Dr. Y because, well among other things, what is good financially for Dr. Y is good for Dr. X.

Its not direct 1:1 profit, but the same crap just indirectly.

Doctors will soon NEVER have an incentive to refer purely because they think their colleague is the best one for the job. Of course this doesnt even happen now in most cases.

If you want crazy, look at Ortho devices where the surgeon owns the Ortho device company or is the wholesaler.

Regardless even in a Nationalized Healthcare System like Britian or Germany there are plenty of such abuses, albiet of a slightly different flavor.

Youre spastic med student concern is misplaced.

 

[pathstudent]

Seriously ladoc. You describe a world where there is mutual benefit for doctors referring patients to each other. How in the hell is a pathologist signing out a prostate biopsy for 50% or 25 % of the pc with the urologistcollectiong the difference beneficial to the pathologist? How is that analogous to an ortho using a product he has patented?

Your very misguided on the real world. This sort of fee splitting is par.

Imagine a mutli-speciality physician group like an IPA or Kaiser or an ACO. Dr. X refers patients to Dr. Y because, well among other things, what is good financially for Dr. Y is good for Dr. X.

Its not direct 1:1 profit, but the same crap just indirectly.

Doctors will soon NEVER have an incentive to refer purely because they think their colleague is the best one for the job. Of course this doesnt even happen now in most cases.

If you want crazy, look at Ortho devices where the surgeon owns the Ortho device company or is the wholesaler.

Regardless even in a Nationalized Healthcare System like Britian or Germany there are plenty of such abuses, albiet of a slightly different flavor.

Youre spastic med student concern is misplaced.

 

[LADoc00]

Seriously ladoc. You describe a world where there is mutual benefit for doctors referring patients to each other. How in the hell is a pathologist signing out a prostate biopsy for 50% or 25 % of the pc with the urologistcollectiong the difference beneficial to the pathologist? How is that analogous to an ortho using a product he has patented?

Its perfectly analogous, but you lack the real world biz experience to see it. To rail against something that is PATENTLY obvious because that's what you can grasp easily from your limited perspective. Im telling you flat out this crap is common. Do I like it? No, obviously not. I agree with your sentiment, BUT it is everywhere in medicine when you start to dig. This is the natural progession of what has exsistent at least since the 80s.

Ortho doesnt invent anything (at least 99%+ of the time). They "patent" common crap like screws and misc hardware and after licensing and what not, pull down another 1-5mil/year on it. The Urologist is doing a similar thing.

See you are missing the forest here. Prior to Pod Labs, local pathologists DIDNT have the biopsies anyway, they went to huge national path mills on the East Coast. Pod labs gave local pathologists 50% MORE than the nothing they got before. Thats actually good by keeping the money local at least.

The moral of this story is:
1.) people with high deductibles are IDIOTS if they dont think they will hit it each and every year. You have to financially analyze your insurance with assumption you will pay 100% of the high deductible each and every year. If not, you are an idiot. These plans can be good (although I really dont like them), but you need to be maximally pessimistic in your planning with them. So the dude in the your story is an idiot if he was mad about his biopsy charges.
2.) Dividing the biopsy in 12 separate containers for 12x88305 is the standard of care, so you are an idiot for leading him to believe otherwise. The treating Urologist is absolutely under no obligation to "barter" with the guy in your story whatsoever so again your advice was insanely dangerous and naive.
3.) If the guy wasnt going to do anything ie biopsy, he should have NEVER had the PSA screening. He is an idiot thrice over at this point.
4.) Lastly, you post alot and have absolutely no clue what the hell you are talking about. Its annoying, bewildering, frustrating and outright lame as you confuse other trainees. Overall most are made more stupid for reading your posts. Stop.

 

[pathstudent]

With all due respect to one of the most legendary, famous and distinguished forumers, I really think ladoc doesn't know what he is talking about with regard to this issue. There once was a day when urologists and gastroenteologists across the board worked with their fellow local pathologists in a collegial fashion. But the greed bug bites and it bites hard and now it is commonplace for a urologist to make 75% or pathologists professional fee for not providng a service for which he doesn't know **** about. This is a holocaust for pathology and horrible for patients and unethical for medicine as a whole. I encourage all pathologists to work with cap, ascp, your local path societies and your state medical boards to end these practices.


And though it has little to do with the main point and is totally an aside. Can anyone produce any literature showing that doing 12 sector biopsies does anything for patients (I.e. improve mortality or morbidity) other than jack up their pathology bill 6-12x?

 

[LADoc00]

I apologize if my posting was harsh but...the realities of today's marketplace are harsh. I think you adapt or die.

Prostate biopsy procedures are well studied in the literature. 12 part mapped biopsy reports are NOT something that pathologists invented to make money. Trust me.

In fact the literature shows that even more cores are even more sensitive. Yes, 16 and even 20-part biopsies are better supported in literature (although insurance companies have come up with a host of reasons to not pay and thus this isnt the standard).

So more cores are more sensitive. That make sense?
In terms of processing the cores, when all the cores are in 1 container, the false negative rate goes way way up. A few reasons for this. For one, there is more info on each slide for the reader to potentially miss. Then the issue in actually a getting a good level on 4-6-8+ cores in one block. You could theoretically separate all the cores into different blocks but then again all those cores were submitted together. When you subdivide specimens into mutli-blocks then it is YOU losing tons of money on reading multi-blocks but only getting $40.45 medicare allowable (or 20 bucks if you are fee splitting!). That wouldnt never be worth it and insurance payors realize this.

I get paid about 800 bucks per prostate pack (when you count immunos and after all my expenses etc) from medicare. If I read 20 sets/day, then yeah that is like crazy money (16000/day or 2.8m if you calculate working 180 days/year) but NO ONE does that. Even if I fee split with a Urologist, that is 1.4m a year!

For 1.4m I would fee split like a MOFO, trust me and so would you. I would put "Podlab Biotch" on the license plate of my Maserati for 1.4 large! That's 144 STACKS of high society dude to put it in perspective.

AND This IS the small fish for health care costs too, trust me.

 

[Substance]

I get paid about 800 bucks per prostate pack (when you count immunos and after all my expenses etc) from medicare. If I read 20 sets/day, then yeah that is like crazy money (16000/day or 2.8m if you calculate working 180 days/year) but NO ONE does that.

This begs the question "Why not?"

 

[LADoc00]

This begs the question "Why not?"

Because no one can move that volume.

Lets say you cooked meth in small hand batchs and sold them to the local tweakers making on average $800/tweaker/month.

Now you are thinking to yourself, wow if I had a billion tweakers at my disposal I could be RICH!

No. there are limited supply of tweakers AND you can only scale up so far before other dudes of like mind cut in on your action.

Prostate biopsies are like the 'theoretical billion tweaker' scenario, interesting to contemplate, but impossible (save for some mega labs with the resources to run hundreds of biopsies sets/day from all parts of the country).

 

[WEBB PINKERTON]

My last tally showed that there were more Urologists in prison for fraud than Pathologists actually.

Oddly, I recently looked this up and then asked a firm to do the leg work to confirm.

If there is something going on in Florida I would really like to know it.

What is the nature of the Pathology fraud charges? Post here or pm me.

Usually the cases I see in Florida are like the link I posted below. Florida is just where my second home is. I dont work there but I constantly see physicians get into trouble for medicare fraud on the news, MANY derm but a fair number pathologists over the years as well. I'd love to see the stats on which specialities have the most incarcerated. LOL

http://labpathconsulting.com/blog/f...-fraud-and-kickback-scheme.html?blogger=admin

 

[LADoc00]

Usually the cases I see in Florida are like the link I posted below. Florida is just where my second home is. I dont work there but I constantly see physicians get into trouble for medicare fraud on the news, MANY derm but a fair number pathologists over the years as well. I'd love to see the stats on which specialities have the most incarcerated. LOL

http://labpathconsulting.com/blog/f...-fraud-and-kickback-scheme.html?blogger=admin

Holy crap balls!

 

[Substance]

Why is the tech component more valuable than the prof component? It doesn't make sense to me. Any ***** can put together a lab, but only a few well-trained *****s can read a slide and give a diagnosis. Shouldn't it be the other way around?

 

[Entgegen]

Why is the tech component more valuable than the prof component? It doesn't make sense to me. Any ***** can put together a lab, but only a few well-trained *****s can read a slide and give a diagnosis. Shouldn't it be the other way around?

If my memory serves, it had to do with pathologists lobbying for the percentage paid by insurance to be heavy on the TC side. This lobbying was done because pathologists would get reimbursed for every CBC and chem panel that went through the lab, so the TC-heavy reimbursements resulted in pathologists banking hard for doing essentially nothing. While this was going on, pathology was one of the highest paid fields in medicine. WELL insurance eventually caught on and put a stop to that, but the TCC ratio remained relatively unchanged.

Anyone with further insight feel free to add to/correct any of this.

 

[LADoc00]

If my memory serves, it had to do with pathologists lobbying for the percentage paid by insurance to be heavy on the TC side. This lobbying was done because pathologists would get reimbursed for every CBC and chem panel that went through the lab, so the TC-heavy reimbursements resulted in pathologists banking hard for doing essentially nothing. While this was going on, pathology was one of the highest paid fields in medicine. WELL insurance eventually caught on and put a stop to that, but the TCC ratio remained relatively unchanged.

Anyone with further insight feel free to add to/correct any of this.

Sounds about right, during the 80s the massive shift occurred that resulted in hospital labs going from Pathologist owned to Hospital owned, essentially blowing up the field of Clinical Pathology, which went from Kim Kardashian-level of excess to full on starving hobo overnight.

Clin Path as its own field has pretty much never recovered from that.

I can definitely see the Syndicate Practice Owners who capitalized the lab conspiring to keep TC reimbursement higher than PC (where often the do nothing old timer Pathologist practice founder simply collected the TC while passing on the lower PC to his enslaved professional employees).

The level of short sightedness in Pathology is stunning.

 

[GeoLeoX]

And though it has little to do with the main point and is totally an aside. Can anyone produce any literature showing that doing 12 sector biopsies does anything for patients (I.e. improve mortality or morbidity) other than jack up their pathology bill 6-12x?

One can raise the same question for screening in general. The most recent Cochrane Review (2010) concludes: "Prostate cancer screening did not significantly decrease all-cause or prostate cancer-specific mortality in a combined meta-analysis of five RCTs." Put that up front and nothing much else matters.

However, these data are based on trials that took all-comers, not specific for "special populations". I follow the NCCN guidelines when I have a question about best practices. Not knowing the details of the particular case, the NCCN algorithms are based on at least level II (nonrandomized, trial-based) evidence. The 12 core TRUS biopsy is the standard based on several large studies that showed 20% of cancers would have been missed if only the sextant technique was used (J Urol 2003 169:125) or 31% (J Urol. 2006 175:1605). It is also known that individual embedding improves the detection of tumors within cores, due to increased surface area representation (J Urol. 2002 168:496).

I didn't chime in against your recent ill-informed polemic on the utility of mismatch repair immunohistochemistry, but this one I couldn't pass up. Please tone down the vitriol, sharpen the rhetoric, and do your due diligence prior to posting. You may think you are raising "valuable discussion points" and while I agree many of your posts are thought-provoking your manner and attitude often prevent the message from being delivered. An inflammatory chat up with an acquaintance in a garage is not the image of pathology that I want for my field.

Keep posting food for thought, but please don't crap on it while it's being served.

 

[Substance]

Sounds about right, during the 80s the massive shift occurred that resulted in hospital labs going from Pathologist owned to Hospital owned, essentially blowing up the field of Clinical Pathology, which went from Kim Kardashian-level of excess to full on starving hobo overnight.

Clin Path as its own field has pretty much never recovered from that.

I can definitely see the Syndicate Practice Owners who capitalized the lab conspiring to keep TC reimbursement higher than PC (where often the do nothing old timer Pathologist practice founder simply collected the TC while passing on the lower PC to his enslaved professional employees).

The level of short sightedness in Pathology is stunning.

That's just ******ed. PC and TC should switch places. That'd fix most problems your field is having.

 

[WEBB PINKERTON]

That's just ******ed. PC and TC should switch places. That'd fix most problems your field is having.

The TC should be more than the PC. Lot more work/costs associated with the TC component than the PC.

 

[sirenomelia]

The TC should be more than the PC. Lot more work/costs associated with the TC component than the PC.

Any many more sources of error/ liability

 

[LADoc00]

The TC should be more than the PC. Lot more work/costs associated with the TC component than the PC.

Not really, you can "buy" the TC component on the open market at most places for 5 bucks a slide. You could never buy the PC read for less than 3 times that.

Free Market says the TC on a 83305 should be somewhere in the range of 15 bucks max (for a built in profit and capital risk) not the 70+ it is now. I fully expect the TC to be slashed so hard as to make most outpatient National Labs biz models unprofitable. If not next year, within 5 years.

 

[Pathwrath]

I fully expect the TC to be slashed so hard as to make most outpatient National Labs biz models unprofitable. If not next year, within 5 years.

It's going to happen, and that's why I'm gritting my teeth and putting up with these in-office lab arrangements for the time being.

 

[Substance]

Not really, you can "buy" the TC component on the open market at most places for 5 bucks a slide. You could never buy the PC read for less than 3 times that.

Free Market says the TC on a 83305 should be somewhere in the range of 15 bucks max (for a built in profit and capital risk) not the 70+ it is now. I fully expect the TC to be slashed so hard as to make most outpatient National Labs biz models unprofitable. If not next year, within 5 years.

So from a business perspective is there any legal reason why a group of pathologists can't open up a lab and charge insurance less than the going rate for TC than the mega labs (you know, 15 bucks for built in profit and capital risk), in order to preserve their PC? Or will this be a net-loss?

To me the TC is much like the assembly line in a car manufacturing plant. The PC is the engineer who designs the car. Only one of those can be automated.

 

[member0007]

the payment made to the urologist, pathologist, hospitals etc by the insurance companies are all negotiable. it's crazy but check out "uwe reinhardt" for discussions on how that works. i hate to be pessimistic but it's probably better to not call out your clinician friends as greedy but rather look at why this is the case.