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

[pathstudent]

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hmm... won't a private insurance company catch on to what is happening and basically find a way to get out of reimbursing the crazy fees to the urologist. i am sure they will in once they get all the handouts and extra customers coming their way after the new healthcare reform. also, 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. also, there is no one lobbying for the interests of the health of the field of pathology and maintain it as a viable profession. for instance, there isn't a pathology representative on the cms committee which determines prices for services and basically, the fee for a medicare tc is like paltry and pc is also not great. honestly, i was hoping for a more comprehensive health care reform with some regulation on all this price gouging and disparate reimbursements etc but that didn't happen. so now i feel like we all have to get health insurance, meaning another huge handout to the private health insurers who already run amok the healthcare system, no matter how nicely they dress it all up, bottom line is the bottom line, for-profit and answers to shareholders right, we know where that got us with the too big to fail banks. along those lines, healthcare is probably the next bubble because real estate is bust and now healthcare basically is the economy. finally, it's probably illegal to s/o a tc/pc deal 2000 miles away. the cases have to be signed out on the premises, at least that's what i have been led to believe, is this true?

I completely agree with your commentary. Regarding your last line, I believe that is true to bill medicare. If the patient is self-pay or private insurance, stark laws aren't enforceable.

 

[2121115]

for instance, there isn't a pathology representative on the cms committee which determines prices for services

Completely false.

 

[Entgegen]

Completely false.

Indeed. Here's the link to the page where you can see the roster of the RUC committee: http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-resource-based-relative-value-scale/the-rvs-update-committee.page

Just click the Current Composition of the RUC link. Our guy is J. Allen Tucker.

 

[BU Pathology]

Indeed. Here's the link to the page where you can see the roster of the RUC committee: http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-resource-based-relative-value-scale/the-rvs-update-committee.page

Just click the Current Composition of the RUC link. Our guy is J. Allen Tucker.

The College of American Pathologists is the second largest physician lobbying group, based on the annual budget. The first is the AMA. We are well represented.

 

[BrainPathology]

The College of American Pathologists is the second largest physician lobbying group, based on the annual budget. The first is the AMA. We are well represented.

And from what I've been told by much more experienced collegues in my work with CAP we have been well fought for over the years. I can understand that some things are not as good as we want them, but from what I gather the efforts of CAP's efforts have prevented them from being FAR worse.

 

[Doormat]

Corrupt in-office urology labs are still pushing the envelope. Check out this urology in-office at Urology of Indiana. Every positive prostate core needle biopsy gets a DNA fingerprinting test to ensure that the correct biopsy belongs to the correct patient. Not only does the urologist get 90% of the global bill for the 12-part core biopsies, he (or she) can also client bill the patient for a DNA simple tandem repeat (STR) identification battery test along with each biopsy! You can code stack for molecular testing of both the cheek swab and each of the biopsies. This amounts to a direct kickback to the urologist of >$4000 per positive patient test. If insurance doesn't pay they just bill the patients directly. Check out the company called "Know error". This company has an arrangement with PLUS diagnostics.

Here is a quote from the endorsing urologist

"Guided by this independent verification of sample identity, my partners and I can recommend therapy to patients with the increased confidence that can only come from a positive DNA match between the patient and his pathology tissue. Having become accustomed to this added measure of confidence, it is difficult now to imagine initiating treatment without it."

http://www.knowerror.com

 

[pathstudent]

Wow that takes sleazy to a whole new level.

Corrupt in-office urology labs are still pushing the envelope. Check out this urology in-office at Urology of Indiana. Every positive prostate core needle biopsy gets a DNA fingerprinting test to ensure that the correct biopsy belongs to the correct patient. Not only does the urologist get 90% of the global bill for the 12-part core biopsies, he (or she) can also client bill the patient for a DNA simple tandem repeat (STR) identification battery test along with each biopsy! You can code stack for molecular testing of both the cheek swab and each of the biopsies. This amounts to a direct kickback to the urologist of >$4000 per positive patient test. If insurance doesn't pay they just bill the patients directly. Check out the company called "Know error". This company has an arrangement with PLUS diagnostics.

Here is a quote from the endorsing urologist

"Guided by this independent verification of sample identity, my partners and I can recommend therapy to patients with the increased confidence that can only come from a positive DNA match between the patient and his pathology tissue. Having become accustomed to this added measure of confidence, it is difficult now to imagine initiating treatment without it."

http://www.knowerror.com

 

[MirkoCrocop]

"We Are Ready for a DNA Timeout"
John Pfeifer, MD, PhD, Vice Chairman for Clinical Affairs, Pathology and Immunology,
Washington University School of Medicine

"Know Error Best Practices"
Ann Anderson, MD, Director of Pathology, Integrated Medical Professionals

Lol!!! A few clicks into the website you can find endorsing pathologists. Do these schmucks have stock in the knowerror system?

 

[gudog]

"We Are Ready for a DNA Timeout"
John Pfeifer, MD, PhD, Vice Chairman for Clinical Affairs, Pathology and Immunology,
Washington University School of Medicine

"Know Error Best Practices"
Ann Anderson, MD, Director of Pathology, Integrated Medical Professionals

Lol!!! A few clicks into the website you can find endorsing pathologists. Do these schmucks have stock in the knowerror system?

I suspect these dudes must have treated a patient who was later found not to have cancer due to a mislableling of specimen mishap.

Prob would only take one of these mishaps to make one consider DNA testing of all positive biopsies.

 

[KCShaw]

That's all well and good, but the risk of labeling/human error doesn't go away, it's just re-assigned to the DNA testing. The error rate might actually be -higher- since they also have another specimen to test and compare against, the DNA standard from the patient. Those errors might be easier to catch before a result is released, since comparisons are being done, but that doesn't mean they're easier to correct for -- probably have to start over after each apparent error/mismatch, with new comparison samples. Expensive and time consuming (don't people realize there are months worth of DNA backlog for criminal investigations that these resources should really be going to?), for probably no benefit and possibly to detriment -- though in the interest of disclosure I haven't read those articles.

 

[mlw03]

That's all well and good, but the risk of labeling/human error doesn't go away, it's just re-assigned to the DNA testing. The error rate might actually be -higher- since they also have another specimen to test and compare against, the DNA standard from the patient. Those errors might be easier to catch before a result is released, since comparisons are being done, but that doesn't mean they're easier to correct for -- probably have to start over after each apparent error/mismatch, with new comparison samples. Expensive and time consuming (don't people realize there are months worth of DNA backlog for criminal investigations that these resources should really be going to?), for probably no benefit and possibly to detriment -- though in the interest of disclosure I haven't read those articles.

The labs doing forensic specimens are not the ones doing these sort of highly profitable patient specimens. The companies involved are presumably much more interested in pleasing stockholders than in helping crime labs with their DNA backlog.

 

[KCShaw]

No doubt, and certainly the monetary resources are differently placed. But in a broader view, that hardware and those technicians ideally should be doing other things, hired and paid for by a different sector. It just speaks to the apparent national priorities of our people, our healthcare and law enforcement systems, our economy, etc.

 

[LADoc00]

Know Error company is a known rob. Stay WELL AWAY from any Know Error sales representative.

they will try to induce you with payments etc.

warning.

 

[member0007]

The College of American Pathologists is the second largest physician lobbying group, based on the annual budget. The first is the AMA. We are well represented.

thanks people!

 

[WEBB PINKERTON]

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.

I said there was more costs associated with TC so it should be more expensive. We all know it is used as an inducement to get medicare/medicaid and other pull through work. Then BILL BILL BILL. Make money with unnecessary immunos, ancillary testing etc. No lab would do the TC for 5 bucks if they werent getting the pull through work. If they did, they wouldnt be in business very long. Of course it is suppose to be illegal to use inducements to get medicare/medicaid patients but you'd have to shut down every lab in America if you enforced that.

Sounds like labcorp and united insurance are being looked at though.....
http://www.huffingtonpost.com/2011/...orporation-of-america-medicare_n_1032654.html

 

[LADoc00]

I said there was more costs associated with TC so it should be more expensive. We all know it is used as an inducement to get medicare/medicaid and other pull through work. Then BILL BILL BILL. Make money with unnecessary immunos, ancillary testing etc. No lab would do the TC for 5 bucks if they werent getting the pull through work. If they did, they wouldnt be in business very long. Of course it is suppose to be illegal to use inducements to get medicare/medicaid patients but you'd have to shut down every lab in America if you enforced that.

Sounds like labcorp and united insurance are being looked at though.....
http://www.huffingtonpost.com/2011/...orporation-of-america-medicare_n_1032654.html

There ARENT more costs associated with TC, especially when its properly scaled up. Your first 1000 glass slides might cost you 100+ bucks a pop, but number 10,001 is less than 5 bucks. I know this for a fact. Im telling you, I can buy cut glass slides for 5-8 bucks depending on a volume a pop.

I wish people would stop reproducing this fiction of TC cost > PC. Or at least listen to real world path people who are actually IN THIS MARKET and not surfing internet porn all day in a sleepy residency program somewhere...

I predict an 80% slash in TC billing codes for Pathology. Very soon. This will have a ripple effect of putting Ameripath, Dianon, CBLPath, OURLab, Bostwick and many others out of business or defunct well before 2020.

I expect molecular and genetic testing to likewise be massively reduced in payments to make companies like GenomicHealth teeter on the edge of bankruptcy within 10 years as well.

 

[bioguy]

...and not surfing internet porn all day in a sleepy residency program somewhere....

damn, you caught me, man!

 

[mlw03]

LA - what do you base those predictions on? I'd think those companies would have some pretty heavy lobbying efforts to ensure their survival and continued financial success.

 

[deleted314957]

There ARENT more costs associated with TC, especially when its properly scaled up. Your first 1000 glass slides might cost you 100+ bucks a pop, but number 10,001 is less than 5 bucks. I know this for a fact. Im telling you, I can buy cut glass slides for 5-8 bucks depending on a volume a pop.

I wish people would stop reproducing this fiction of TC cost > PC. Or at least listen to real world path people who are actually IN THIS MARKET and not surfing internet porn all day in a sleepy residency program somewhere...

I predict an 80% slash in TC billing codes for Pathology. Very soon. This will have a ripple effect of putting Ameripath, Dianon, CBLPath, OURLab, Bostwick and many others out of business or defunct well before 2020.

I expect molecular and genetic testing to likewise be massively reduced in payments to make companies like GenomicHealth teeter on the edge of bankruptcy within 10 years as well.

i have heard this gloom and doom since TEFRA in 1982 which gutted pathology clinical pathology money. I was actually told in 1981, just before i started my residency that"any money you make in pathology will come from the clinical lab and that any reputation i make will come from anatomic path."
I have just never seen it. as a pp partner in 1992 i made $700K which is about 1M today. As you've all heard, we sold and cashed out but the money is still very good, in the orthopod range. Maybe i won't get any more raises but the apocalypse doesn't seem to come. I am thankful that i am where i am but i don't work for some obscure and out-of the way employer.

 

[KluverB]

Duh. No surprises here....

"Self-referring urologists billed Medicare for nearly 75% more anatomic pathology (AP) specimens compared to non self-referring physicians, according to a study published today in a leading health care policy journal. Furthermore, the study found no increase in cancer detection for the patients of self-referring physicians—in fact, the detection rate was 14% lower than that of non self-referring physicians."

New Evidence Links Self-Referral Labs to Increased Utilization, Lower Cancer Detection Rates

 

[KeratinPearls]

Duh. No surprises here....

"Self-referring urologists billed Medicare for nearly 75% more anatomic pathology (AP) specimens compared to non self-referring physicians, according to a study published today in a leading health care policy journal. Furthermore, the study found no increase in cancer detection for the patients of self-referring physicians—in fact, the detection rate was 14% lower than that of non self-referring physicians."

New Evidence Links Self-Referral Labs to Increased Utilization, Lower Cancer Detection Rates

What is the status of these in office labs? Does anyone know? When are these labs going to be illegal?

Anyways great to see this study. Hopefully, this will end in office labs once and for all.

 

[pathstudent]

What is the status of these in office labs? Does anyone know? When are these labs going to be illegal?

Anyways great to see this study. Hopefully, this will end in office labs once and for all.

It would be good if nytimes picked it up. I don't know if it is big enough issue though.

 

[KeratinPearls]

It would be good if nytimes picked it up. I don't know if it is big enough issue though.

Ill forward the article to the editor. It's worth a try to bring these dbags down. It will bring a lot of volume back to pathologists like they were meant to be. However, there will always be those reference labs and their dirty tactics. At least we as pathologists have a fighting chance to take back what is ours.

 

[pathstudent]

Ill forward the article to the editor. It's worth a try to bring these dbags down. It will bring a lot of volume back to pathologists like they were meant to be. However, there will always be those reference labs and their dirty tactics. At least we as pathologists have a fighting chance to take back what is ours.

Good Idea. I am sure CAP will do a media blitz on it, but it is worth sending it along as a grass roots thing.

I sent the article to my senators and my congressperson.

 

[pathstudent]

WSJ has picked up the story! http://online.wsj.com/article/SB10001424052702304587704577334151947578204.html


Here is the AUAs first response. If the AUA tries to frame urologists profiting of pathology services as anything other than taking advantage of a loophole, they are a sleazier organization than I ever would have guessed. Party is over. It is patently unethical to any normal person.


AUA Preparing Official Response to Study on Use of In-House Pathology Services

This afternoon, the journal Health Affairs is expected to release a study on physician self-referral of anatomic pathology services. Although at the writing of this article the study is still under strict embargo, we understand that it documents overall trends regarding anatomic pathology testing services utilization for prostate biopsies, and compares the specific number of pathology specimens billed to Medicare by physicians who in-source pathology testing vs. those who do not. We understand that this study was funded by the College of American Pathologists, therefore we have some concerns about what conclusions may have been drawn.

As a leading advocate for the specialty of urology, we want you to know that the AUA is already in discussions with key media outlets ensuring that our voice is heard. We will be actively reviewing the study and preparing an official response. Please watch your inbox in the coming days for updates from the AUA on this issue.

 

[WEBB PINKERTON]

Ill forward the article to the editor. It's worth a try to bring these dbags down. It will bring a lot of volume back to pathologists like they were meant to be. However, there will always be those reference labs and their dirty tactics. At least we as pathologists have a fighting chance to take back what is ours.

The volume will just go to other labs that exploit the pathologist surplus. You can either be a slave to a GI/Urology group or Ameripath. You are screwed either way. It's a shame these in-office labs are supposedly so low paying. Would be nice to have more variety of work environments other than slide mills. Virtually all of the new AP labs being started are in-office labs. You can probably count on one hand any new startups that arent in-office. We need alternatives to working for these large corporate labs. Friend of mine left the grind and works for drug company looking at rat liver bx all day long.

The pathologist surplus is killing us.

Our profession isnt full of angels. Pathologists are just as guilty as other physicians in ripping people off. I see it daily in people ordering unnecessary immunos etc.

 

[KCShaw]

Eh, I half expect the urologists to appeal to the public, which doesn't care about expense and isn't very clued in to current appropriate medical practice, with a couple of simple questions like "Wouldn't you rather have -your- urologist and all their expertise controlling what happens to -your- biopsy, than some corporate lab in another state?" ("corporate" is a catch-all for everything that is evil in the public eye, right?) and "Wouldn't you feel better knowing that you're being checked out by a urologist who cares enough to test you every 3 months instead of every year?", or somesuch.

While I find it hilarious, if somewhat expected, to hear of these results I really don't see anything changing until it's made illegal or unfunded. I'd rather the former, because the latter would just mean insurance has taken control of one more piece of medicine. Actually, I'd rather medicine take care of this kind of thing internally, but we don't seem to have much teeth for each other outside of individual issues like licensing or malpractice suits, and I don't see that changing anytime soon either.

 

[Unty]

These in office labs wont last forever. When they become illegal, pathology groups will have only large reference labs to compete against.

 

[WEBB PINKERTON]

These in office labs wont last forever. When they become illegal, pathology groups will have only large reference labs to compete against.

You likely will be working for a large reference lab. You cant survive unless you have economy of scale.

I wouldnt mind in-office labs if pathologists werent a dime a dozen.
If it wasnt for the pathologist surplus, who knows Urologists/GI docs may actually recruit pathologists and pay them fairly.

"Client billing" has been around forever so why wont in-office labs stay around? They are both the same thing (profit from doing more and more specimens). The wall street journal article years ago about "client billing" did very little, which is what this in-office lab article will accomplish. We managed to get rid of client billing on AP specimens in my state and it is nice but the rest of the lab it is still business as usual. I think there are now a whopping 17 states that have outlawed client billing for AP specimens. If we continue at this pace, sometime in the year 2040 it will be illegal in all 50 states. Heck by that time technology will have replaced us anyways.

 

[lipomas]

There is no inherent problem with in office labs. They do make sense as a medical strategy and business practice to keep costs down. However, the quality often suffers. So arguing that it makes sense as a patient care thing is kind of silly. They would have better access to the pathologist but that doesn't really add much since it isn't hard to have access anyway.

Most of the money is in the technical fees anyway. A lot of the blather online is that the urology groups make their money off the professional fees and pay the pathologist a pittance, but I don't think that is terribly accurate. No doubt the majority do not pay the pathologist the full professional fee, but the money is in the technical.

And yeah, basically it's all about money. All this nonsense about patient care and quality is garbage. It's about money. The proof is in the pudding. They can spin it all they want but all the data about physician-owned services and utilization is consistent with it.
-Physician owned labs do more biopsies and more of them are benign.
-Physician owned labs do vastly more immunostains
-Physician owned radiation equipment is used more
-Physician owned labs utilize esoteric tests (which they perform themselves) more, like FISH and DNA matching.

Basically, these idiots are ruining it for everyone else. They are going to cash out until the gravy train stops at which point they will be far enough along that it doesn't really matter to them. And then the fees will keep getting cut because anything which makes money is obviously overpriced if you ask government policy experts. But expenses will not go down.

 

[KeratinPearls]

There is no inherent problem with in office labs. They do make sense as a medical strategy and business practice to keep costs down. However, the quality often suffers. So arguing that it makes sense as a patient care thing is kind of silly. They would have better access to the pathologist but that doesn't really add much since it isn't hard to have access anyway.

Most of the money is in the technical fees anyway. A lot of the blather online is that the urology groups make their money off the professional fees and pay the pathologist a pittance, but I don't think that is terribly accurate. No doubt the majority do not pay the pathologist the full professional fee, but the money is in the technical.

And yeah, basically it's all about money. All this nonsense about patient care and quality is garbage. It's about money. The proof is in the pudding. They can spin it all they want but all the data about physician-owned services and utilization is consistent with it.
-Physician owned labs do more biopsies and more of them are benign.
-Physician owned labs do vastly more immunostains
-Physician owned radiation equipment is used more
-Physician owned labs utilize esoteric tests (which they perform themselves) more, like FISH and DNA matching.

Basically, these idiots are ruining it for everyone else. They are going to cash out until the gravy train stops at which point they will be far enough along that it doesn't really matter to them. And then the fees will keep getting cut because anything which makes money is obviously overpriced if you ask government policy experts. But expenses will not go down.

What % of the professional do these crooks take? I cant even imagine the grin on their faces with 12 core prostates dual stains on all 12 cores and FISH Urovysion all in house technical and part of the professional. This is ridiculous. No wonder why pathologists get no respect from anyone else. We are like everyone's highly educated b*tch. Pathologists must seem like technicians to some docs.

 

[Whiskeyjack]

All this hullabaloo abt being peoples b*tches. I bet there are only a very few pathologists that aren't. I mean really how many out there are collecting their FULL professional fees. Likely the senior partners/owners are screwing you anyway. And I think the clinicians are more likely to value you than your senior partners because you sure as hell know more pathology than they(the clinicians) do.
Truth be told I was all up in arms abt the whole pod lab thing in the beginning but now the apathy amongst the pathologists I know..... I cant help but think its nobody's fault but theirs. (You should see how they cream themselves over meaningless positions like director of this or co-director of that when I absolutely know there's been NO increase in salary or benefits and the residents and fellows join in the ridiculous preening show. Laughable) Plus I'll rather have the pod labs comparitively little peckers rape me than the Ameripath boys. As the guru, LA DOC, says biz skillz trump anything.
So try this and see if it fits.....
1)Work for a few years save some money, maybe do it with a colleague.
2) Approach a clinician group that don't have a lab and offer to set one up WITH them with the money you saved as capital. Become an in house pathologist, as well as lab director, do a kick ass job and leverage off your investment for better pay excluding the value of the investment itself.
I think you'll have a better chance of being treated fairly than them fire you for a cheaper pathologist and risk the legal wreck as you try to extricate the value(plus accrual) of your capital (both cash and time spent professionally developing the lab). I would personally even prefer this model of a couple of pathologists per pod lab to any large pathology group practices. Plus you cut out those in house lab set up creeps who I personally despise-its one thing getting stiffed by another MD and yet another getting stiffed by a trumped up tech.
I have absolutely no biz background and all this might be some real naive BS but at least I'm thinking. CAP is run by the 'old guard' pathologists who prey just as much on younger pathologists and all they're saying to the pod labs is... "I know you didn't MOFO... these is MA B*TCHES!"

 

[pathstudent]

What % of the professional do these crooks take? I cant even imagine the grin on their faces with 12 core prostates dual stains on all 12 cores and FISH Urovysion all in house technical and part of the professional. This is ridiculous. No wonder why pathologists get no respect from anyone else. We are like everyone's highly educated b*tch. Pathologists must seem like technicians to some docs.

I am sure it varies. But one pathologist I know said his group was offered ten dollars a biopsy to sign it out. The pathologist said "well medicare pays us about 40" and the urologists response was "well we think your worth about $2 but we will pay you 10". The pathologist walked out. But someone took that job and so the urologists are keeping about 75% of the professional fee.

It is a disgusting world out there. This kind of funny business wouldn't be allowed to go on in other specialties. I,e, if cardiologists were giving a 75% kickback to family practice docs for referrals, a state medical board or medicarewould investigate that operation. But for some reason it is ok in pathology.

 

[path24]

Instead of fighting this with "articles", how about we make it so pathologists aren't a dime a dozen and having to work for peanuts to feed their families. The problem would stop if the urologist couldn't find someone to do for them....pretty obvious solution here. Yes there will always be the one guy that would, but a lot what tell them to go to hell if we wouldn't all be fighting currently for business.

Well this just may mean less biopsies...less of a need for pathologists. Strong work ASCP/CAP. I could careless who gets the tc component, pathologists are lucky to be getting a full prof component.

 

[lipomas]

Instead of fighting this with "articles", how about we make it so pathologists aren't a dime a dozen and having to work for peanuts to feed their families. The problem would stop if the urologist couldn't find someone to do for them....pretty obvious solution here. Yes there will always be the one guy that would, but a lot what tell them to go to hell if we wouldn't all be fighting currently for business.

Well this just may mean less biopsies...less of a need for pathologists. Strong work ASCP/CAP. I could careless who gets the tc component, pathologists are lucky to be getting a full prof component.

OK, so you tell me how a "shortage" of pathologists is going to help.

My scenario of a shortage of pathologists means fewer pathologists around, which also means fewer subspecialized pathologists, which means more business (especially the specialized stuff like prostate bx and GI bx) go to reference labs who can handle the volume and expertise.

If the urologist "can't find someone" to staff an in office lab he will just go to a reference lab who will provide some other sweetener. The pathologist supply issue is a red herring. The main issues are regulatory mechanisms and loopholes. Having too many pathologists isn't good either, but it doesn't really change much for the practicing pathologist now.

 

[KCShaw]

I thought part of the argument includes the assumption that even megalabs have to soak up a few pathologists in order to run their volume. Yeah, they may be able to do more for less as compared to some smaller practices, but that doesn't necessarily mean they can take on 30%..50%..or whatever more volume without needing to hire -anyone-, -ever-. That said, sure, a cheap megalab is tough to compete with regardless. And yeah, I think billing and reimbursement problems (what is/isn't illegal vs unethical vs immoral, as well as how much gets paid to who for what) are certainly significant, and medicine as a profession, not even getting to specialties, appears to have failed to address -any- of those issues.

 

[lipomas]

I thought part of the argument includes the assumption that even megalabs have to soak up a few pathologists in order to run their volume. Yeah, they may be able to do more for less as compared to some smaller practices, but that doesn't necessarily mean they can take on 30%..50%..or whatever more volume without needing to hire -anyone-, -ever-. That said, sure, a cheap megalab is tough to compete with regardless. And yeah, I think billing and reimbursement problems (what is/isn't illegal vs unethical vs immoral, as well as how much gets paid to who for what) are certainly significant, and medicine as a profession, not even getting to specialties, appears to have failed to address -any- of those issues.

Yeah but if megalabs start getting short of pathologists they can slightly raise their pay to compete. You still aren't going to be a partner, and lots of path grads are still going to be drawn to the "I don't want to be a partner, I just want to work my 8 hours and go home" lifestyle that makes so many people go into ER.

Like I said, the in-office lab isn't necessarily a big problem if it is done properly. There are some large urology and GI groups which run quality in office labs and actually hire competent pathologists and techs, and pay them well. They still overutilize services for the most part though.

Just attributing this whole problem to "an oversupply of pathologists" is simplistic and short sighted and neglects the real causes. You can argue all you want that an oversupply of pathologists permits the system to perpetuate but I would posit that if a shortage happens, the people that are going to struggle to hire pathologists are NOT in office labs, but are the smaller pathology groups who have to run labs, take call, cover frozens, all that.

 

[Torsed]

Most GI pod labs I know of pay the pathologist a set wage per case and bill for the whole professional/technical themselves. Pathologist would probably be doing well to get a percentage. I really can't blame the GI/Urologists for pod labs if there are pathologists who would play this game with them.

 

[pathstudent]

Most GI pod labs I know of pay the pathologist a set wage per case and bill for the whole professional/technical themselves. Pathologist would probably be doing well to get a percentage. I really can't blame the GI/Urologists for pod labs if there are pathologists who would play this game with them.

This is what is known as fee splitting, no matter what you call it or how you arrange it. It is illegal by medicare, state medicaid and the AMA states it as unethical. It is the target of anti-mark-up laws.

 

[Substance]

Is it even legal for pathologists to work at in-office labs if they are only given a % of the professional component?

As it looks, the urologists hire a path, bill for 100% technical and take x% professional. Now, could that not be construed as the pathologist, in this weak job market, stating that if the urologist sends him referrals aka biopsies, he will give x% of the billings back to the urologist?

If that is the case, then I cannot see an arrangement that makes in-office labs legal at all other than the pathologist billing 100% for professional services rendered.

 

[2121115]

Is it even legal for pathologists to work at in-office labs if they are only given a % of the professional component?

As it looks, the urologists hire a path, bill for 100% technical and take x% professional. Now, could that not be construed as the pathologist, in this weak job market, stating that if the urologist sends him referrals aka biopsies, he will give x% of the billings back to the urologist?

If that is the case, then I cannot see an arrangement that makes in-office labs legal at all other than the pathologist billing 100% for professional services rendered.

It is illegal for medicare patients, but perfectly fine for those with private insurance.

 

[WEBB PINKERTON]

It is illegal for medicare patients, but perfectly fine for those with private insurance.

I guess we need a single government payer system. At least we wouldn't have to deal with in-office labs taking our technical/professional components and other physicians forcing us into "client billing" for the technical part of tissues, paps etc.

Before "client billing" was outlawed in my state, medicare/medicaid patients were the most profitable for us (on the outreach side) which is kind of sad. The insurance monopoly will probably make that true again at some point but at least we dont have to offer 10 dollar skins and 16 dollar paps any longer.

 

[member0007]

FYI... NY Times picked up the story this week on some obscure corner, hehe.

The more I consider the Affordable Care Act, the more I like it. I did get into arguments with democrats about it and what a sham and how it doesn't do enough ...etc etc etc, which was a few months ago because the only solution is a single payer system.

Well... I don't think so anymore. However, I do think that we should do away with the employment based healthcare system entirely. Why should having a job at a company that pays for health insurance be the only way to really have health insurance? Frankly, I would rather individuals could pay for affordable care on the market/ exchange. This enables for a lower rate that now the employers get to bargain and negotiate a good rate for based on the # of employees they hire and they get to spend a fraction of the cost that is presented to an individual. For ex: my health insurance was like 6k or something like that, but I am sure if I contact the insurer, they would quote me something ridiculous like 10 or 12k for the same coverage (this is just a conjecture that has not been fully investigated). UGGGGGHHHHH...but even 6K is too high and 10k is out of question. I am going to do a little investigation in the next few months and I can report back on this but if anyone has any info on this please post a link or something Anyway, it is ridiculous that health insurance is so costly.

The whole arbitrary and unregulated nature of healthcare is frustrating and the idea that it should be tied to employment etc is very elitist and not very democratic or based in principles of capitalism (ahem, conservatives). Of course, I am going to move to a state that has decided to go ahead with their own version of the obama-care. Frankly, I am curious to see just how much it will cost to insure yourself or get catastrophe insurance only and pay for all usual primary care costs oneself.

 

[mlw03]

Interesting comments. I'll say what I've said before and tick off the conservatives on here. Health care is expensive in the US because it's a business. And businesses exist to make money. If they don't make money, they go under. So in my view, it's about whether one believes healthcare should be a product for sale like anything else. If so, the system we have reflects that and is OK, but if you believe healthcare is a right that should be widely available to all, then our system leaves quite a bit to be desired.

FYI... NY Times picked up the story this week on some obscure corner, hehe.

The more I consider the Affordable Care Act, the more I like it. I did get into arguments with democrats about it and what a sham and how it doesn't do enough ...etc etc etc, which was a few months ago because the only solution is a single payer system.

Well... I don't think so anymore. However, I do think that we should do away with the employment based healthcare system entirely. Why should having a job at a company that pays for health insurance be the only way to really have health insurance? Frankly, I would rather individuals could pay for affordable care on the market/ exchange. This enables for a lower rate that now the employers get to bargain and negotiate a good rate for based on the # of employees they hire and they get to spend a fraction of the cost that is presented to an individual. For ex: my health insurance was like 6k or something like that, but I am sure if I contact the insurer, they would quote me something ridiculous like 10 or 12k for the same coverage (this is just a conjecture that has not been fully investigated). UGGGGGHHHHH...but even 6K is too high and 10k is out of question. I am going to do a little investigation in the next few months and I can report back on this but if anyone has any info on this please post a link or something Anyway, it is ridiculous that health insurance is so costly.

The whole arbitrary and unregulated nature of healthcare is frustrating and the idea that it should be tied to employment etc is very elitist and not very democratic or based in principles of capitalism (ahem, conservatives). Of course, I am going to move to a state that has decided to go ahead with their own version of the obama-care. Frankly, I am curious to see just how much it will cost to insure yourself or get catastrophe insurance only and pay for all usual primary care costs oneself.

 

[lipomas]

Is it even legal for pathologists to work at in-office labs if they are only given a % of the professional component?

As it looks, the urologists hire a path, bill for 100% technical and take x% professional. Now, could that not be construed as the pathologist, in this weak job market, stating that if the urologist sends him referrals aka biopsies, he will give x% of the billings back to the urologist?

If that is the case, then I cannot see an arrangement that makes in-office labs legal at all other than the pathologist billing 100% for professional services rendered.

I don't know. What you are describing sounds exactly like what academic centers do. The hire a pathologist, bill for 100% of the technical and professional, and pay the pathologist a salary. Is this different because the pathologist gets "compensation time" for other activities like research or teaching? I don't know. What about pathologists who are employees of large health centers? They don't get 100% of what they bill.

I am not sure this is technically illegal, but maybe someone can explain it to me. Why is it "fee splitting" if the urology group performs technical + professional and pays the pathologist a salary that is less than 100% of prof fee, how the heck is that illegal? Sounds to me like running a business. It might be unethical but it isn't illegal.

I think "fee splitting" is when the TC and PC are performed at separate places and the urology group gets "paid" for the PC even though the PC is NOT performed at their site.

 

[malchik]

Interesting comments. I'll say what I've said before and tick off the conservatives on here. Health care is expensive in the US because it's a business. And businesses exist to make money. If they don't make money, they go under. .

It does not necessarily follow that X is expensive because X is a business. Yes businesses have to make money, but they also have to compete or they go under, which exerts downward pressure on the product's price. Why is the US postal service unable to compete with UPS and Fedex?

Healthcare is getting more expensive everywhere; it is a question of who pays and in what form. Buy your own insurance, employer-purchased ( = paycut for employee) or higher taxes.

 

[TMZ2007]

Why is the US postal service unable to compete with UPS and Fedex?

Because a 2006 postal reform law required the previously profitable USPS to prepay 75 years of retirement obligations in 10 years.

http://www.uspsoig.gov/foia_files/RARC-WP-10-001.pdf

 

[malchik]

Because a 2006 postal reform law required the previously profitable USPS to prepay 75 years of retirement obligations in 10 years.

http://www.uspsoig.gov/foia_files/RARC-WP-10-001.pdf

Well, that's part of it. But even if that were reversed the postal service would be facing insolvency within a year or two, as revenues have been declining. See: http://www.pbs.org/wnet/need-to-know/five-things/the-u-s-postal-service/11433/

But after thinking about it, this is a bad example that I used, because the usps doesn't directly compete with private mailers, as the latter are not in the junk mail business which is how usps makes money. Maybe this will lead to the end of junk mail. . .

Anyway, the premise I am not sure I agree with is that privatization increases cost. I actually am not opposed to single payer in some form, but not because it will make healthcare cheaper.

 

[lipomas]

The post office also can't increase prices. They could probably double the price of a stamp and demand wouldn't decline a ton, even if people say they would use less stamps (they are lying).

Stamps in some countries in europe are the equivalent of $1 I think.

 

[member0007]

All this hullabaloo abt being peoples b*tches. I bet there are only a very few pathologists that aren't. I mean really how many out there are collecting their FULL professional fees. Likely the senior partners/owners are screwing you anyway. And I think the clinicians are more likely to value you than your senior partners because you sure as hell know more pathology than they(the clinicians) do.
Truth be told I was all up in arms abt the whole pod lab thing in the beginning but now the apathy amongst the pathologists I know..... I cant help but think its nobody's fault but theirs. (You should see how they cream themselves over meaningless positions like director of this or co-director of that when I absolutely know there's been NO increase in salary or benefits and the residents and fellows join in the ridiculous preening show. Laughable) Plus I'll rather have the pod labs comparitively little peckers rape me than the Ameripath boys. As the guru, LA DOC, says biz skillz trump anything.
So try this and see if it fits.....
1)Work for a few years save some money, maybe do it with a colleague.
2) Approach a clinician group that don't have a lab and offer to set one up WITH them with the money you saved as capital. Become an in house pathologist, as well as lab director, do a kick ass job and leverage off your investment for better pay excluding the value of the investment itself.
I think you'll have a better chance of being treated fairly than them fire you for a cheaper pathologist and risk the legal wreck as you try to extricate the value(plus accrual) of your capital (both cash and time spent professionally developing the lab). I would personally even prefer this model of a couple of pathologists per pod lab to any large pathology group practices. Plus you cut out those in house lab set up creeps who I personally despise-its one thing getting stiffed by another MD and yet another getting stiffed by a trumped up tech.
I have absolutely no biz background and all this might be some real naive BS but at least I'm thinking. CAP is run by the 'old guard' pathologists who prey just as much on younger pathologists and all they're saying to the pod labs is... "I know you didn't MOFO... these is MA B*TCHES!"

hullabaloo