what is reasonable for GI practices to pay pathologists?

[vistaril]

My fiance is a GI fellow graduating in 5 months, and she is debating between a few different offers from large GI groups.

The group that she thinks is the best 'fit' for her has a current compensation package in years 1-2 that is 5-10% less than the other two groups, but the group states that this difference will be made up by the time she starts. Apparently they are very high volume in terms of biopsies(huge outpt scoping center) and have an onsite path lab. My fiance and I already know about the cut in TC reimbursements, and this is factored in with their estimated offer.

The issue is that this group states that they will be able to make up some of the portion of difference in starting salaries by renogotiating with the pathology group when their contract runs out in a few months. Right now they are paying the pathologists $19 per. Not per pt/case, but for each billing code. They state they expect the new negotiated rate to be be between 9 and 12 dollars, and that this savings in cost will make up the differences in offers(since they do so much volume)....

Is this reasonable/possible? I don't know a lot about pathology(I'm a pgy-4 in psych), but being in psych I do know what it is like to feel like the red headed stepchild and lowest on the totem pole(!), but even coming from that perspective it seems like accepting between 9 and 12 dollars to do anything is sorta absurd.....

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[Tissue issue]

What does your fiancee think reasonable payment for pathologist diagnosis is? Is she considering the quality of the pathologist signing out her cases?

 

[vistaril]

What does your fiancee think reasonable payment for pathologist diagnosis is? Is she considering the quality of the pathologist signing out her cases?

I don't think she has any idea what is reasonable or not...we were talking about this the other night.

 

[pathstudent]

The Medicare Global on an 88305 was about 105 dollars (some places more, some places less). Private insurers pay slighly more than Medicare, some considerably more if the GI group can negotiate a good contract. but lets just say 120.

Now it is closer to 70 per Medicare specimen. Likely the private insurers are still paying over closer to 120 or they could have gone down too depends on the contract and how fast insurers are moving.

In any case, the GI group is paying the pathologist far less than the Professional component for interpreting the slides. With their new offer, they are trying to make up the difference for losing some of the TC by taking more of the PC from the pathologist.

I am sure the money sounds good as if you can sign-out 100 biopsies a day (which is easy) your fiance would make 900. But the GIs would be collecting closer to 9000 to pay their expenses and split the rest.

I would not take one of these jobs if I was your wife as there is no security. If this type of unethical practice is ever made illegal or if reibursement gets cut even lower, she will be out of job pronto and she will be regarded as a bit of a parriah to local pathology groups. This is not a long term viable way to practice.

My fiance is a GI fellow graduating in 5 months, and she is debating between a few different offers from large GI groups.

The group that she thinks is the best 'fit' for her has a current compensation package in years 1-2 that is 5-10% less than the other two groups, but the group states that this difference will be made up by the time she starts. Apparently they are very high volume in terms of biopsies(huge outpt scoping center) and have an onsite path lab. My fiance and I already know about the cut in TC reimbursements, and this is factored in with their estimated offer.

The issue is that this group states that they will be able to make up some of the portion of difference in starting salaries by renogotiating with the pathology group when their contract runs out in a few months. Right now they are paying the pathologists $19 per. Not per pt/case, but for each billing code. They state they expect the new negotiated rate to be be between 9 and 12 dollars, and that this savings in cost will make up the differences in offers(since they do so much volume)....

Is this reasonable/possible? I don't know a lot about pathology(I'm a pgy-4 in psych), but being in psych I do know what it is like to feel like the red headed stepchild and lowest on the totem pole(!), but even coming from that perspective it seems like accepting between 9 and 12 dollars to do anything is sorta absurd.....

 

[vistaril]

The Medicare Global on an 88305 was about 105 dollars (some places more, some places less). Private insurers pay slighly more than Medicare, some considerably more if the GI group can negotiate a good contract. but lets just say 120.

Now it is closer to 70 per Medicare specimen. Likely the private insurers are still paying over closer to 120 or they could have gone down too depends on the contract and how fast insurers are moving.

In any case, the GI group is paying the pathologist far less than the Professional component for interpreting the slides. With their new offer, they are trying to make up the difference for losing some of the TC by taking more of the PC from the pathologist.

I am sure the money sounds good as if you can sign-out 100 biopsies a day (which is easy) your fiance would make 900. But the GIs would be collecting closer to 9000 to pay their expenses and split the rest.

I would not take one of these jobs if I was your wife as there is no security. If this type of unethical practice is ever made illegal or if reibursement gets cut even lower, she will be out of job pronto and she will be regarded as a bit of a parriah to local pathology groups. This is not a long term viable way to practice.

oh Im sorry if I didn't make it clear...my fiance is the GI fellow potentially taking the GI job in this practice. There is a small salary difference between this job(where it feels right) and a couple other jobs, but the partners assure her that when their current contract is up with the path group they will be able to knock about 10 dollars off what they currently pay for path services....if they do that, the numbers would indicate that indeed that would cover the salary difference. I wanted to know how realistic it is that this group my fiance is about to join can get that down to 9-12 dollars each....or if they are just saying that to make my fiance believe that the revenue would be equal to the other two offers in a couple months.

 

[TMZ2007]

Wait a sec, you are wanting advice about how badly the GI practice can screw over the path lab and still get away with it? Probably not going to get much help there, bucko 🙄

 

[vistaril]

Wait a sec, you are wanting advice about how badly the GI practice can screw over the path lab and still get away with it? Probably not going to get much help there, bucko 🙄

I just don't know enough about pathology(never rotated in pathology in med school....come to think of it not sure if I have ever met a pathologist in real life before) to know how long it takes to do read an 88305 or whatever.....

if you can do almost 100 a day, and they are all set up for you, that seems like 10 dollars is pretty fair right? Or can you not do that many?

 

[pathstudent]

I just don't know enough about pathology(never rotated in pathology in med school....come to think of it not sure if I have ever met a pathologist in real life before) to know how long it takes to do read an 88305 or whatever.....

if you can do almost 100 a day, and they are all set up for you, that seems like 10 dollars is pretty fair right? Or can you not do that many?

No it is not fair as the PC for 88305 is 35 or more. So you are getting paid 25 cents on the dollar. What I don't get is why gastroenterologists think it is fair that they keep the other 75 cents for a physician service that they are not providing.

 

[WEBB PINKERTON]

If you work in pathology you are used to seeing the absurd on a daily basis.

9 to 12 dollars is reasonable considering the oversupply of pathologists. A local group will gladly do it for that. The pathologists staffing these places shouldnt be considered the pariah. The idiots training all these pathologist creating the oversupply are the pariahs.

 

[vistaril]

No it is not fair as the PC for 88305 is 35 or more. So you are getting paid 25 cents on the dollar. What I don't get is why gastroenterologists think it is fair that they keep the other 75 cents for a physician service that they are not providing.

from the conversations I've heard, it sounded like they resented having to pay the lab as much as they do(or at least did under the old contract expiring soon)....several years ago this practice was scoping at the hospital and they weren't collecting facility fee. I think they resented that as well. I think they view themselves as the person running the show in a 'this is my patient and I'm in control' sense, and they view pathologists not as colleagues and certainly not as equal peers in another speciality but rather as a commodity....no different than having a facility of their own to scope vs having to use the hospital.

 

[Arctic Char]

If you work in pathology you are used to seeing the absurd on a daily basis.

9 to 12 dollars is reasonable considering the oversupply of pathologists. A local group will gladly do it for that. The pathologists staffing these places shouldnt be considered the pariah. The idiots training all these pathologist creating the oversupply are the pariahs.

 

[sickofit]

Wow, Vistaril, I'm so glad we could help you out over here on the path board. You're clearly a real solid guy 👍

http://forums.studentdoctor.net/showthread.php?t=978735
Some highlights:

Fiance is about to take a position where she is guaranteed 85,000/year............from pathology alone. That's like free money. Just a trivial "oh, and here is a check for 85k for something you don't even do we found lying around" type of money.

dude, you aren't listening...she is making around 85k next year. From *pathology* alone. To put it in perspective, that would be like you or me finding out we are going to make big money collecting the change in our office chairs after they dropped out of patient pockets. Literally money that is free and requires nothing on their part.......

lol....dude....85k...for the pathology!!!! Just with that extra wrinkle, if we were both making the same thing after that(which obviously isnt going to be the case), she's going to be making already that much more than me. And that's just an 85k money grab that was an afterthought....sort of a "oh yeah, why are we letting the pathologists take this money again from us" moment of clarity.

For us, this is income we've earned that is being taken from us by other doctors. Not an afterthought for us. Glad we could help.

 

[vistaril]

Wow, Vistaril, I'm so glad we could help you out over here on the path board. You're clearly a real solid guy 👍

http://forums.studentdoctor.net/showthread.php?t=978735
Some highlights:

Fiance is about to take a position where she is guaranteed 85,000/year............from pathology alone. That's like free money. Just a trivial "oh, and here is a check for 85k for something you don't even do we found lying around" type of money.

dude, you aren't listening...she is making around 85k next year. From *pathology* alone. To put it in perspective, that would be like you or me finding out we are going to make big money collecting the change in our office chairs after they dropped out of patient pockets. Literally money that is free and requires nothing on their part.......

lol....dude....85k...for the pathology!!!! Just with that extra wrinkle, if we were both making the same thing after that(which obviously isnt going to be the case), she's going to be making already that much more than me. And that's just an 85k money grab that was an afterthought....sort of a "oh yeah, why are we letting the pathologists take this money again from us" moment of clarity.

For us, this is income we've earned that is being taken from us by other doctors. Not an afterthought for us. Glad we could help.

lol, dude...I'm a psychiatrist so I know how it feels to be treated like crap from other specialties. And people don't respect us as colleagues either🙂

In a fair world, my fiance wouldn't get any of your money and the rates for these sorts of biopsies(high volume outpt) would be reduced a lot....if it's really possible to do a hundred of these in a workday, then 10-15 dollars doesn't seem unreasonable.....right now it sounds like it's really the taxpayers who are getting screwed.

 

[Doormat]

This is a strange post. Smells like a possible troll to me. A male psych resident married to a graduating female clinical GI fellow asking about the absolute minimum pathologists will accept for reading an 88305 and the effect on a future employment contract?

The new changes to the PFS for 2013 has winners and losers. Clinical gastroenterologists, urologists, and dermatologists are on the losing end regardless. They could get their slides read for 50 cents per case and still not make up the lost revenue with the 33% global cut to the 88305 (the original PC was only 30% of the global 88305 charge and 33>30). This difference simply cannot be made up. The cut can be mitigated by cutting payments to pathologist to outrageous levels, those suggested by Bernie Ness and Joe P at in office pathology (IOP). The cut can also be mitigated by performing more biopsies. Dermatologists are best positioned to pump up the volume and biopsy every lump, bump, and freckle on a patient. I saw a report from a derm self-referral lab where 4 separate fibrous papules of the nose were biopsied on a patient. GI docs can biopsy more during scope sessions, but it takes time to nibble away at prominent mucosal folds and subtle excresences. Urologists are SOL as their 12 bottle core sextant biopsies were already maxed out. In new risk sharing models, health insurance companies are partnering with large health systems to help stem the avalanche of overutilization. Soon the docs who perform 10 biopsies per endoscopy or 10 biopsies per patient in derm clinic are going to be "out of network."

I am a hospital based pathologist who does a lot of 88309s. Starting January 1st, I now collect $450 for each 88309 PC versus $355 for an 88309 PC last year. I I feel sorry for pathologists relegated to contract 88305 work.

The huge 88305 cut was a thing of beauty. The GI group will re-negotiate a pathology contract in a few months. Yes, a sweatshop lab with a huge economy of scale will accomadate them. The biopsies will be read by a sweatshop "pathologist" who can't get a job anywhere else and reads 100+ of cases per day. The sweatshop may not be local. As LADoc indicates, increased shipping costs using FedEx and UPS may actually exceed the total reimbursement to a lab performing pathology interpretation at a steeply discounted rate. The sweatshop pathologist needs to maintain expensive annual medical licensure in many states. In addition, any sweatshop pathologist boarded after 2006 will have to perform maintenance of certification (MOC) to be board certified. Of course the GI group could use a non-boarded pathologist because they don't give a rat's ass. However, the largest malpractice carrier in the western US (Doctors Company Inc.) won't allow it for GI groups that they insure. Any sweat shop pathologist reading just one type of biopsy for 10 years is unlikely to successfully re-certify.

Winners and losers.

 

[vistaril]

This is a strange post. Smells like a possible troll to me. A male psych resident married to a graduating female clinical GI fellow asking about the absolute minimum pathologists will accept for reading an 88305 and the effect on a future employment contract?

The new changes to the PFS for 2013 has winners and losers. Clinical gastroenterologists, urologists, and dermatologists are on the losing end regardless. They could get their slides read for 50 cents per case and still not make up the lost revenue with the 33% global cut to the 88305 (the original PC was only 30% of the global 88305 charge and 33>30). This difference simply cannot be made up. The cut can be mitigated by cutting payments to pathologist to outrageous levels, those suggested by Bernie Ness and Joe P at in office pathology (IOP). The cut can also be mitigated by performing more biopsies. Dermatologists are best positioned to pump up the volume and biopsy every lump, bump, and freckle on a patient. I saw a report from a derm self-referral lab where 4 separate fibrous papules of the nose were biopsied on a patient. GI docs can biopsy more during scope sessions, but it takes time to nibble away at prominent mucosal folds and subtle excresences. Urologists are SOL as their 12 bottle core sextant biopsies were already maxed out. In new risk sharing models, health insurance companies are partnering with large health systems to help stem the avalanche of overutilization. Soon the docs who perform 10 biopsies per endoscopy or 10 biopsies per patient in derm clinic are going to be "out of network."

I am a hospital based pathologist who does a lot of 88309s. Starting January 1st, I now collect $450 for each 88309 PC versus $355 for an 88309 PC last year. I I feel sorry for pathologists relegated to contract 88305 work.

The huge 88305 cut was a thing of beauty. The GI group will re-negotiate a pathology contract in a few months. Yes, a sweatshop lab with a huge economy of scale will accomadate them. The biopsies will be read by a sweatshop "pathologist" who can't get a job anywhere else and reads 100+ of cases per day. The sweatshop may not be local. As LADoc indicates, increased shipping costs using FedEx and UPS may actually exceed the total reimbursement to a lab performing pathology interpretation at a steeply discounted rate. The sweatshop pathologist needs to maintain expensive annual medical licensure in many states. In addition, any sweatshop pathologist boarded after 2006 will have to perform maintenance of certification (MOC) to be board certified. Of course the GI group could use a non-boarded pathologist because they don't give a rat's ass. However, the largest malpractice carrier in the western US (Doctors Company Inc.) won't allow it for GI groups that they insure. Any sweat shop pathologist reading just one type of biopsy for 10 years is unlikely to successfully re-certify.

Winners and losers.

not sure why that is a strange combination...plenty of males in psych and females in GI. anyone can check my history in(mostly) the psych forums where a long time ago I made note that my fiance is a GI.

My understanding is that this GI group does not use 'sweatshop' pathologists but rather just local guys. The slides are read on site. They aren't shipping them anyway for reads.

As far as board certification issues go, this sounds more like wishful thinking on your part. Many reference lab people read only read one type of slide now, and there isn't massive panic that they are eventually going to not be board certified. Also, some of the FMGs who speak incredibly poor english(Im in psych I should know) also do very well on tests....if a test is involved in recertification as is the case in most specialties, a lot of them will do very well.

 

[sickofit]

lol, dude...I'm a psychiatrist so I know how it feels to be treated like crap from other specialties. And people don't respect us as colleagues either🙂

In a fair world, my fiance wouldn't get any of your money and the rates for these sorts of biopsies(high volume outpt) would be reduced a lot....if it's really possible to do a hundred of these in a workday, then 10-15 dollars doesn't seem unreasonable.....right now it sounds like it's really the taxpayers who are getting screwed.

LOLOLOLOLOLOL!
Really, dude, there's a major difference between pathology and psychiatry: no one's stealing any of your money in psychiatry. So, please, leave us alone and go back to psychiatry, where your opinion is so dearly valued:

But vistaril goes to a "Top" program. He even said so... 🙄

I have to agree. Every time I see Vistaril show up here visions of a funeral with violins playing appear. Look out, here's Debbie Downer.

Im getting a little sick of vistaril...whats ur issue man. You're saying you're spewing the truth, but the truth is you're way off.

If you really believe that 12 step and detox is the only treatment for addiction and psychiatrists have no reason to understand neurologic diseases like epilepsy, I'm really starting to doubt you're a psychiatry resident at all.

This combined with all your other posts is enough for me to start to suspect a troll. Psych drop-out or never-ran? Medicine intern dumped by a psychiatrist SO? Scientologist? Many possibilities here...

Yes the inconsistencies do seem to be piling up, just personally my BS meter was pinged when Vistaril skated a little too close to the edge of giving medical advice in the thread I started.

After this *****ic comment, I am officially blocking Vistaril. I can't take it anymore.

 

[vistaril]

LOLOLOLOLOLOL!
Really, dude, there's a major difference between pathology and psychiatry: no one's stealing any of your money in psychiatry. So, please, leave us alone and go back to psychiatry, where your opinion is so dearly valued:

actually it is; I've had many tell me privately it's nice to hear a more realistic perspective than the 'everything is perfect' image many there(usually med students) push.

But that's not the point....I guess it all just depends on how you view it. You think GIs are 'stealing' your money, whereas GIs think you are an incovenience in their way that they must pay off.

 

[itsthepleats]

But that's not the point....I guess it all just depends on how you view it. You think GIs are 'stealing' your money, whereas GIs think you are an incovenience in their way that they must pay off.[/QUOTE]

Since you're a psychiatrist and don't routinely rely on pathologists' expertise to help manage/treat your patients, your perpetuating the above sentiment is somewhat understandable if not completely ignorant. I find it interesting if GIs do in fact find pathologists an inconvenience considering that we DIAGNOSE their patients with cancer, we tell them if their patient's colitis is active or chronic, we find CMV, herpes, etc. infections in their patients who are immunosuppressed, we tell them if their patients have GVHD (just to name a few areas in which pathologists make critical diagnoses on GI biopsies).

We're such a huge inconvenience that we enable these clinicians to treat their patients, to manage their chronic diseases, to guide therapy, and for all of our hard work the GI docs get to keep 80% of the revenue for OUR services. Yes, I can see exactly why pathologists are the problem in this scenario.

If we're such a huge inconvenience to GIs, then they should stop biopsying patients....but then then wouldn't get to bill for the procedure and client bill for the pathology services.

The fact of the matter is that if a GI doc had to turn over 80% of the reimbursement they receive for their hard work to every PCP who referred patients to them, they might consider the billing scheme BS too. Please keep that in mind when referring to the work that we do, with our expertise that we gained through a residency just like you and your fiance, through fellowships just like you and your fiance, and through multiple board certifications as an "inconvenience." Particularly because almost every single medical specialty absolutely relies on pathology services at some point or another to make a critical diagnosis that informs the treatment or management of patients.

You started this thread by asking what a reasonable amount an 88305 biopsy is worth in terms of reimbursement. Why don't you ask you fiance what she thinks is a reasonable amount for her to collect on an 88305 for doing absolutely none of the work required to actually diagnose that biopsy.

 

[Doormat]

Wow. Look at all those negative posts about Vistaril.

I don't deny the death spiral of anatomic pathology in the open market. Lots of shady arrangements will continue. I certainly don't have to deal with it. We'll see what the local pathologists do when they are offered $9 per case. If they take it, they deserve it.

 

[vistaril]

Since you're a psychiatrist and don't routinely rely on pathologists' expertise to help manage/treat your patients, your perpetuating the above sentiment is somewhat understandable if not completely ignorant. I find it interesting if GIs do in fact find pathologists an inconvenience considering that we DIAGNOSE their patients with .

My sense was that she(honestly I cant speak for all GIs...just her and a couple of her friends) views you as a technical commodity...

 

[itsthepleats]

My sense was that she(honestly I cant speak for all GIs...just her and a couple of her friends) views you as a technical commodity...

Yes, and the fact that she does is ludicrous considering that she couldn't do her job without us. In the future, she should use some of that money she's mining from pathology to send her very skilled, highly trained technical commodities a fruit basket in thanks. I prefer grapefruit.

 

[Tissue issue]

:troll:

I think Doormat is right - we have troll behavior here. Although valid issues are being raised, let's stop feeding the troll.

 

[pathstudent]

If you work in pathology you are used to seeing the absurd on a daily basis.

9 to 12 dollars is reasonable considering the oversupply of pathologists. A local group will gladly do it for that. The pathologists staffing these places shouldnt be considered the pariah. The idiots training all these pathologist creating the oversupply are the pariahs.

Totally disagree. if you are a pathologist that is willing to split pc you are a pariah in our community and the reason why other physicians view us as not equals as gi docs and uros etc dont split their pc.

And for those med students considering pathology, eyes wide open. This is the real world.

And lastly this dude is a troll.

 

[Path or bust]

My sense was that she(honestly I cant speak for all GIs...just her and a couple of her friends) views you as a technical commodity...

I believe nurse practitioners are now scoping patients.

Soon GI will go the way of anesthesia, worry about that. We'll be fine. 😉

http://forums.studentdoctor.net/showthread.php?t=865041

 

[WEBB PINKERTON]

Totally disagree. if you are a pathologist that is willing to split pc you are a pariah in our community and the reason why other physicians view us as not equals as gi docs and uros etc dont split their pc.

And for those med students considering pathology, eyes wide open. This is the real world.

And lastly this dude is a troll.

Do your research. Most of the pathologists staffing these places are the LOCAL groups. So this pariah talk is garbage.

There are way too many pathologists out there. I have no doubt people will take that deal. What are they supposed to do when they got bills to pay? The ONLY people that need vilified are the programs causing this mess, not the pathologists taking these deals.

 

[vistaril]

Do your research. Most of the pathologists staffing these places are the LOCAL groups. So this pariah talk is garbage.
QUOTE]

of course they are local....isn't one of the rules GI's have to obey to stay within IOP laws and essential bundle the service(for themselves) is to have pathologists read on site? That's the whole concept of an IOP.

 

[vistaril]

Totally disagree. if you are a pathologist that is willing to split pc you are a pariah in our community and the reason why other physicians view us as not equals as gi docs and uros etc dont split their pc.
.

why in the world would a GI doc or urologist ever split their fee? pcps go out of their way to be nice to them so they will see their patients in a timely manner...otherwise they won't and the pcp may lose patients because their patients will become frustrated their pcp can't get them in. That's even moreso true with derm is my understanding(although I dont know any derms). Derm wait times are insanely long, and if you are a pcp it helps to have an 'in'.

Supply and demand.

 

[2121115]

This whole thread is an epic troll.

Don't feed the troll.

Yaah can you please delete this thread?

 

[pathstudent]

Do your research. Most of the pathologists staffing these places are the LOCAL groups. So this pariah talk is garbage.

There are way too many pathologists out there. I have no doubt people will take that deal. What are they supposed to do when they got bills to pay? The ONLY people that need vilified are the programs causing this mess, not the pathologists taking these deals.

Do my research?

Our group has been made these offers and we declined them. The local GI group still sends us their government payers as it is illegal for them to bill medicare, military, medicaid, etc... But when they set up their lab business (before my time here)they asked us if we wanted to do their path. We asked if we would bill for PC, they said no. So we said no.

All the other local groups said no too. They got some douche from the local university to leave his job there and do their path. If that guy ever loses his job, he is done in this community unless the university when take him back. He is a pariah in addition to being a douche. He is a douche pariah.

 

[vistaril]

Do my research?

Our group has been made these offers and we declined them. The local GI group still sends us their government payers as it is illegal for them to bill medicare, military, medicaid, etc... But when they set up their lab business (before my time here)they asked us if we wanted to do their path. We asked if we would bill for PC, they said no. So we said no.

All the other local groups said no too. They got some douche from the local university to leave his job there and do their path. If that guy ever loses his job, he is done in this community unless the university when take him back. He is a pariah in addition to being a douche. He is a douche pariah.

well it just takes one. Second, why would he lose his job? Third, if he did, they could probably recruit someone else to do it...a new grad somewhere.

The fundamental issue seems to be that the govt(and therefore private insurers) reimburse far too much for outpatient GI and GU. If the PC component were more like 17 dollars instead of 40 dollas(and the TC kept falling as well), then the margins would be such that GU and GI groups would feel it not worth it.

Because some people on here are saying that a decent pathologist can run through 110+ outpt GI or GU 88305s a day. If that's the case, ~12 dollars a pop seems pretty fair seeing as how there is going to be virtually no overhead at all for the path in such a setup so it's all net profit.

As a taxpayer, I'm the one who is really getting the shaft.

 

[WEBB PINKERTON]

Do my research?

Our group has been made these offers and we declined them. The local GI group still sends us their government payers as it is illegal for them to bill medicare, military, medicaid, etc... But when they set up their lab business (before my time here)they asked us if we wanted to do their path. We asked if we would bill for PC, they said no. So we said no.

All the other local groups said no too. They got some douche from the local university to leave his job there and do their path. If that guy ever loses his job, he is done in this community unless the university when take him back. He is a pariah in addition to being a douche. He is a douche pariah.

Douche pariah, you been watching Jersey shore? I'd be pissed at him too but I am more pissed about this dreadful job market that has been created from the oversupply.

Where I am at, the local groups give in and just agree to do the work for whatever the specialist demands. It really is the hungar games.

Most of the time you have to move away after you lose a job in pathology anyways. That's why you should be very careful about who you marry. Make sure she is either a stay at home mom or has skills that can find work easily. I've seen paths stuck on the sidelines doing locum for very long stretches because of the spouse.

 

[icpshootyz]

Vistaril, what are you not understanding? The PC is the PROFESSIONAL COMPONENT, which should be renamed PATHOLOGIST COMPONENT. Why on earth should anyone other than the pathologist receive ANY of the professional component? Please, give a valid reason why a clinician should be able to ever keep the payment that is for pathology diagnostic services. Not lab technical services, not histology, not processing, the actual physical diagnostics of a biopsy. How, in any world, is it legal for a clinical physician to keep this payment for themselves and only pay out a fraction of it to the actual physician (pathologist) that reads the slide and makes the diagnosis, while at the same time billing the patient for A) the office visit, B) the procedure that resulted in the biopsy specimen, and C) the technical component by owning the lab? Please give any valid reason why that clinician should also get paid for D) the diagnosis of the slide. Please. Your only answer should be: because they're money-grubbing wh0res that are willing to screw their colleagues. I can't think of any other valid answer.

 

[BS81]

Vistaril, what are you not understanding? The PC is the PROFESSIONAL COMPONENT, which should be renamed PATHOLOGIST COMPONENT. Why on earth should anyone other than the pathologist receive ANY of the professional component? Please, give a valid reason why a clinician should be able to ever keep the payment that is for pathology diagnostic services. Not lab technical services, not histology, not processing, the actual physical diagnostics of a biopsy. How, in any world, is it legal for a clinical physician to keep this payment for themselves and only pay out a fraction of it to the actual physician (pathologist) that reads the slide and makes the diagnosis, while at the same time billing the patient for A) the office visit, B) the procedure that resulted in the biopsy specimen, and C) the technical component by owning the lab? Please give any valid reason why that clinician should also get paid for D) the diagnosis of the slide. Please. Your only answer should be: because they're money-grubbing wh0res that are willing to screw their colleagues. I can't think of any other valid answer.

People don't grind scopes all day because it is intellectually stimulating. And they do it because they can because that's what the current system allows. What would you expect from someone who is doing their job mostly just for the money? They run their practice like a real business, and if that's what the market allows...

 

[vistaril]

Vistaril, what are you not understanding? The PC is the PROFESSIONAL COMPONENT, which should be renamed PATHOLOGIST COMPONENT. Why on earth should anyone other than the pathologist receive ANY of the professional component? Please, give a valid reason why a clinician should be able to ever keep the payment that is for pathology diagnostic services. Not lab technical services, not histology, not processing, the actual physical diagnostics of a biopsy. How, in any world, is it legal for a clinical physician to keep this payment for themselves and only pay out a fraction of it to the actual physician (pathologist) that reads the slide and makes the diagnosis, while at the same time billing the patient for A) the office visit, B) the procedure that resulted in the biopsy specimen, and C) the technical component by owning the lab? Please give any valid reason why that clinician should also get paid for D) the diagnosis of the slide. Please. Your only answer should be: because they're money-grubbing wh0res that are willing to screw their colleagues. I can't think of any other valid answer.

one could easily argue that allowing the free market to work is the ethical thing to do. The fact that there are pathologists competing with each other to make half(or whatever) of the pc from outpatient GI and uro groups tells me that the real value of such a service is much less than the PC paid by medicare(and thus private insurers)......now as a taxpayer I am somewhat bothered by the fact that *anyone* is profiting on this overpayment, but from an ethical standpoint I really don't see how it matters whether it is the uro or GI or pathologist....

frankly, just from scanning this board the last day or so since posting the question, it appears that there is a great deal of animosity towards pathologists(amongst some) who work in IOPs. This often includes degrading comments about their skill set, IMG status, competencies as a pathologist,etc....the obvious question is that if these pathologists who are supposedly subpar can run through 100+ GI biopsies or GU biopsies a day, what does that say about the skill set involved to do that and what the compensation level should be?

 

[Enkidu]

frankly, just from scanning this board the last day or so since posting the question, it appears that there is a great deal of animosity towards pathologists(amongst some) who work in IOPs. This often includes degrading comments about their skill set, IMG status, competencies as a pathologist,etc....the obvious question is that if these pathologists who are supposedly subpar can run through 100+ GI biopsies or GU biopsies a day, what does that say about the skill set involved to do that and what the compensation level should be?

Well, those in-office setups have incredibly low rates of cancer in their biopsies because they are economically incentivized to perform more biopsies than necessary - so I bet a lot of it is pretty simple. As for the pod lab pathologists being subpar - I don't think that's the general consensus of this forum - they are mostly just the same community pathologists who sign out the pod stuff. Many people seem to consider them morally subpar though.

 

[icpshootyz]

Anyone can put a diagnosis on a line and sign out a case. That has zero bearing on whether they are right or not. I don't believe the pathologists in IOP labs are necessarily subpar, I believe they're stuck taking what jobs are out there, and currently there's a giant loophole that is allowing clinicians to essentially STEAL money from their colleagues. This is not fair market and has zero to do with tax payments or the proper reimbursement. This is about greedy clinicians taking a portion of reimbursement that was never meant for their services. And you most certainly did not answer my question -

How, in any world, is it legal for a clinical physician to keep this payment for themselves and only pay out a fraction of it to the actual physician (pathologist) that reads the slide and makes the diagnosis, while at the same time billing the patient for A) the office visit, B) the procedure that resulted in the biopsy specimen, and C) the technical component by owning the lab?

Notice the government lowered the TC, NOT the PC. The PC is actually valued, i.e. the diagnosis we provide is valued as being worthy of significant reimbursement. The TC was just determined to be of less value. The PC actually increased in this latest valuation, therefore pathologists should earn MORE after the TC cut, not less. Anything else is highly unethical of the clinical physician who "employs" pathologists.

 

[vistaril]

How, in any world, is it legal for a clinical physician to keep this payment for themselves and only pay out a fraction of it to the actual physician (pathologist) that reads the slide and makes the diagnosis, while at the same time billing the patient for A) the office visit, B) the procedure that resulted in the biopsy specimen, and C) the technical component by owning the lab?.

because it is legal and because that's what the market dictates....that is why. Nobody is putting a gun to these pathologists heads and making them do this. You could easily argue it would be unethical not to allow pathologists this free market opportunity.

 

[icpshootyz]

And that's why we are doing our best to keep money-grubbing wh0res like your fiance from stealing food from our mouths. That's why we are pushing for legislation that will close this loophole, and hopefully shut down IOP labs, which are essentially flaunting the anti-kickback legislation. Because when it comes down to it, this is a kickback. The clinician is receiving a portion of the fee for a referred service. No other way about it.

 

[2121115]

And that's why we are doing our best to keep money-grubbing wh0res like your fiance from stealing food from our mouths. That's why we are pushing for legislation that will close this loophole, and hopefully shut down IOP labs, which are essentially flaunting the anti-kickback legislation. Because when it comes down to it, this is a kickback. The clinician is receiving a portion of the fee for a referred service. No other way about it.

icpshootyz, the guy is a troll. He knows way to much lingo, etc to be a psych resident. Don't give in and argue with him.

 

[icpshootyz]

I know I know. It's just fun to get the blood boiling sometimes, you know?

 

[path24]

Trollish origin, but interesting thread that is (sadly) real to the business of pathology. Oversupply.

 

[icpshootyz]

Trollish origin, but interesting thread that is (sadly) real to the business of pathology. Oversupply.

It also goes beyond oversupply, though. If you work at a private path lab and all of your former clinician clients now set up IOP labs, it isn't oversupply that means you no longer have specimens to read, it's flat-out greed of fellow clinicians. Sure, we'd love it if pathologists didn't take these IOP TC/PC jobs, but right now we're being squeezed out by clinicians receiving payments for services they never rendered. Free market? My ***** free market. This is a loophole, nothing more, and hopefully one that the "free" market regulates away.

 

[malchik]

I am a fellow and I see a lot of these cases referred to our hospital. At least 3 of these labs employ academic pathologists in my department who appear to be moonlighting to make some extra cash, probably against their contract. So even if you substantially decreased the supply of pathologists, you would still have the academic types who seem to be willing to do this part time.

 

[path24]

It also goes beyond oversupply, though. If you work at a private path lab and all of your former clinician clients now set up IOP labs, it isn't oversupply that means you no longer have specimens to read, it's flat-out greed of fellow clinicians. Sure, we'd love it if pathologists didn't take these IOP TC/PC jobs, but right now we're being squeezed out by clinicians receiving payments for services they never rendered. Free market? My ***** free market. This is a loophole, nothing more, and hopefully one that the "free" market regulates away.

The clinicians are starting the labs to recoup payment cuts elsewhere. They have the patient and their specimen. The TC belongs to who owns the lab, be it a hospital, doc...etc. My major issue is them keeping the PC, which I believe mainly comes down to oversupply. Some pathologists will always take a side job to make some extra cash, but if there wasn't an oversupply i feel they would all be getting their full PC. Pathologists are fighting each other for work. Its a fight for every specimen and groups/individuals are willing to give up some PC to keep at least some work. No need to offer full PC, just a cut of it. Someone always says yes, there is just not enough work to go around. A specimen can get an appointment right away, a patient may wait days, weeks, months depending on the type of doc which seems to come down to the supply of that doc in the area. I don't want patients to have to wait long to get their results, but lets not make ourselves a commodity/employee like we have. Oversupply is not the only part of the issue, but a main one. The big one concerning PC payments.

 

[vistaril]

And that's why we are doing our best to keep money-grubbing wh0res like your fiance from stealing food from our mouths. That's why we are pushing for legislation that will close this loophole, and hopefully shut down IOP labs, which are essentially flaunting the anti-kickback legislation. Because when it comes down to it, this is a kickback. The clinician is receiving a portion of the fee for a referred service. No other way about it.

you're missing the bigger picture....if IOPs ceased to exist, all that outpatient high volume GI and GU would just go to megareference labs now. Under various arrangements that you guys wouldnt be happy with either.

The bigger picture is if that a pathologist can really run through these slides that easily and that efficiently(and GI groups are as content to hire the lowest bidder as suggested here), then reimbursement rates need to be cut.

I wouldn't count on shutting down IOP labs.....don't see how you have any support for such a thing. The clinician groups wanting to keep them have more members, money, influence than AP when it comes to legislation.

 

[vistaril]

The clinicians are starting the labs to recoup payment cuts elsewhere. They have the patient and their specimen. The TC belongs to who owns the lab, be it a hospital, doc...etc. My major issue is them keeping the PC, which I believe mainly comes down to oversupply. .

I would argue you are too hung up on how it is broken down.....if they made TC 50cents and PC 2 million dollars tommorrow, you still wouldn't get any more money from GI groups because the basic curve with respect to your services hasn't changed.

As a taxpayer, I want to see the TC/PC as low as possible. period.

 

[2121115]

I would argue you are too hung up on how it is broken down.....if they made TC 50cents and PC 2 million dollars tommorrow, you still wouldn't get any more money from GI groups because the basic curve with respect to your services hasn't changed.

As a taxpayer, I want to see the TC/PC as low as possible. period.

What about all the GI docs that do colonoscopies making unreal bank and go home before 4pm. Perhaps that means the colonoscopy is overvalued. As a tax payer I want to see the colonoscopy reduced to as low reimbursement as possible. Period.

You can make that argument for anything in medicine.

Seriously. GTFO troll.

Yaah please delete this thread.

 

[vistaril]

What about all the GI docs that do colonoscopies making unreal bank and go home before 4pm. Perhaps that means the colonoscopy is overvalued. As a tax payer I want to see the colonoscopy reduced to as low reimbursement as possible. Period.

You can make that argument for anything in medicine.

Seriously. GTFO troll.

Yaah please delete this thread.

Well I'll pass on stooping to your level and being insulting, but one difference is that GI docs do have some competition for colonoscopies(ie they arent the only specialty that can do them and surgeons do shoulder a portion of the colonoscopy load in many communities). The fact that surgeons don't all quit their practices and try to do colonoscopies 24/7 and start competing in a race to the bottom driving down prices(as paths would each other) indicates that the colonoscopy isn't that overvalued.....if it were surgeons would just scope all day with GIs.

 

[malchik]

If cms really intends the pc to pay for the pathologist's professional opinion, then the only entity that should be able to bill pc should be the pathologist who signed it out. Very simple. Everyone's ire and energies should be focused like a laser on cms alone, not oversupply, not iop labs, not ref labs, etc

 

[vistaril]

If cms really intends the pc to pay for the pathologist's professional opinion, then the only entity that should be able to bill pc should be the pathologist who signed it out. Very simple.

that doesn't follow at all....