Thrombus

Member
Removed
Removed
Account on Hold
10+ Year Member
Sep 27, 2004
749
95
Bust our butt to keep the business and some reference lab undercuts us to take away business. I wonder how many administrative meetings these idiots have to sit through like we do? Its a bunch of crooks. These sales reps are like roaches. You exterminate one and 5 come back at you.

And there is no pathology oversupply problem as claimed by some.....ha ha ha. Memo to you in denial: YOU CAN'T BE EXPLOITED LIKE THIS IF YOU ARE IN DEMAND!!!!
 

KeratinPearls

10+ Year Member
Apr 2, 2007
824
10
Status
Fellow [Any Field]
Bust our butt to keep the business and some reference lab undercuts us to take away business. I wonder how many administrative meetings these idiots have to sit through like we do? Its a bunch of crooks. These sales reps are like roaches. You exterminate one and 5 come back at you.

And there is no pathology oversupply problem as claimed by some.....ha ha ha. Memo to you in denial: YOU CAN'T BE EXPLOITED LIKE THIS IF YOU ARE IN DEMAND!!!!
That's unfortunate. So mostly derm, GI or GU biopsies? These labs charge like a few bucks for biopsies? IS that how they work?
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
Thrombus

What I don't get is how can they "undercut" you. You don't bill clinicians. You bill patients/insurance company, no? Now a reference lab might negotiate a lower fee with the insurance company but an insurance company can't order the physician where to send the biopsy.

If you are paying clinicians for the business that has to a violation of cms or a state medical board.

I don't see how you can be undercut.

Please explain
 

2121115

10+ Year Member
7+ Year Member
Jan 23, 2007
1,667
39
Status
Attending Physician
The reference lab lets the clinician bill global and then they pay the reference lab a fraction of the global fee. The reference lab agrees to this situation and thus they undercut the local pathology group. This is legal in many states but some states have outlawed this or at least passed disclosure laws which mandate that the clinician who is billing the global to disclose to the patient that they have a financial interest in the pathology fees.
 

KeratinPearls

10+ Year Member
Apr 2, 2007
824
10
Status
Fellow [Any Field]
The reference lab lets the clinician bill global and then they pay the reference lab a fraction of the global fee. The reference lab agrees to this situation and thus they undercut the local pathology group. This is legal in many states but some states have outlawed this or at least passed disclosure laws which mandate that the clinician who is billing the global to disclose to the patient that they have a financial interest in the pathology fees.
So reference labs and podlabs are all taking away biopsies from community pathologists, right?

Podlabs work the same way...they hire a pathologist and pay him a good salary and bill for global, right?

How come podlabs aren't illegal? Isn't there a financial incentive on the clinicians side to take more biopsies so to make more profit?
 
OP
T

Thrombus

Member
Removed
Removed
Account on Hold
10+ Year Member
Sep 27, 2004
749
95
The reference lab lets the clinician bill global and then they pay the reference lab a fraction of the global fee. The reference lab agrees to this situation and thus they undercut the local pathology group. This is legal in many states but some states have outlawed this or at least passed disclosure laws which mandate that the clinician who is billing the global to disclose to the patient that they have a financial interest in the pathology fees.
This is how the "real world" works. For those of you who haven't been explained this by your advisors, you have been done a HUGE disservice. Advisors and academic pathologists need to start being open about what is going on to exploit pathologists. I had no idea how this stuff worked until I started working. Now it is a dogfight and I have 2 paws wrapped behind my back due to the shady nature of the reference labs and how they are able to exploit pathologists.

If you work for one of these companies, you are part of the problem and a liability to our field.
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
The reference lab lets the clinician bill global and then they pay the reference lab a fraction of the global fee. The reference lab agrees to this situation and thus they undercut the local pathology group. This is legal in many states but some states have outlawed this or at least passed disclosure laws which mandate that the clinician who is billing the global to disclose to the patient that they have a financial interest in the pathology fees.
You can really do that? Are you sure?

It seems like fee splitting to me, like if a Fam Practice doc got a kick back for referring a patient with abdominal pain to a particular gastroenterologist, but at the same time it seems like pure capitalism too, and we all believe in capitalism and free enterprise here, right?

I guess all the pathologists can do is not present those biopsies at tumor board and such and hopefully they respect you enough and appreciate your input to their patient to not switch on you, but if it means 50k more per year in their pocket for not having to work any harder, then who can blame them?
 
OP
T

Thrombus

Member
Removed
Removed
Account on Hold
10+ Year Member
Sep 27, 2004
749
95
You can really do that? Are you sure?

It seems like fee splitting to me, like if a Fam Practice doc got a kick back for referring a patient with abdominal pain to a particular gastroenterologist, but at the same time it seems like pure capitalism too, and we all believe in capitalism and free enterprise here, right?

I guess all the pathologists can do is not present those biopsies at tumor board and such and hopefully they respect you enough and appreciate your input to their patient to not switch on you, but if it means 50k more per year in their pocket for not having to work any harder, then who can blame them?
It IS capitalism but at the same time the information needs to get back to medical students and program directors that the oversupply problem is leading to exploitation, layoffs in addition to extreme difficulty in finding a good private practice job. And we also as a profession have rights to address this issue. Increasing awareness is the first obstacle. The second is reducing the free labor that programs receive with residents....one that is probably insurmountable as academic pathologists demonstrate a tendency to not work hard on the whole and many refuse to get their butts of their chair and gross a specimen.
 

Pathologee

10+ Year Member
Mar 20, 2009
136
4
Status
Fellow [Any Field]
refuse to get their butts of their chair and gross a specimen.
That is a bold accusation! Unfortunately it is probably true more often than not. I'll never forget watching the chair, director of AP and director of surg path come into a busy gross room on separate occasions and start grossing a radical neck or take a colon to find lymph nodes. If it's not above them, it's not above me either.
 

KCShaw

10+ Year Member
7+ Year Member
Oct 25, 2007
1,369
20
Status
Attending Physician
We learned very, very quickly who not to bother asking for help grossing a specimen -- some had no idea and could be a real liability. Most knew they had no idea and went to find one of the attendings who did, or just asked a senior resident/chief resident or PA to deal with it. Attendings who knew what they were doing were a real asset though, as they tended to bypass extra unnecessary cruff or irrelevant overanalysis; getting it done and moving on can be a problem at times for newbies.

As for billing, competition, anti-trust violations, and so forth.. one of the benefits of FP is that in general we deal with such things a lot less. Of course, we also get to deal with county/state governments regarding our budgets a lot more.
 

LADoc00

Gen X, the last great generation
15+ Year Member
Sep 9, 2004
6,489
560
Status
Attending Physician
What for profit outpatient labs do:

1.) tell clinicians you "dont want their business anymore" and send it to them. The sales people often say they actually checked with you first or your office and confirmed you no longer want the outpatient work...this is a classic one. Outright lie. I may try to sue the next time I catch one in the act.

2.) Provide an in-office EMR in exchange for the business. At one point a clear violation of Stark law, but Stark himself is a blithering idiot and left more than enough loopholes for outpatient sharks to swim though.

Lession 1: Politicians are utterly clueless when passing laws supposedly to clean up these shady biz practices. Politicians are like a cancer on the dying rectum of American society.

3.) Outright bribe with cash. This is more difficult to detect as it is truly highly illegal, but is often happening. More often the bribes take the form of dinners, untraceable gifts and inducements that have no physical record. I would not all be suprised if such inducements even included hookers-n-coke in some areas.
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
So I am right when I say there is no such thing as undercutting as pathologists don't bill clinicians. So it is not like walmart moving in a putting the small mom and pop dime store out of business.

But the reference labs take the business via quasi-ethical/unethical means.
 
OP
T

Thrombus

Member
Removed
Removed
Account on Hold
10+ Year Member
Sep 27, 2004
749
95
So I am right when I say there is no such thing as undercutting as pathologists don't bill clinicians. So it is not like walmart moving in a putting the small mom and pop dime store out of business.

But the reference labs take the business via quasi-ethical/unethical means.
No you are wrong. Reference labs are billing clinicians and the clinicians turn around and mark that bill up sometimes 100-500% to their patients.
 

yaah

Boring
Staff member
Administrator
15+ Year Member
Aug 15, 2003
27,947
331
Fixing in 10% neutral buffered formalin
Status
Attending Physician
THere is no "undercutting" technically, but they will go to the physician's office and tell them how they can get them a way to make an extra amount of money by doing nothing. The reference lab then allows the physician office to bill for the path fee and then they keep a lot of it. It's completely unethical, and is equivalent to me pocketing a gastroenterologist's procedural fee for doing a colonoscopy.

The other way is to set up a histo lab within the physician office group so that they can perform and bill for the technical fee. That is a little less unethical but has a lot of potential for mismanagement and poor outcome due to lack of supervision and quality control.

These problems would still exist in the absence of oversupply.
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
^agreed. It is not a question of supply.

The loopholes that allow anatomic testing be treated like clinical lab testing is a big part of what allows this. That and the fact that patients can't choose their pathologists.
 
Last edited:
OP
T

Thrombus

Member
Removed
Removed
Account on Hold
10+ Year Member
Sep 27, 2004
749
95
Wrong....it is all about supply.

1. If there was no oversupply, the clinicians would be begging for someone to read their specimens, not the other way around. There would be no maddening hunt to gather the invaluable surgical pathology specimen. There would be plenty of work for any and all and no reference lab would send out its salesmen to steal from anyone else as their pathologists (if they could get anyone to work for them) would already be maxed out.

2. If there was no oversupply, pathologists would not be exploited for pennies on the dollar.

I can't believe that folks such as you can make it through high school, let alone everything else and somehow be so oblivious to this.
 

Autopsy101

10+ Year Member
Jan 31, 2009
139
40
Status
Attending Physician
In our area we have definately seen the in-office EMR as the big incentive to switch to these larger labs. They provide the expensive computer system, then their AP reports are added directly to the patient chart with beautiful color photos of the lesions. While we have to work with our HBO system provided by the hospital with no hope of adding photos to reports due to the age of the system. (Not that we have computers that have the RAM to support the cameras we bought for digital images and not that digital images make a better pathology report)

All the clinicians who have switched claim it is because of ease of use of the system. They can find all their reports in one system and no one in their office staff has to scan in our paper reports.
 

yaah

Boring
Staff member
Administrator
15+ Year Member
Aug 15, 2003
27,947
331
Fixing in 10% neutral buffered formalin
Status
Attending Physician
Wrong....it is all about supply.

1. If there was no oversupply, the clinicians would be begging for someone to read their specimens, not the other way around. There would be no maddening hunt to gather the invaluable surgical pathology specimen. There would be plenty of work for any and all and no reference lab would send out its salesmen to steal from anyone else as their pathologists (if they could get anyone to work for them) would already be maxed out.

2. If there was no oversupply, pathologists would not be exploited for pennies on the dollar.

I can't believe that folks such as you can make it through high school, let alone everything else and somehow be so oblivious to this.
Dude. It is not ALL about supply. In order to create the situation you are suggesting there would have to be severe undersupply. Even with adequate supply or even slight undersupply these arrangements would exist. Why? Because these jobs hold many desirable characteristics to some pathologists. No call. No CP. Just reading out your specialty. The only change would be in salary. Obvioulsy things would almost certainly be better financially for individual pathologists, but it's hard to say just how life would look. Pathologists would continue to specialize because that would be a way to control their lifestyle and work schedule, and that would leave fewer general pathologists.

If you know anything about economics you would probably also acknowledge that an undersupply would paradoxically lead to these situations also - because if there were a shortage of pathologists labs and clinicians would look to consolidation in order to ensure continuity and quality of care. And it would provide increasing opportunity for large labs to gain business and influence (because there would be even LESS competition). Others would step in where pathologists could not.

I know you are really pushing hard to make this into a simplistic matter but it is not simplistic. There are many factors of which pathologist supply is but one. Politics and regulations are much more important - which is ironic since many of the very angry on here want less government regulation and less government involvement in medicine.
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
Dude. It is not ALL about supply. In order to create the situation you are suggesting there would have to be severe undersupply. Even with adequate supply or even slight undersupply these arrangements would exist. Why? Because these jobs hold many desirable characteristics to some pathologists. No call. No CP. Just reading out your specialty. The only change would be in salary. Obvioulsy things would almost certainly be better financially for individual pathologists, but it's hard to say just how life would look. Pathologists would continue to specialize because that would be a way to control their lifestyle and work schedule, and that would leave fewer general pathologists.

If you know anything about economics you would probably also acknowledge that an undersupply would paradoxically lead to these situations also - because if there were a shortage of pathologists labs and clinicians would look to consolidation in order to ensure continuity and quality of care. And it would provide increasing opportunity for large labs to gain business and influence (because there would be even LESS competition). Others would step in where pathologists could not.

I know you are really pushing hard to make this into a simplistic matter but it is not simplistic. There are many factors of which pathologist supply is but one. Politics and regulations are much more important - which is ironic since many of the very angry on here want less government regulation and less government involvement in medicine.
yeah yaah,

it is so dumb of thrombus to say that I couldn't even graduate high school.

it is not just about over supply.

CMS allows loopholes that give AP the same restrictions as CP testing. That allows for alot of the condo labs.

Plus the TC component for an 88305 is about 75 dollars if reimbursed by medicare and can be up to 120-140 when reimbursed by private insurance. Mind you that is not the TC for a single case. It is for each specimen in that case. So if you have a 12 biopsy prostate case or a 10 GI biopsy case that can generate up to 750-1000 if medicare and up to 1500 if private insurance and that is just for making the slides and processing the blocks. A smart guy who is not a pathologist, whether a gastroenterologist or just a regular business man, quickly realizes the TC reimbursement for 100 88305s a day is about 12-15k. And as we all know 100 gi/prostate/derm biopsies ain't all that much. Now pathology is inherently filled with INTPs and introverted type B people in general and there are a lot of pathologists who don't want to be hospital based, don't want to deal with neuropath frozens or organ retrieval in the middle of the night, don't want to have to do tumor boards, don't want to have to answer questions about chemistry and coag and don't want to have to deal with administration and moving up in the med exec committee. Now if I had opened up a lab that could get 100 biopsies a day, I could offer such a pathologist the PC for those cases which would range from 3500-5000 per day depending on the mix of medicare/private. But then I could realize that that would be a million a year in salary, so I would say, "Hey I'll give you 400k a year" which probably seems like a crap load to a lot of pathologists, then I will pocket the 12000 for the TC and the 2000k a year for the PC that I didn't give you. That is what the reference labs and gastro groups do to pathologists. And that is why they want to take the business away from the hospital based path groups. The TC is too lucrative. I really think we need to go back to the day when PC (i.e. the diagnosis) is regarded as more valuable than the TC (i.e. grossing and slide cutting) of biopsies. But as I have said before pathologists did this to themselves by being greedy and complaining that TC reimbursement was too low for which CMS slashed PC and tacked it onto TC.

But back to the whole thing about undercutting. The reference labs don't undercut anybody. And if they offer this EMR thing where their reports are automatically entered into the patient's outpatient chart rather than being autofaxed over, then it sounds like to me that the reference labs might offer a better product. It doesn't sound like payola or undercutting, it sounds high-tech and sophisticated. Community pathologists have three choices and that is to do more to build personal bridges/loyalty with the clinicians so they don't lose business, invest in EMR for themselves with an eye on the long haul, or continue to fret and gripe like thrombus, raider, and ex-PCM.

Or you could go into academics and not have to worry about all this because it is a closed system without all the parasites and you can see more interested and rewarding stuff, be surrounded by scientists and culture.
 

Pathologee

10+ Year Member
Mar 20, 2009
136
4
Status
Fellow [Any Field]
yeah yaah,

it is so dumb of thrombus to say that I couldn't even graduate high school.

it is not just about over supply.

CMS allows loopholes that give AP the same restrictions as CP testing. That allows for alot of the condo labs.

Plus the TC component for an 88305 is about 75 dollars if reimbursed by medicare and can be up to 120-140 when reimbursed by private insurance. Mind you that is not the TC for a single case. It is for each specimen in that case. So if you have a 12 biopsy prostate case or a 10 GI biopsy case that can generate up to 750-1000 if medicare and up to 1500 if private insurance and that is just for making the slides and processing the blocks. A smart guy who is not a pathologist, whether a gastroenterologist or just a regular business man, quickly realizes the TC reimbursement for 100 88305s a day is about 12-15k. And as we all know 100 gi/prostate/derm biopsies ain't all that much. Now pathology is inherently filled with INTPs and introverted type B people in general and there are a lot of pathologists who don't want to be hospital based, don't want to deal with neuropath frozens or organ retrieval in the middle of the night, don't want to have to do tumor boards, don't want to have to answer questions about chemistry and coag and don't want to have to deal with administration and moving up in the med exec committee. Now if I had opened up a lab that could get 100 biopsies a day, I could offer such a pathologist the PC for those cases which would range from 3500-5000 per day depending on the mix of medicare/private. But then I could realize that that would be a million a year in salary, so I would say, "Hey I'll give you 400k a year" which probably seems like a crap load to a lot of pathologists, then I will pocket the 12000 for the TC and the 2000k a year for the PC that I didn't give you. That is what the reference labs and gastro groups do to pathologists. And that is why they want to take the business away from the hospital based path groups. The TC is too lucrative. I really think we need to go back to the day when PC (i.e. the diagnosis) is regarded as more valuable than the TC (i.e. grossing and slide cutting) of biopsies. But as I have said before pathologists did this to themselves by being greedy and complaining that TC reimbursement was too low for which CMS slashed PC and tacked it onto TC.

But back to the whole thing about undercutting. The reference labs don't undercut anybody. And if they offer this EMR thing where their reports are automatically entered into the patient's outpatient chart rather than being autofaxed over, then it sounds like to me that the reference labs might offer a better product. It doesn't sound like payola or undercutting, it sounds high-tech and sophisticated. Community pathologists have three choices and that is to do more to build personal bridges/loyalty with the clinicians so they don't lose business, invest in EMR for themselves with an eye on the long haul, or continue to fret and gripe like thrombus, raider, and ex-PCM.

Or you could go into academics and not have to worry about all this because it is a closed system without all the parasites and you can see more interested and rewarding stuff, be surrounded by scientists and culture.
Are you sharing your account with someone? I've mostly been reading the forum for a few years and there are times when you sound like a clueless resident, but mostly you sound like an arrogant academic terd.

You came up with a pretty amazing dissertation on how a Pod lab works even though a few days ago you had no idea how a reference lab operates. At this point you can't even tell the difference between a Pod lab and a reference lab. You even had the audacity to call out other members of the forum on Friday night but you deleted the post on by Saturday morning. If you can't put it out there on an anonymous internet forum, how the hell can you put it out there when it comes time to sign out a case. Maybe you are one of the "consultants" that sends out a 2 page single spaced soliloquoy with 4 references and no diagnosis.

I have been at academic places less prestigious and more prestigious than you, and even in the worst cases I have never met anyone who is so arrogant and cocksure to state that academics is the Way. To. Go.

So what? You see interesting GI cases all day long. That may tickle your fancy, but many of us went into pathology because of a love for a wide variety of medicine. You want to know who else looks at GI cases all day long? Most community practice pathologists. You know who doesn't? Arrogant academic pathologists who have painted themselves into a corner by only wanting to do THEIR specialty and turf away all GI cases. You know why they turf away GI cases? Because anal academic GI pathologists who put out meaningless papers that have very little clinical impact just so they can get their "N" number of publications up and scare people into sending them consults.

Don't be so sure that your closed academic system will be in place forever. I have seen what happens when a naive or money grubbing hospital decides to turn the lab and histology over to a reference lab like Quest. Guess who is forced to do frozens, sign out an amputation or help make heads or tails of a laryngectomy? Anal GI pathologist, that's who! At this point you will scurry to a 75 man GI group who will pay you 600k to sign out GIs from your basement via telepathology sending you to the career that you ardently mock on these forums.

This ain't no pedicure. This ain't no manicure. This is a FACIAL.
Pathstudent et al. "Re:Our Pathology Forefathers...did you know?" Internet Forum 27May 2010. Studentdoctor.com Forums/Pathology.

You happy? I cited you. That should keep you from being able to sleep on your front for a few nights.
 

yaah

Boring
Staff member
Administrator
15+ Year Member
Aug 15, 2003
27,947
331
Fixing in 10% neutral buffered formalin
Status
Attending Physician
Academic programs have also lost business (and will continue to do so) to pod labs and reference labs. Large institutions which employ lots of physicians have less risk, but many academic programs work with outside groups, particularly surgeons (and dermatologists). I know residents who never see prostate biopsies unless they are reviewed as a second opinion prior to surgery.
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
Academic programs have also lost business (and will continue to do so) to pod labs and reference labs. Large institutions which employ lots of physicians have less risk, but many academic programs work with outside groups, particularly surgeons (and dermatologists). I know residents who never see prostate biopsies unless they are reviewed as a second opinion prior to surgery.
Can you name one of these many academic programs. I don't know a single one. What do you mean surgeons. Surgeons typically operate out of the o.r. And pathologists get out everyhing out of the or. Can you imagine the Michigan gastros not giving their specimens to the dept of path and giving them to a comm practice pod lab pathologist? Can you imagine the Hopkins or msk or Indiana uros not giving their prostates to the path dept?

Name one of these resuidents that has never seen a prostae bx.

Seriously name these many academic programs. I'm calling you out.
 

yaah

Boring
Staff member
Administrator
15+ Year Member
Aug 15, 2003
27,947
331
Fixing in 10% neutral buffered formalin
Status
Attending Physician
Just talk to some residents at USCAP or whatever conference you go to. Larger programs like UM or JHU are more immune. But in the past many academic programs had outreach where they would take in outside biopsies from private groups. That is changing. There are smaller academic programs (or semi-private programs that have residents) which have lost business.
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
Just talk to some residents at USCAP or whatever conference you go to. Larger programs like UM or JHU are more immune. But in the past many academic programs had outreach where they would take in outside biopsies from private groups. That is changing. There are smaller academic programs (or semi-private programs that have residents) which have lost business.

Understood.

I don't really care for outreach material anyway. I know it pays the bills, but it takes away time from research.
 

Pathologee

10+ Year Member
Mar 20, 2009
136
4
Status
Fellow [Any Field]
Just talk to some residents at USCAP or whatever conference you go to. Larger programs like UM or JHU are more immune. But in the past many academic programs had outreach where they would take in outside biopsies from private groups. That is changing. There are smaller academic programs (or semi-private programs that have residents) which have lost business.
I know a big academic program and a small private/academic hybrid that had their biopsies taken away by a big lab. It is somewhat gangsta. They come in with their big fleet of couriers, pick up all the biopsies in the clinician offices and take it back to their lab and process the material lab. "See this? I keep it now!" For awhile the one program was only getting biopsies from the physician office building associated with the hospital. They ended up coming up with a plan to combat the lab and get their material back and were successful.
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
No you are wrong. Reference labs are billing clinicians and the clinicians turn around and mark that bill up sometimes 100-500% to their patients.
That is another thing that makes me wonder if you don't know how things work or if I don't know how things work.

The reference lab bills clinician. I get that. But the clinicians can't "mark stuff up". They have to be contracted to bill for the pathology services and the insurance company pays them whatever percent of medicare they could negotiate. The clinicians can't just be billing the patient or they would lose all their patients.


Were you involved in billing clinicians for pathology diagnoses and then allowing the clinician to bill insurance for them? If so you are no different than anyone else. Is that how you were "undercut". Serves you right if you ask me.

It just seems wrong to me that another doctor can bill for services he didn't provide, but I guess if he employs the pathologist he can.

But I have never heard of a cardiologist allowing a family practice doc bill for his work. Does this go on in other specialties?
 

2121115

10+ Year Member
7+ Year Member
Jan 23, 2007
1,667
39
Status
Attending Physician
But I have never heard of a cardiologist allowing a family practice doc bill for his work. Does this go on in other specialties?
That is because it is illegal for them to do that. Pathologists are screwed on this one because this (in addition to in office radiology) is legal.
 

dermpathdoc

DO Path
10+ Year Member
Aug 24, 2005
477
10
Pacific Northwest
Status
Attending Physician
I left one academic program in NJ affiliated with UMDNJ where several of their affiliated hospitals lost massive amounts of work due to thier surgeons mandating thier biopsies get sent to places like labcorp/quest/urocor...one month we lost 2/3rds of our derm cases when lab merged with Ameripath...despite the ire of the many derms who i had established a relationship with over 15 years of practice in the region..that was when I saw the writing on the wall and relocated to an area less served by those jerks

Can you name one of these many academic programs. I don't know a single one. What do you mean surgeons. Surgeons typically operate out of the o.r. And pathologists get out everyhing out of the or. Can you imagine the Michigan gastros not giving their specimens to the dept of path and giving them to a comm practice pod lab pathologist? Can you imagine the Hopkins or msk or Indiana uros not giving their prostates to the path dept?

Name one of these resuidents that has never seen a prostae bx.

Seriously name these many academic programs. I'm calling you out.
 

WEBB PINKERTON

7+ Year Member
Dec 16, 2010
1,442
329
Status
Non-Student
There are so many billing abuses going on right now in pathology it is unreal. I've gotten shaken down by physicians to lower my "client pricing" 1 dollar on some specimens (pap tests) or they were switching to a large reference lab. This was an office that has sent specimens to my institution for decades. It hurts like hell to hear stuff like that. Everyone in lab medicine need to fight these abuses going on. We almost got "client billing" banned in our state last year but urologists and others caused teh bill to stall in the house.
 

KeratinPearls

10+ Year Member
Apr 2, 2007
824
10
Status
Fellow [Any Field]
That is because it is illegal for them to do that. Pathologists are screwed on this one because this (in addition to in office radiology) is legal.
Pathology from what Ive been hearing is becoming corporatized. Looks like pathologists will, in the future, be working for a reference lab. All practices will be bought out by huge reference labs like Ameripath, etc.

Anyone disagree?
 
Last edited:

2121115

10+ Year Member
7+ Year Member
Jan 23, 2007
1,667
39
Status
Attending Physician
Pathology from what Ive been hearing is becoming corporatized. Looks like pathologists will, in the future, be working for a reference lab. All practices will be bought out by huge reference labs like Ameripath, etc.

Anyone disagree?
I disagree.
 

yaah

Boring
Staff member
Administrator
15+ Year Member
Aug 15, 2003
27,947
331
Fixing in 10% neutral buffered formalin
Status
Attending Physician
Pathology from what Ive been hearing is becoming corporatized. Looks like pathologists will, in the future, be working for a reference lab. All practices will be bought out by huge reference labs like Ameripath, etc.

Anyone disagree?
I disagree. Not all practices are going to be bought. Many will survive because they run good businesses and have good situations. Others will merge with hospitals, and others will be bought out by reference labs. It is not much different from other specialties. Many specialty groups are being purchased by hospitals or health systems. Where I live I know of an orthopedic group, a cardiology group, an internal medicine group, an OB/Gyn group, and others who have been bought by a hospital or health system. Pathology groups are being bought by either reference labs or hospitals/health systems.
 

mikesheree

Lifetime Donor
Gold Donor
7+ Year Member
Feb 27, 2010
1,179
300
NOT behind a scope.
Status
Attending Physician
Being bought out can be rather compelling, especially if you are being bought out prior to an initial public offering. The deal can be worth a few million dollars. What does the private practice cottage industry offer today? You put in your years, make some good money and when you retire a new associate buys your equity for a couple hundred grand and you get a nice dinner and a "gold watch". There is no cash in opportunity. I was a pp partner in the early 90's, bought in as a partner for about 200k, made between 500-
700k per year for 4 years and then we sold because we saw this WAS ENDING and we were right. We all made a few M and those of us who chose to stay became employees rather than owners and we were on a salary with bonus opportunity and had very cheap stock purchase options.
When we we bought AGAIN by a bigger fish the stock we had was worth much more and we "sold the same horse twice" for another chunk of money. How the hell else do you plan to get out any equity? I now make well north of 400k doing EXACTLY the same thing in EXACTLY the same place I did as a pp partner but I am financially set for life. This is the wave of the future. I am a solo hospital lab medical director associated with a large group with any type of back-up I could need. I do an 8-4 5 d/week with 8 weeks off. Call is 6 weeks/year and i almost NEVER get called. What the hell more could you ask for?
 

KeratinPearls

10+ Year Member
Apr 2, 2007
824
10
Status
Fellow [Any Field]
Being bought out can be rather compelling, especially if you are being bought out prior to an initial public offering. The deal can be worth a few million dollars. What does the private practice cottage industry offer today? You put in your years, make some good money and when you retire a new associate buys your equity for a couple hundred grand and you get a nice dinner and a "gold watch". There is no cash in opportunity. I was a pp partner in the early 90's, bought in as a partner for about 200k, made between 500-
700k per year for 4 years and then we sold because we saw this WAS ENDING and we were right. We all made a few M and those of us who chose to stay became employees rather than owners and we were on a salary with bonus opportunity and had very cheap stock purchase options.
When we we bought AGAIN by a bigger fish the stock we had was worth much more and we "sold the same horse twice" for another chunk of money. How the hell else do you plan to get out any equity? I now make well north of 400k doing EXACTLY the same thing in EXACTLY the same place I did as a pp partner but I am financially set for life. This is the wave of the future. I am a solo hospital lab medical director associated with a large group with any type of back-up I could need. I do an 8-4 5 d/week with 8 weeks off. Call is 6 weeks/year and i almost NEVER get called. What the hell more could you ask for?
Hook me up!
 

2121115

10+ Year Member
7+ Year Member
Jan 23, 2007
1,667
39
Status
Attending Physician
Being bought out can be rather compelling, especially if you are being bought out prior to an initial public offering. The deal can be worth a few million dollars. What does the private practice cottage industry offer today? You put in your years, make some good money and when you retire a new associate buys your equity for a couple hundred grand and you get a nice dinner and a "gold watch". There is no cash in opportunity. I was a pp partner in the early 90's, bought in as a partner for about 200k, made between 500-
700k per year for 4 years and then we sold because we saw this WAS ENDING and we were right. We all made a few M and those of us who chose to stay became employees rather than owners and we were on a salary with bonus opportunity and had very cheap stock purchase options.
When we we bought AGAIN by a bigger fish the stock we had was worth much more and we "sold the same horse twice" for another chunk of money. How the hell else do you plan to get out any equity? I now make well north of 400k doing EXACTLY the same thing in EXACTLY the same place I did as a pp partner but I am financially set for life. This is the wave of the future. I am a solo hospital lab medical director associated with a large group with any type of back-up I could need. I do an 8-4 5 d/week with 8 weeks off. Call is 6 weeks/year and i almost NEVER get called. What the hell more could you ask for?
This is a great deal if you are a partner before the buyout. If you are just an associate during pre-partnership or a new hire then it is not so great. I am really happy for you that things have worked out well, but the next generation coming up won't get the same benefits. It is the "wave of the future" for you certainly, but for a new pathology trainee it is a less promising future. Granted, you don't owe us anything and I wouldn't expect you to do differently but please don't put on this act like it is a great deal for anyone but you.
 

mikesheree

Lifetime Donor
Gold Donor
7+ Year Member
Feb 27, 2010
1,179
300
NOT behind a scope.
Status
Attending Physician
This is a great deal if you are a partner before the buyout. If you are just an associate during pre-partnership or a new hire then it is not so great. I am really happy for you that things have worked out well, but the next generation coming up won't get the same benefits. It is the "wave of the future" for you certainly, but for a new pathology trainee it is a less promising future. Granted, you don't owe us anything and I wouldn't expect you to do differently but please don't put on this act like it is a great deal for anyone but you.
You seem resigned to the idea that opportunity will always pass you ( and those of your generation ) by. I was not always a partner and I know of several other groups who did not strike while the iron was hot for whatever reason and are now sorry. I assure you that my great deal was not the last one coming down the pike.
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
You seem resigned to the idea that opportunity will always pass you ( and those of your generation ) by. I was not always a partner and I know of several other groups who did not strike while the iron was hot for whatever reason and are now sorry. I assure you that my great deal was not the last one coming down the pike.
Well that must be nice. But the personal stories I have heard from people that joined Ameripath practices, is that it really sucks.

Ameripath doesn't give your group millions of dollars as a gift. They plan on getting that money back plus a lot more over time.

Like I wrote once, a woman told me the deal was is that Ameripath took the first 27% off the top of all reimbursement then you split the remaining 73% evenly. Which means junior people get 37.5% of what the reimbursement is. I also hear of stories where you have to go out and grovel to new clinicians to get cases and not necessarily see much gain to the new revenue if you get the business. In fact I have never met a junior person who worked at a place like Ameripath that didn't want to get out.

Now if you are getting tons of cheap stock which becomes worth a lot of money for which you can sell, then I guess that is a different story. But good luck predicting that.

And what do you mean when you say the iron isn't hot? Are practices no longer purchased?
 

mikesheree

Lifetime Donor
Gold Donor
7+ Year Member
Feb 27, 2010
1,179
300
NOT behind a scope.
Status
Attending Physician
i did not "predict" it--it was in the sales contract. and i stated that my deal certainly was not the last one that will come along.

and in keeping with the xmas season- if they want to leave " then let them do so and decrease the surplus population"
 

mikesheree

Lifetime Donor
Gold Donor
7+ Year Member
Feb 27, 2010
1,179
300
NOT behind a scope.
Status
Attending Physician
Well that must be nice. But the personal stories I have heard from people that joined Ameripath practices, is that it really sucks.

Ameripath doesn't give your group millions of dollars as a gift. They plan on getting that money back plus a lot more over time.

Like I wrote once, a woman told me the deal was is that Ameripath took the first 27% off the top of all reimbursement then you split the remaining 73% evenly. Which means junior people get 37.5% of what the reimbursement is. I also hear of stories where you have to go out and grovel to new clinicians to get cases and not necessarily see much gain to the new revenue if you get the business. In fact I have never met a junior person who worked at a place like Ameripath that didn't want to get out.

Now if you are getting tons of cheap stock which becomes worth a lot of money for which you can sell, then I guess that is a different story. But good luck predicting that.

And what do you mean when you say the iron isn't hot? Are practices no longer purchased?
i did not "predict" it. It was part of the sales contract. I also said my deal was not the last that will come along.

And in keeping with the xmas season-if they want to get out "let them do so and decrease the surplus population." Now I have to go out and grovel.
 

LADoc00

Gen X, the last great generation
15+ Year Member
Sep 9, 2004
6,489
560
Status
Attending Physician
Being bought out can be rather compelling, especially if you are being bought out prior to an initial public offering. The deal can be worth a few million dollars. What does the private practice cottage industry offer today? You put in your years, make some good money and when you retire a new associate buys your equity for a couple hundred grand and you get a nice dinner and a "gold watch". There is no cash in opportunity. I was a pp partner in the early 90's, bought in as a partner for about 200k, made between 500-
700k per year for 4 years and then we sold because we saw this WAS ENDING and we were right. We all made a few M and those of us who chose to stay became employees rather than owners and we were on a salary with bonus opportunity and had very cheap stock purchase options.
When we we bought AGAIN by a bigger fish the stock we had was worth much more and we "sold the same horse twice" for another chunk of money. How the hell else do you plan to get out any equity? I now make well north of 400k doing EXACTLY the same thing in EXACTLY the same place I did as a pp partner but I am financially set for life. This is the wave of the future. I am a solo hospital lab medical director associated with a large group with any type of back-up I could need. I do an 8-4 5 d/week with 8 weeks off. Call is 6 weeks/year and i almost NEVER get called. What the hell more could you ask for?
Mike, you are one of the lucky ones.

In my roughly 30-40 regular contacts I check with, this is not even remotely a possibility.

You are an anomaly. Pure and simple. Your experience is that of a bygone era that has no bearing on current times, its like comparing Berlin in Spring of 1939 vs. 1945.

Mike, take a few moments each day to pray to whatever God you worship for the incredible opportunity afforded you and your family.

May the saddest day of your future be no worse than the happiest day of your past.

----
unfortunately the other posters on this board cant (err shouldnt?) count on winning the lottery as their success plan in pathology.
 

mikesheree

Lifetime Donor
Gold Donor
7+ Year Member
Feb 27, 2010
1,179
300
NOT behind a scope.
Status
Attending Physician
Mike, you are one of the lucky ones.

In my roughly 30-40 regular contacts I check with, this is not even remotely a possibility.

You are an anomaly. Pure and simple. Your experience is that of a bygone era that has no bearing on current times, its like comparing Berlin in Spring of 1939 vs. 1945.

Mike, take a few moments each day to pray to whatever God you worship for the incredible opportunity afforded you and your family.

May the saddest day of your future be no worse than the happiest day of your past.

----
unfortunately the other posters on this board cant (err shouldnt?) count on winning the lottery as their success plan in pathology.
I am very grateful for what the military and private practice have given me and I hope such opportunities are not shut to the generation (i'm 59) behind me although things have certainly changed over the past 30 or so years.
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
I am very grateful for what the military and private practice have given me and I hope such opportunities are not shut to the generation (i'm 59) behind me although things have certainly changed over the past 30 or so years.
Too bad making 550k-700k a year seemed like peanuts. Yeah, making that for 30 years is a mere 15-20 million dollars.

I am sure droves of newly minted pathologists would love a chance to earn that for 30 years and "only" get a 200k buy-out and a gold watch.
 

2121115

10+ Year Member
7+ Year Member
Jan 23, 2007
1,667
39
Status
Attending Physician
Too bad making 550k-700k a year seemed like peanuts. Yeah, making that for 30 years is a mere 15-20 million dollars.

I am sure droves of newly minted pathologists would love a chance to earn that for 30 years and "only" get a 200k buy-out and a gold watch.
Let them eat cake.

----- mikesheree
 

pathstudent

Sound Kapital
15+ Year Member
Mar 17, 2003
2,987
78
43
Visit site
Status
Pre-Health (Field Undecided)
And what do you mean when you say this the wave of the future. If a new pathologist joins your group, do they have any hope of selling the practice or getting a bunch of cheap stock. Hell no. You are a hoser of young pathologists, but I would have done the same thing. You are a lucky man. Like a guy that sold all his las Vegas real estate in 2007 or his dot com stock before 2000.
Being bought out can be rather compelling, especially if you are being bought out prior to an initial public offering. The deal can be worth a few million dollars. What does the private practice cottage industry offer today? You put in your years, make some good money and when you retire a new associate buys your equity for a couple hundred grand and you get a nice dinner and a "gold watch". There is no cash in opportunity. I was a pp partner in the early 90's, bought in as a partner for about 200k, made between 500-
700k per year for 4 years and then we sold because we saw this WAS ENDING and we were right. We all made a few M and those of us who chose to stay became employees rather than owners and we were on a salary with bonus opportunity and had very cheap stock purchase options.
When we we bought AGAIN by a bigger fish the stock we had was worth much more and we "sold the same horse twice" for another chunk of money. How the hell else do you plan to get out any equity? I now make well north of 400k doing EXACTLY the same thing in EXACTLY the same place I did as a pp partner but I am financially set for life. This is the wave of the future. I am a solo hospital lab medical director associated with a large group with any type of back-up I could need. I do an 8-4 5 d/week with 8 weeks off. Call is 6 weeks/year and i almost NEVER get called. What the hell more could you ask for?
 
Last edited:

zao275

Assistant Professor
10+ Year Member
Sep 3, 2004
486
3
Little Rock, AR
Status
Attending Physician
i did not "predict" it--it was in the sales contract. and i stated that my deal certainly was not the last one that will come along.

and in keeping with the xmas season- if they want to leave " then let them do so and decrease the surplus population"
bonus point for the great Dickens quote!:thumbup:
 

Adrian Cocot

Junior Member
15+ Year Member
Apr 17, 2003
138
20
Visit site
Status
What for profit outpatient labs do:

2.) Provide an in-office EMR in exchange for the business. At one point a clear violation of Stark law, but Stark himself is a blithering idiot and left more than enough loopholes for outpatient sharks to swim though.
QFT. My group just lost a client to Gi Path in Tennesee because of this. There's going to be a lot of small pathology groups that simply won't be able to match that kind of financial impetus (40K just for one EMR), and I have a feeling that it's going to get pretty ugly as we get closer to the 2014 deadline.
 

Entgegen

10+ Year Member
Apr 9, 2006
440
8
Status
Resident [Any Field]
QFT. My group just lost a client to Gi Path in Tennesee because of this. There's going to be a lot of small pathology groups that simply won't be able to match that kind of financial impetus (40K just for one EMR), and I have a feeling that it's going to get pretty ugly as we get closer to the 2014 deadline.
Of what deadline do you speak?