Yet another example of physicians profiting from lab work

[WEBB PINKERTON]

More greed in the world of urology.....

http://online.wsj.com/articles/how-medicare-self-referral-thrives-on-loophole-1414031401

It's beyond time to take the financial incentive away from physicians to order lab tests. We are creating a fake market.

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[yaah]

I believe it is fairly common practice for in-office urology labs to own a FISH setup, and then reflex all the atypical urines to FISH testing. The interesting question would be what their atypical % rate is. More than 20%?

 

[WEBB PINKERTON]

Looking at the Medicare website, you can tell the % getting FISH done. Just look up the data for the pathologists at this place in the article. It is interesting to say the least.

I don't like the article calling out the pathologist working at the place in Florida. He is just signing out what is ordered. What are they suppose to do? Tell them that they are overutilizing the test? They would be shown the door mighty fast. The blame needs to go to the urologists who ordered this test.

 

[2121115]

I believe it is fairly common practice for in-office urology labs to own a FISH setup, and then reflex all the atypical urines to FISH testing. The interesting question would be what their atypical % rate is. More than 20%?

What is an appropriate atypical rate, IYO?

 

[yaah]

What is an appropriate atypical rate, IYO?

Tough to answer because practice patterns are different. If you have clinicians who send it on every patient it's lower, closer to 5-10%. But if they are more judicious then it can be closer to 20%. I think in our group it usually averages around 10% or so, maybe a bit higher. I don't really know what an appropriate rate is though unless you can see how often your atypicals turn out to be actual pathology.

 

[WEBB PINKERTON]

If people keep ordering it on nearly 100 percent of their cases, Palmetto will be making the decision.

 

[yaah]

IMO when FISH is helpful is in suspicious (maybe some persistent atypical) urines where there is no lesion on cystoscopy. If FISH positive, especially when strongly positive (more than 10 cells) there's usually cancer. FISH is not helpful in urines where it is atypical because there are clusters.

 

[coroner]

That's the problem: reflexing all atypicals instead of suspicious only, which as you mentioned is common practice by in-office urology labs. And if the urologists don't have an in-office lab, requiring them to send out to a hospital/reference lab, there is usually no resistance from the pathologists because they gotta make those same urologists happy so they can keep getting their prostate biopsies. Everyone's got their hand in someone else's pocket...

 

[WEBB PINKERTON]

You are seeing the cycle of waste. We are a spineless bunch who just do as we are told. All that talk about pathologists being "gate keepers" to prevent overutilization and promote appropriate usage is BS.

If we eliminated waste from our profession, there would 30 percent unemployment rate. The fake market allows program directors to come onto this board and enthusiastically proclaim "everyone found a job!" A fair number of those jobs shouldnt exist in the first place and we are making health care more and more unaffordable.

 

[medgator]

It's not just path, also in rad onc, urologists have been benefiting for years....

http://forums.studentdoctor.net/threads/can-we-talk-about-urorad.405549/