CAP Response to Mitchell Study

| April 16, 2012

The College of American Pathologists recently mentioned, as I discussed last week a study looking at the number of specimen containers collected (and billed to Medicare) for prostate biopsies for self-referring (in-office laboratories) versus non self-referring urologists (send specimens to a lab to be processed and read).  There has been some concern that urologists, who have a stake in a lab they may own, would have financial incentive to do more biopsies, generate more cups and generate more 88305 codes than if they simply sent the work to a lab to be done.  

The null hypothesis for the study by a noted public policy economist at Georgetown University was that there would be no difference in number of specimens between those who owned their labs versus those who referred to laboratories.

The study found otherwise, that self-referring labs generate more cups for themselves than those who sent the specimens to another laboratory.  If you make more, you do more.  Simple economics.

Sadly, despite doing more biopsies, the cancer detection rate did not increase.  It actually decreased.  I don't think a multivariate analysis was done, based on how study was contructed (Medicare claims for these specimens from 2005 – 2007), but nevertheless, doing more biopsies did not yield more cancer.  

So, what does the CAP do with this information?  Essentially nothing in the course of the past week.

There was a Statline release with a link to the study by Dr. Mitchell last Monday and a members-only Webinar on the matter last Friday.  Dr. Mitchell reviewed her design study, methods, results and conclusions for about 30 minutes and then a member-driven Q&A followed for the remaining time.  

The session was moderated by Dr. George Kwass, a practicing pathologist in Massachusetts and CAP Board of Governors member.  

The member generated questions that were read by staff to Dr. Kwass and Dr. Mitchell ranged from design characteristics to what the College plans to do with the information.

This perhaps was the most disappointing part of the webinar.  Dr. Kwass specifically responded to the question of what does the College plan to do with "It is a work in progress".

On April 12th, the AUA fired off this letter, applauding the Journal which published the Mitchell Study and mentioned the "turf war" between pathology and urology on this matter and defended their practice of 12 cores versus less.

An organization called LUGPA which stands for The Large Urology Group Practice Association had a press release on Friday, hours before the CAP Webinar to its members.

The press release states: "This study simply furthers the political agenda of its sponsors to recapture lost market share and does not deserve credible recognition," states Dr. Deepak A. Kapoor, President of LUGPA and Chairman and CEO of Integrated Medical Professionals, PLLC. "To suggest that certain practices are performing extra and unnecessary pathology work for their own remuneration when they are working within rational clinical guidelines is offensive. It shows a total lack of understanding of proper prostate cancer diagnosis."

The College of American Pathologists published an alert, link to study, information on its advocacy site which I mentioned last week and holds a members-only webinar.  

Assuming the College did not know the results when the study was completed or during the peer-review process, it should have had 4 or 5 action items and more talking points ready to go, whether the results were favorable or unfavorable to the College's interests in this "turf war" as mentioned by our urology colleagues.  

Instead, we get "It is a work in progress".  A work in progress, strictly defined is "Material that has entered the production process but is not yet a finished product."  

Work in progress (WIP) therefore refers to all materials and partly finished products that are at various stages of the production process. WIP excludes inventory of raw materials at the start of the production cycle and finished products inventory at the end of the production cycle.

The term could also be used to ongoing projects, as I have used it, for example, months-long software implementations, home contruction or contract negotiations where everyone is working towards a common goal and end desired product.  

If the study was, say started in 2010 and in part, funded by the CAP, why is that an organization called LUGPA is firing their bullets and we are still having only, as far as I can tell members-only calls?

What is the College, its board, advocacy groups, political action committee or PR engine going to do before the likes of LUGPA, AUA or IOP continue to put their own spin on this?

Pathologists are data driven.  We have the data now.  Why don't we have a succint plan to use the data after many years?


Category: Pathology News

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