This blog is about 6 months old and as frequent readers of this blog know, most post contents are re-posted news items I think may be of interest in digital pathology and the pathology community in general. Occasionally, I make some opinions about the piece and/or comment on its importance. In doing so, 2 items have surprised me, the amount of positive feedback and interest and the amount of content that in actuality is re-published or re-posted on blogs routinely, with or without original ideas about a news story.
Some bloggers create several original ideas or opinions while others post thoughts on particular items they find of interest. Some personalize with family photos, trip stories or recount a recent illness perhaps to help others in need.
My recent posting about the ASCP/USCAP seminar to be held on “sleaze, graft and corruption” received a record number of page views. Several comments from pathologists, residents, medical students and vendor associates were received about the meeting announcement. I felt only one was suitable for posting without editing their comments but all came down to the same thought, “Is this a joke?”
Esteemed colleagues, this is no joke. This is for real. While the CAP works with the Centers for Medicare and Medicaid (CMS) on anti-markup rules, POD labs and Stark Legislation, pathologists are being employed by urology and gastroenterology groups to read their slides from office biopsies acquired by their practice, sent to the lab and pathologist that they own and operate. People are splitting hairs whether it is the “same building” or “centralized facility”. Come on.
When is the last time you saw a radiologist working in the back of a neurosurgeon’s office reading CT and MRI scans who just happens to own the equipment and pay the radiologist’s salary for his/her services? How about a cardiothoracic surgeon who is employed by a cardiology group or a pediatrician employed by an obstetrician. It is absurd. Those physicians lose objectivity, autonomy and there are obvious self-referral issues and conflicts of interest that go far beyond loss of appropriate payment for technical component and professional component.
The joke is that this is happening in pathology and occurs very rarely among or to other specialties. Pathology residents and fellows are being successfully recruited into these groups. Historically, internists ran clinical laboratories before clinical pathology took hold, in large part, being of the large technical component reimbursements. It of course is common practice in many physician’s offices with point of care testing who employ phlebotomists and medical technologists. Many dermatopathology-trained dermatologists read their own biopsies. Again, how many pulmonologists own the chest x-ray machine and hi-res CT scanner and employ radiologist(s)?
So, we are left with articles, grand rounds and seminars at academic meetings with objectives of these programs to “demonstrate increased awareness”, “acquire technologies to compete” and “help pathology organizations combat this threat” with words such as “pathology, surgical pathologist, sleaze and corruption” in the title.
Comments (2)
J Oppenheimer fred seid I HAVE WASTED MANY HOURS SENDING EMAILS TO ASCP,CAP AND CMS.
TOO MANY BEHIND THE DOOR AGREEMENTS AND PROTECTION OF THE KEY FIGURES IN THIS POD LAB ISSUE.
EVEN AS THEY TALK AND NYSDOH GOES AROUND INSPECTING LABS, THE DOCS SKIRT THE LAW EVEN READING BIOPSIES THROUGH THE WEB AND SENDING RESULTS TO THE POD OR LAB FOR REPORT GENERATION. THE PATHOLOGISTS ARE HOME READING THE WORK.
PATHOLOGIST CAN HAVE CONNECTIONS TO 5 PODS MAKING SUBSTANDARD SALARIES.
THIS SOUNDS SO FAMILIAR AS WAS DOCUMENTED IN THE PAP FIELD AS “PIECEWORK” PRACTICES.
WHERE IS THE CONTROL?
YOU CANNOT CONTROL GI AND DERM AND UROLOLOGIST WHO JUST WANT TO COVER FINANCIAL AND THINK BY HIRING OUTSIDE PATHOLOGIST WHO DONOT GENERALLY CARE ABOUT MAINTAINING QUALITY BUT CARE ABOUT A LIVING ONLY ,WILL BE ACCURATE IN DOING WORK IN SO MANY PODS TO MAKE UP THE LOSS OF MONEY THEY CANNOT GET IN THE HOSPITAL OR COMMERICAL LAB.
CMS IS JUST CIRCUMVENTING THE STARK LAW AS THE OTHER REGULARTORY AGENCIES THAT ALLOW THIS AND AFRAID TO JUST MAKE A DECISION THAT WILL PROTECT AND SECURE THE QUALITY AND PRIVACY OF THE PATIENTS.
THE ACCURACY THESE REGULATORY AGENCIES CANNOT CONTROL BECAUSE THESE PODS HIRE THE DOCTOR THAT WILL TAKE THE CHEAPER RATES AND THESE FELLOWS CANNOT WORK IN HOSPITALS BECAUSE THEY MAKE TOO MANY ERRORS AND HAVE THE REVIEW BOARDS ON THERE TAILS. MANY OF THEM ARE THE PATHOLOGIST TRAVELING FROM ONE LAB TO ANOTHER MAKING THE SAME ERRORS.
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With decreasing reimbursements for surgery and increased office staff and capital expenses, clinicians are increasingly looking at the revenues generated by pathology to make ends meet. Reselling pathology services is easy, since it requires no work from the urologist other than adding additional CPT codes when billing the payor, but it is legal in only some states and does not allow the collection of specimens from Medicare patients.
The TC/PC (Technical Component/ Professional Component) allows the clinician (usually urologist or gasteroenterologist) to collect from all payors. In this model, the clinician hires a pathologist as a part-time employee to come to his office and read the biopsies (as well as cytology and FISH cases). The clinician uses the -26 professional component modifier to bill for the pathologist’s services. Medicare pays an average of $36 for each 88305-26 and $41 for each 88342-26 so a twelve specimen biopsy case (as is the norm with prostate biopsies) with a triple stain generates $555 in professional fees. If the pathologist is paid $500/hr and reads four such cases in that time he pockets the $500 while generating $2220 minus $500 or $1720 for the urologist. Meanwhile the laboratory generates $3200 in 88305-TC and $660 in 88342-TC for a total of $3860. Both clinician and pathologist benefit.
But why should the lab make $3860 and the clinician only half as much? This can be remedied by bringing the technical component in-house as some of the larger clinical group have done and many more are planning. Is it possible that the more one profits by doing an activity the more such activity is undertaken? By comparing the amount of billable biopsy specimens obtained by those clinicians who do not profit from pathology with the amount of billable biopsy specimens obtained by those clinicians who do profit, it has been my experience that this is certainly the case. One can even compare the amount of specimens submitted by the same clinician both before and after they started to profit from such activity.
Each laboratory needs to foster a relationship with the clinician who supplies specimens. The desire for a lasting relationship encourages competing laboratories to kick-back as much of their excess profits as necessary to form and retain this relationship. Supplying attractive sales reps (who routinely make over $150K, and often over $250K/yr) with company credit cards for expensive meals and fishing/golfing outings ease the relationship as do charitable donations, reimbursements for expensive computer systems, payments to office staff, in-office placement of nurses and phlebotomists, free office and medical supplies, continuing education credits, free management and recruiting services, etc. The cost of these perks is considerable and can only be generated by performing unnecessary medical tests (excessive IHC stains including triple prostate stains on multiple cores, Giemsa staining of urine cytology, routine FISH Urovysion testing and addition to urine cytology, etc.