Not surprising since our health care system is biased to pay for tests and
treatments, not results. On top of this there are serious questions as to
whether the PSA screening that leads to biopsies is useful in the long term.
There is a recommendation out there to stop PSA screening for most men since it
is largely non-specific. That test is what leads to the biopsies. Less
screening = fewer biopsies = less revenue.
Tim Morken
-----Original Message-----
From: histonet-boun...@lists.utsouthwestern.edu
[mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Daniel Schneider
Sent: Tuesday, April 10, 2012 11:22 AM
To: Histonet
Subject: [Histonet] In House Labs in WSJ
The Wall Street Journal served up a timely article for us.
You'll see both sides of the argument below. One side is right.
DLS
HEALTH INDUSTRY
April 9, 2012, 7:22 p.m. ET
Prostate-Test Fees Challenged
By CHRISTOPHER WEAVER
Doctors in urology groups that profit from tests for prostate cancer order more
of them than doctors who send samples to independent laboratories, according to
a study Monday in the journal Health Affairs.
The study found that doctors' practices that do their own lab work bill the
federal Medicare program for analyzing 72% more prostate tissue samples per
biopsy while detecting fewer cases of cancer than counterparts who send
specimens to outside labs.
Hiring pathologists boosts revenue for a practice and creates a potential
incentive to increase the number of tests ordered, said Jean Mitchell, a
Georgetown University economist and author of the study.
That fewer cancers were detected-21% versus 35% for those sent to external labs,
according to the study-suggests "financial incentives"
may play a role in decisions to order the tests, Ms. Mitchell said.
Some urologists said the research doesn't necessarily indicate financial
motives. Urologists in larger group practices that have in-house pathologists
may be more aggressive in testing because they seek to catch cancer earlier,
said Steven Schlossberg, a Yale urologist who heads a health-policy panel for
the American Urological Association and wasn't involved in the research. Also,
Dr. Schlossberg noted, the figures, which cover 36,261 biopsies from 2005
through 2007, are five years old.
The study was financed by the College of American Pathologists and the American
Clinical Laboratory Association. It is the last salvo in a turf war between
laboratory companies and physician groups that have opened their own labs to
conduct tests.
Regulators and economists scrutinizing the growing costs of health care have
targeted a range of related activities by doctors, known as self-referrals.
Although a set of 1990s-era laws, named for their proponent, Rep. Pete Stark
(D., Calif.), ban doctors from referring patients to most companies in which
they have a financial interest, urology groups can enter the pathology business
because of an exemption for certain services performed within physicians'
offices. The pathologists and other groups are lobbying Congress to end the
exemption.
At issue in the study is a quirk of billing for lab procedures. Labs get paid
based on the number of jars used to hold specimens from a prostate biopsy.
Doctors can choose to put several specimens in one jar or put each in its own
jar, potentially boosting lab fees, which averaged about $104 a jar in 2010,
according to the study.
Urologists in practices with in-house pathologists sent 11.4 jars per biopsy
for testing versus 5.9 jars per biopsy for other doctors in 2005.
Some doctors say that separating the samples can help them better map any
cancer.
In addition, urologists in recent years have been taking more samples during a
biopsy to better identify the location of any cancer, said John Hollingsworth,
an assistant professor of urology at the University of Michigan. The standard
number of samples taken doubled to 12 over the last decade, he said.
The Health Affairs study's conclusions are "largely around billing practices, not
around clinical practices," said George Kwass, a pathologist based in Massachusetts
and board member of the College of American Pathologists. Urologists who team up with
pathologists appear to bill more, he said, leading to potential waste.
Urology groups are consolidating, and increasingly moving into the pathology
business. One large practice based on New York's Long Island, Integrated
Medical Professionals, opened its lab in 2010 to control costs and because
doctors encountered errors in outside test results, said the group's chairman,
Deepak Kapoor.
"We don't make a fortune on pathology," Dr. Kapoor said.
But lab businesses are seeing revenue vanish. Texas pathology group ProPath
stopped getting prostate tissue from large urology groups more than four years
ago, said executive director Krista Crews, when these clients began doing lab
work in-house. The group still gets referrals from small, one and two-doctor
practices, she said.
Large laboratory companies are worried about the trend, too. Quest Diagnostics Inc. DGX
-2.52%said in its latest annual filings that if physicians, including urologists as well
as gastroenterologists and skin and cancer doctors, continued to "internalize"
testing services, it could reduce the company's sales.
Write to Christopher Weaver at christopher.wea...@wsj.com
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