It's never made sense to me to submit prostate biopsies A-L in separate
containers. I'm not an Interventional Radiologist or a Urologist, but when was
the last time you saw a Urologic Surgeon remove 1/12 of a prostate? And even
for targeted radiation or prostate brachytherapy (radioactive seeds) I would
think localizing the neoplasm in a specific quadrant would be sufficient. I've
worked in several labs where multiple prostate bxs would be submitted in one
container (after agreement by the Clinician and the Pathologist) to save a
non-insured patient money.
JW - I've always thought this was for financial gain only... I fussed and
fussed at my pathologists
because they were being courted by urologists - finally it all fell
through, but it just wasn't right
for pathology to leave the hospital. Medicare stopped the multiple
payments a few years ago tho.
In my opinion, this is only the beginning. If the Patient Protection and
Affordable Care Act kicks in, I think the 15 member Independent Payment
Advisory Board is going to be finding A LOT of procedures like this that the
government will refuse to pay for. Even if one could make an argument that a
procedure is medically sound, these decisions will be made after a cost/benefit
analysis. e.g.:
Is it beneficial to submit every appendix when the incidence rate of
carcinoid tumor of the appendix is 1 in 100,000? (source:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356383/)
JW - it does if you're the patient with the carcinoid.
Is it worth it to diagnose *Helicobacter *via (highly remunerative) IHC
when they can be visualized on an H&E? Especially since there is an
inexpensive, simple and safe breath test available.
JW - still thinking about this one - if the pathologist is sitting in
the courtroom because he/she missed one - it might be.
My 2 cents...
Joyce Weems
Pathology Manager
678-843-7376 Phone
678-843-7831 Fax
joyce.we...@emoryhealthcare.org
www.saintjosephsatlanta.org
5665 Peachtree Dunwoody Road
Atlanta, GA 30342
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-----Original Message-----
From: histonet-boun...@lists.utsouthwestern.edu
[mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Davide Costanzo
Sent: Tuesday, October 30, 2012 4:47 PM
To: Jay Lundgren
Cc: histonet@lists.utsouthwestern.edu; Webster, Thomas S.
Subject: Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and
future trends
Well said!
Sent from my iPhone
On Oct 30, 2012, at 1:19 PM, Jay Lundgren <jaylundg...@gmail.com> wrote:
It's never made sense to me to submit prostate biopsies A-L in separate
containers. I'm not an Interventional Radiologist or a Urologist, but when was
the last time you saw a Urologic Surgeon remove 1/12 of a prostate? And even
for targeted radiation or prostate brachytherapy (radioactive seeds) I would
think localizing the neoplasm in a specific quadrant would be sufficient. I've
worked in several labs where multiple prostate bxs would be submitted in one
container (after agreement by the Clinician and the Pathologist) to save a
non-insured patient money.
In my opinion, this is only the beginning. If the Patient Protection and
Affordable Care Act kicks in, I think the 15 member Independent Payment
Advisory Board is going to be finding A LOT of procedures like this that the
government will refuse to pay for. Even if one could make an argument that a
procedure is medically sound, these decisions will be made after a cost/benefit
analysis. e.g.:
Is it beneficial to submit every appendix when the incidence rate of
carcinoid tumor of the appendix is 1 in 100,000? (source:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356383/)
Is it worth it to diagnose *Helicobacter *via (highly
remunerative) IHC when they can be visualized on an H&E? Especially since
there is an inexpensive, simple and safe breath test available.
Brace yourselves Histonet, winter is coming.
Sincerely,
Jay A. Lundgren, M.S., HTL
(ASCP)
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