Re: [Histonet] Stark Law
Google Jane Pine Wood - best Stark law attorney in the US. Sent from my iPhone On Dec 17, 2012, at 12:36 PM, Jennifer MacDonald jmacdon...@mtsac.edu wrote: Is anyone familiar with the Stark Law or can recommend a good resource? The lab is located in California. Thanks, Jennifer ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] Tissue Processors
The excelsior is getting rave reviews from folks I know that use it. The University of Miami just ordered a few of them from my understanding. Might want to call there and ask their opinion. Personally, I think Sakura is losing ground and for good reason. We use exclusively Thermo branded equipment here. STP420 and Pathcentre. Both are great. Sent from my iPhone On Dec 4, 2012, at 12:49 PM, Tim Wheelock twheel...@mclean.harvard.edu wrote: Hi Everyone: I am currently evaluating three tissue processors. They are the Sakura VIP6, the Leica ASP 6025, and the Thermo-Fisher Excelsior ES. I was wondering if people could give me their critical opinions and preferences on these three machines. In addition to reliability and ease of use, I am interested in people's experience with tech support, software, or any other factor-positive or negative-that prompted your decision. I currently have a 14 year old Shandon Hypercenter XP. Thank you, Tim Wheelock Neuropathology Laboratory Harvard Brain Bank McLean Hospital Belmont, MA ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] 88305TC starting to hit the fan...
Tell them Rene! Too many Fox News listeners here I suspect. Sent from my iPhone On Nov 20, 2012, at 6:05 AM, Rene J Buesa rjbu...@yahoo.com wrote: The law provides economic assistance to those with low income who cannot afford insurance. It would be nice if we all read the law instead of paying attention to those who try to scare people. René J. From: Bernice Frederick b-freder...@northwestern.edu To: Rene J Buesa rjbu...@yahoo.com; David Kemler histot...@yahoo.com; Fellow HistoNetters Histonet@Lists.UTSouthwestern.edu Sent: Tuesday, November 20, 2012 9:00 AM Subject: RE: [Histonet] 88305TC starting to hit the fan... But can they afford to buy it Bernice Frederick HTL (ASCP) Senior Research Tech Pathology Core Facility ECOGPCO-RL Robert. H. Lurie Cancer Center Northwestern University 710 N Fairbanks Court Olson 8-421 Chicago,IL 60611 312-503-3723 b-freder...@northwestern.edu -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Rene J Buesa Sent: Tuesday, November 20, 2012 7:58 AM To: David Kemler; Fellow HistoNetters Subject: Re: [Histonet] 88305TC starting to hit the fan... Tell that to all those who have pre-existing medical conditions that can now buy health insurance. René J. From: David Kemler histot...@yahoo.com To: Fellow HistoNetters Histonet@Lists.UTSouthwestern.edu Sent: Monday, November 19, 2012 9:49 PM Subject: Re: [Histonet] 88305TC starting to hit the fan... Hmmm...I think more people should have paid attention to Obamacare two years ago when it was being shoved down eveyones throat. Oh well.. as old saying goes...You ain't seen nottin' yet! I'm just amazed that there are so many in the profession who are surprised about the changes beginning to take place, there are many, many more to come in 2013 14 and all of them affect your job or lack thereof. :) Everyone had the opportunity to change things on November 6th - they chose not to. So, you live with it. Yours, David From: Davide Costanzo pathloc...@gmail.com To: Webster, Thomas S. twebs...@crh.org Cc: histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Sent: Monday, November 19, 2012 6:46 PM Subject: Re: [Histonet] 88305TC starting to hit the fan... While this stinks on many levels, I have to take issue with the shift wealth from specialists to family practice - family practice docs have been the frontline of medicine, all the while earning less than a quarter of what specialists earn. It's about time they get a boost. Too many specialists earn over a million a year, while the family practice guys/ladies can barely pay their student loans. Sent from my iPhone On Nov 19, 2012, at 1:25 PM, Webster, Thomas S. twebs...@crh.org wrote: CAP had a webinar last week about the cut. These are some very scary times. For some reason the government has decided to shift wealth from specialists to family practice. I am becoming more angry with the affordable care act everyday. http://www.cap.org/apps/cap.portal?_nfpb=truecntvwrPtlt_actionOverrid e=%2Fportlets%2FcontentViewer%2Fshow_windowLabel=cntvwrPtltcntvwrPtl t%7BactionForm.contentReference%7D=advocacy%2Fadvocacy_related_webinar s.html_state=maximized_pageLabel=cntvwr CONFIDENTIALITY NOTICE: This e-mail message, including all attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. You may NOT use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender by reply e-mail immediately. Please destroy all copies of the original message and all attachments. Your cooperation is greatly appreciated. Columbus Regional Hospital 2400 East 17th Street Columbus, Indiana 47201___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] 88305TC starting to hit the fan...
This is not a political forum. Keep your anti-President talk off this site. Sent from my iPhone On Nov 19, 2012, at 6:49 PM, David Kemler histot...@yahoo.com wrote: Hmmm...I think more people should have paid attention to Obamacare two years ago when it was being shoved down eveyones throat. Oh well.. as old saying goes...You ain't seen nottin' yet! I'm just amazed that there are so many in the profession who are surprised about the changes beginning to take place, there are many, many more to come in 2013 14 and all of them affect your job or lack thereof. :) Everyone had the opportunity to change things on November 6th - they chose not to. So, you live with it. Yours, David From: Davide Costanzo pathloc...@gmail.com To: Webster, Thomas S. twebs...@crh.org Cc: histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Sent: Monday, November 19, 2012 6:46 PM Subject: Re: [Histonet] 88305TC starting to hit the fan... While this stinks on many levels, I have to take issue with the shift wealth from specialists to family practice - family practice docs have been the frontline of medicine, all the while earning less than a quarter of what specialists earn. It's about time they get a boost. Too many specialists earn over a million a year, while the family practice guys/ladies can barely pay their student loans. Sent from my iPhone On Nov 19, 2012, at 1:25 PM, Webster, Thomas S. twebs...@crh.org wrote: CAP had a webinar last week about the cut. These are some very scary times. For some reason the government has decided to shift wealth from specialists to family practice. I am becoming more angry with the affordable care act everyday. http://www.cap.org/apps/cap.portal?_nfpb=truecntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow_windowLabel=cntvwrPtltcntvwrPtlt%7BactionForm.contentReference%7D=advocacy%2Fadvocacy_related_webinars.html_state=maximized_pageLabel=cntvwr CONFIDENTIALITY NOTICE: This e-mail message, including all attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. You may NOT use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender by reply e-mail immediately. Please destroy all copies of the original message and all attachments. Your cooperation is greatly appreciated. Columbus Regional Hospital 2400 East 17th Street Columbus, Indiana 47201___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] 88305TC starting to hit the fan...
Nicely stated! Sent from my iPhone On Nov 20, 2012, at 6:49 AM, Weems, Joyce K. joyce.we...@emoryhealthcare.org wrote: There are caps on what folks must pay, folks... please read the law. There are many good things about the new law. Also realize that all of the changes we're facing are not part of Obamacare. The Grandfather clause has been ending for years. Congress finally let it this year. Something had to change and change is hard. Let's work together with our Congress to adjust what needs to be adjusted as needed. Maybe they will begin to work together if we demand it. Happy Thanksgiving - we still have much to be thankful for!! 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 This e-mail, including any attachments is the property of Saint Joseph's Hospital and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email. -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Rene J Buesa Sent: Tuesday, November 20, 2012 9:04 AM To: Bernice Frederick; David Kemler; Fellow HistoNetters Subject: Re: [Histonet] 88305TC starting to hit the fan... The law provides economic assistance to those with low income who cannot afford insurance. It would be nice if we all read the law instead of paying attention to those who try to scare people. René J. From: Bernice Frederick b-freder...@northwestern.edu To: Rene J Buesa rjbu...@yahoo.com; David Kemler histot...@yahoo.com; Fellow HistoNetters Histonet@Lists.UTSouthwestern.edu Sent: Tuesday, November 20, 2012 9:00 AM Subject: RE: [Histonet] 88305TC starting to hit the fan... But can they afford to buy it Bernice Frederick HTL (ASCP) Senior Research Tech Pathology Core Facility ECOGPCO-RL Robert. H. Lurie Cancer Center Northwestern University 710 N Fairbanks Court Olson 8-421 Chicago,IL 60611 312-503-3723 b-freder...@northwestern.edu -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Rene J Buesa Sent: Tuesday, November 20, 2012 7:58 AM To: David Kemler; Fellow HistoNetters Subject: Re: [Histonet] 88305TC starting to hit the fan... Tell that to all those who have pre-existing medical conditions that can now buy health insurance. René J. From: David Kemler histot...@yahoo.com To: Fellow HistoNetters Histonet@Lists.UTSouthwestern.edu Sent: Monday, November 19, 2012 9:49 PM Subject: Re: [Histonet] 88305TC starting to hit the fan... Hmmm...I think more people should have paid attention to Obamacare two years ago when it was being shoved down eveyones throat. Oh well.. as old saying goes...You ain't seen nottin' yet! I'm just amazed that there are so many in the profession who are surprised about the changes beginning to take place, there are many, many more to come in 2013 14 and all of them affect your job or lack thereof. :) Everyone had the opportunity to change things on November 6th - they chose not to. So, you live with it. Yours, David From: Davide Costanzo pathloc...@gmail.com To: Webster, Thomas S. twebs...@crh.org Cc: histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Sent: Monday, November 19, 2012 6:46 PM Subject: Re: [Histonet] 88305TC starting to hit the fan... While this stinks on many levels, I have to take issue with the shift wealth from specialists to family practice - family practice docs have been the frontline of medicine, all the while earning less than a quarter of what specialists earn. It's about time they get a boost. Too many specialists earn over a million a year, while the family practice guys/ladies can barely pay their student loans. Sent from my iPhone On Nov 19, 2012, at 1:25 PM, Webster, Thomas S. twebs...@crh.org wrote: CAP had a webinar last week about the cut. These are some very scary times. For some reason the government has decided to shift wealth from specialists to family practice. I am becoming more angry with the affordable care act everyday. http://www.cap.org/apps/cap.portal?_nfpb=truecntvwrPtlt_actionOverrid e=%2Fportlets%2FcontentViewer%2Fshow_windowLabel=cntvwrPtltcntvwrPtl t%7BactionForm.contentReference%7D=advocacy%2Fadvocacy_related_webinar s.html_state=maximized_pageLabel=cntvwr CONFIDENTIALITY NOTICE: This e-mail message, including all attachments, is for the sole use
Re: [Histonet] Pa Leeeze
Well put. I do think too many are panic stricken over losing a job. The work will still be there, but it might be at a different location. Physicians are not going to stop doing biopsies because the pay has been cut to the lab. The only thing that may cost a few jobs is if over-utilization is curbed. However, in my opinion that is not a large enough number to cause widespread panic among lab employees. If POL's begin closing, the work will return elsewhere. Those techs are free to apply for those jobs, and there will likely be a new job elsewhere for every one cut at your current practice. In my personal opinion, I think PA's should be far more concerned than techs. We could see a surge in the number of grossing techs out there, and a decline in the use of NAACLS trained PA's where the biopsy rate is high. So for all those techs that are worried, think positively - you may just experience a surge in job opportunities, and jobs with more attractive shifts. David On Tue, Nov 20, 2012 at 12:25 PM, O'Donnell, Bill billodonn...@catholichealth.net wrote: Like it or not, politics played a part in the cut of 88305. So did POLs, CAP and a host of other factors. Finger pointing in time of uncertainty somehow makes us all feel better, but it doesn't give us concrete ways of addressing the problem. Histology has enjoyed a fairly long period of great reimbursement, reasonable per-test costs, and a certain amount of security in that what we do is unique. That is all changing, but was likely to change at least some no matter who was elected to do whatever. Remember the panic when DRG's first arrived? There is no doubt that labs are going to have to get leaner, but this was already a trend. Find reasonable ways to cut costs. I know. We've been doing this for years But it needs to go further. Some people will lose their jobs. I may well be one of them and I don't like it, but it is a reality. If I go down, it will not be for lack of trying to maintain. 88305 cuts are big but there are a lot of clinical services getting cuts as well. Hospitals need to do what they can to keep the doors open for the benefit of the patient. Pay cuts, bonuses+/-, benefits, hiring freezes, capital freezes are all looming on the horizon. If at all possible, fight them, but do not exhaust yourselves. It's a new world - and it will sometimes be ugly. Blame the Democrats or the Republicans, Wall Street or Main Street, but figure out how to adapt. OK. So What can we do to ride out the storm? 1. Find a marketing advantage. POLs and certain smaller private labs cannot remain the bargain they once were. My lab is expectiing to get back some of what we lost to them a few years back. We are the only game in our town Why are we losing business to labs in other areas? It should all be staying here. 2. Become politically active. Demand better from your elected officials and from your professional organizations that are lobbyists(sp). If they can't do the job, use your vote or your membership fees to fire them OR run for office yourself. Become an activist in your professional organization. 3. Maintain high standards. Cut-backs and performance improvement need not automatically equate to less quality. I hate it when people assume that shaving a couple of minutes must necessitate poor cutting. How close to borderline is your current quality if this is your attitude. Yes, that was snarky, but think about it. 4. Remember the mantra of the Hitchhikers Guide to the Universe: DON'T PANIC. When you are caught up in a panic mentality, thinking and problem solving suffer. We need our heads in the game if we are going to come out on top. (How's that for my best Zig Zigler impersonation)? Above all - have a nice day and thank you for letting me vent a bit. Bill -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Bruce Gapinski Sent: Tuesday, November 20, 2012 10:37 AM To: 'histonet@lists.utsouthwestern.edu' Subject: [Histonet] Pa Leeeze Wow, How disappointing. Looking for constructive ways to keep my lab open and I get political stuff. Did you all go crazy in the 80's with Ronald Ray-gun and the DRG's? Too young? Bruce Gapinsk HT (ASCP) Chief Histologist Marin Medical Laboratories PathGroup SF Important Notice: This e-mail is intended for the use of the person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient, any disclosure, copying, distribution, or use of the contents of this message is strictly prohibited. If you have received this e-mail in error, please destroy this message and contact the Security Officer at PathGroup, Inc immediately at 615-562-9255. Thank you ___ Histonet mailing list
Re: [Histonet] 88305TC starting to hit the fan...
While this stinks on many levels, I have to take issue with the shift wealth from specialists to family practice - family practice docs have been the frontline of medicine, all the while earning less than a quarter of what specialists earn. It's about time they get a boost. Too many specialists earn over a million a year, while the family practice guys/ladies can barely pay their student loans. Sent from my iPhone On Nov 19, 2012, at 1:25 PM, Webster, Thomas S. twebs...@crh.org wrote: CAP had a webinar last week about the cut. These are some very scary times. For some reason the government has decided to shift wealth from specialists to family practice. I am becoming more angry with the affordable care act everyday. http://www.cap.org/apps/cap.portal?_nfpb=truecntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow_windowLabel=cntvwrPtltcntvwrPtlt%7BactionForm.contentReference%7D=advocacy%2Fadvocacy_related_webinars.html_state=maximized_pageLabel=cntvwr CONFIDENTIALITY NOTICE: This e-mail message, including all attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. You may NOT use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender by reply e-mail immediately. Please destroy all copies of the original message and all attachments. Your cooperation is greatly appreciated. Columbus Regional Hospital 2400 East 17th Street Columbus, Indiana 47201___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] Devasting news on 88305TC component
That is devastating! Do you have a link to this information? Sent from my iPhone On Nov 2, 2012, at 4:53 AM, Webster, Thomas S. twebs...@crh.org wrote: Devastating I meant CONFIDENTIALITY NOTICE: This e-mail message, including all attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. You may NOT use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender by reply e-mail immediately. Please destroy all copies of the original message and all attachments. Your cooperation is greatly appreciated. Columbus Regional Hospital 2400 East 17th Street Columbus, Indiana 47201___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] POL labs
POL's, which incidentally pay me well, are at least somewhat dangerous. Though I benefit greatly from them, I am also not going to sit on this forum and lie about how deserving they all are. There surely is over utilization going on. Denial of that fact does none of us any good. Sent from my iPhone On Oct 31, 2012, at 12:40 PM, Nicole Tatum nic...@dlcjax.com wrote: Let me start by sharing this: Definition of FREE ENTERPRISE : freedom of private business to organize and operate for profit in a competitive system without interference by government beyond regulation necessary to protect public interest and keep the national economy in balance. Key Word being For Profit. Health care is a commodity that is bought and sold and the medical industry is big bucks for our economy. So what if a POL is for profit, so are some hospitals, pharmaceutical companies, pharmacies, and the local gas station. My point being is, just because a POL is for profit does not mean that the facility does not offer the same quality of care as a national laboratory who is also seeking profit. So, as far as Im concerned the Doctor, owner, or medical director is able to bill for any test he performs in his facility that is currently licensed and regulated. I really dont think the setting should be a factor. We all will see changes and cuts. I do not believe this thread has any thing to do specifically with the election. Besides it doesnt really matter what side of the fence your on. Cuts are comming, dare I say rationing. Even if socialized medicine does not get passed and Romney wins, Medicare will have to decrease its allowable payouts each year. I personally am more worried about what that will mean for our payscale. For those of you who dont know me, I DO work in a POL lab. Im not bias, but I don't think the location of my lab is relative to the fact that it shouldn't be allowed to exist because its for profit. Just my thought. Happy Halloween to all. Nicole Tatum, HT ASCP ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends
We still bill 88305 x 12 on prostates. It is common to do that, despite the obvious abuse this represents. Sent from my iPhone On Oct 30, 2012, at 10:38 AM, Webster, Thomas S. twebs...@crh.org wrote: The technical component of the 88305 CPT code is about to get slashed next month by CMS. This will likely have an impact on the growth of in-office labs I am sure. Other codes are scheduled to be cut in 2014, including immunos and cytology 88112. It wont be nearly as profitable to have an in office lab. Plus Urologists aren't allowed to bill 88305x12 any longer. Some were putting cores in 12 different containers. Just look for more client billing to replace the in office labs. CONFIDENTIALITY NOTICE: This e-mail message, including all attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. You may NOT use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender by reply e-mail immediately. Please destroy all copies of the original message and all attachments. Your cooperation is greatly appreciated. Columbus Regional Hospital 2400 East 17th Street Columbus, Indiana 47201___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends
Because going from 2 parts (left and right only) to 6, and now to 12,18 or even 24 does not seem to have had any effect on quality of care, nor changed outcomes much at all. Do you have any data to demonstrate justification for a six-fold increase in pathology fees? I'm curious. I was going to do my second masters thesis on cost-benefit analysis of multipart prostate biopsies, when I was told if I did I would lose my job. Sent from my iPhone On Oct 30, 2012, at 12:24 PM, Joe W. Walker, Jr. joewal...@rrmc.org wrote: Davide, I'm curious as to why you would characterize a 12 part prostate biopsy billing 88305x12 abuse? Joe W. Walker, Jr. MS, SCT(ASCP)CM Anatomical Pathology Manager Rutland Regional Medical Center 160 Allen Street, Rutland, VT 05701 P: 802.747.1790 F: 802.747.6525 NEW EMAIL: joewal...@rrmc.org www.rrmc.org Our Vision: To be the Best Community Healthcare System in New England Rutland Regional...Vermont's 1st Hospital to Achieve Both ANCC Magnet Recognition® and the Governor's Award for Performance Excellence -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Davide Costanzo Sent: Tuesday, October 30, 2012 2:56 PM To: Webster, Thomas S. Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends We still bill 88305 x 12 on prostates. It is common to do that, despite the obvious abuse this represents. Sent from my iPhone On Oct 30, 2012, at 10:38 AM, Webster, Thomas S. twebs...@crh.org wrote: The technical component of the 88305 CPT code is about to get slashed next month by CMS. This will likely have an impact on the growth of in-office labs I am sure. Other codes are scheduled to be cut in 2014, including immunos and cytology 88112. It wont be nearly as profitable to have an in office lab. Plus Urologists aren't allowed to bill 88305x12 any longer. Some were putting cores in 12 different containers. Just look for more client billing to replace the in office labs. CONFIDENTIALITY NOTICE: This e-mail message, including all attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. You may NOT use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender by reply e-mail immediately. Please destroy all copies of the original message and all attachments. Your cooperation is greatly appreciated. Columbus Regional Hospital 2400 East 17th Street Columbus, Indiana 47201___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet This message (and any included attachments) is from Rutland Regional Health Services and is intended only for the addressee(s). The information contained herein may include privileged or otherwise confidential information. Unauthorized review, forwarding, printing, copying, distributing, or using such information is strictly prohibited and may be unlawful. If you received this message in error, or have reason to believe you are not authorized to receive it, please promptly delete this message and notify the sender by e-mail. Thank You ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
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 HE? 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) ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends
Rene, The problem is not that we charge, the problem is that the urologist submits in too many containers. This abuse (greed) is why we are destined for deeper cuts soon. Sent from my iPhone On Oct 30, 2012, at 1:07 PM, Rene J Buesa rjbu...@yahoo.com wrote: I really do not find that an abuse. You are doing the work x12, so the billing (charge) should also be x12! René J. *From:* Davide Costanzo pathloc...@gmail.com *To:* Webster, Thomas S. twebs...@crh.org *Cc:* histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu *Sent:* Tuesday, October 30, 2012 2:56 PM *Subject:* Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends We still bill 88305 x 12 on prostates. It is common to do that, despite the obvious abuse this represents. Sent from my iPhone On Oct 30, 2012, at 10:38 AM, Webster, Thomas S. twebs...@crh.org wrote: The technical component of the 88305 CPT code is about to get slashed next month by CMS. This will likely have an impact on the growth of in-office labs I am sure. Other codes are scheduled to be cut in 2014, including immunos and cytology 88112. It wont be nearly as profitable to have an in office lab. Plus Urologists aren't allowed to bill 88305x12 any longer. Some were putting cores in 12 different containers. Just look for more client billing to replace the in office labs. CONFIDENTIALITY NOTICE: This e-mail message, including all attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. You may NOT use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender by reply e-mail immediately. Please destroy all copies of the original message and all attachments. Your cooperation is greatly appreciated. Columbus Regional Hospital 2400 East 17th Street Columbus, Indiana 47201___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] Number of blocks
Can we get a mailing list for these files? I would love to see these articles as well. dcosta...@pathmdlabs.com Thanks Rene Sent from my iPhone On Oct 25, 2012, at 8:00 AM, Rene J Buesa rjbu...@yahoo.com wrote: Will: I would like to do that very much but unfortunately Histonet is set in a way that they do not accept atttachments and any e-mail with them will not go through. René J. From: Will Chappell cha...@yahoo.com To: Hannen, Valerie valerie.han...@parrishmed.com Cc: Rene J Buesa rjbu...@yahoo.com; Dorothy Ragland-Glass techman...@yahoo.com; Histonet@lists.utsouthwestern.edu Histonet@lists.utsouthwestern.edu Sent: Thursday, October 25, 2012 10:37 AM Subject: Re: [Histonet] Number of blocks In fact, can you share them with all of histonet? Sent from my iPhone On Oct 25, 2012, at 7:33 AM, Hannen, Valerie valerie.han...@parrishmed.com wrote: Rene, I have been asked in the past about productivity in our department. Can you share those articles with me as well? Thanks!! Valerie Valerie A. Hannen, MLT(ASCP),HTL,SU(FL) Histology Section Chief Parrish Medical Center 951 N. Washington Ave. Titusville, Florida 32976 Phone:(321) 268-6333 ext. 7506 Fax: (321) 268-6149 valerie.han...@parrishmed.com -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Rene J Buesa Sent: Thursday, October 25, 2012 10:18 AM To: Dorothy Ragland-Glass; Histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Number of blocks Hi Dorothy: Your manager is wrong and probably influenced by some productivity consultant trying to appear tough or preparing to justiffy a staff reduction. The average sectioning productivity obtained in 325 histology laboratories (221 in the US and 114 in 24 foreign countries) is 24 blocks per hour. Under separate cover I am sending two articles dealing with this issue and that of staffing that you will be able to show to your manager. René J. From: Dorothy Ragland-Glass techman...@yahoo.com To: Histonet@lists.utsouthwestern.edu Sent: Wednesday, October 24, 2012 8:38 AM Subject: [Histonet] Number of blocks It was annouced by a histo lab manager that techs are expected to cut 40-50 blocks per hour. That seems to me to be rather high. I don't see quality slides being turned out. It is quantity and profit above patient care. I am old school, and I remember something about quality and patient first. Besides what kind of impact on morality of the techs, back problems and carpal tunnel syndrom is laying ahead for the cutter after cranking the microtome repeatedly that many blocks without a break. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet == This email is intended solely for the use of the individual to whom it is addressed and may contain information that is privileged, confidential or otherwise exempt from disclosure under applicable law. If the reader of this email is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately delete this message. Thank you == ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] RE: Number of blocks (Contact HistoCare)
Does anyone want a tech cutting 40 blocks per hour? You can't have quality at that rate. Sent from my iPhone On Oct 25, 2012, at 2:39 PM, Mayer,Toysha N tnma...@mdanderson.org wrote: Another thing to consider is, is this averaged out over several hours or not. Sitting and cutting 50 blocks in one hour of time is a stretch, but if I average it out over 2-3 hours I can cut almost that many (40). That would be multiple types of tissues and varying number of sections, but not just time myself and cut for one hour and stop. Also think of how long it takes to trim those blocks. While the 40-50 number is high, look at how many are cut over time, it should average out as 30+ per hour. Toysha Mayer Message: 1 Date: Thu, 25 Oct 2012 11:23:07 -0500 From: Contact HistoCare cont...@histocare.com Subject: [Histonet] Number of blocks To: histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Message-ID: b23bea86-5f91-4f2b-918c-f68d3cffb...@histocare.com Content-Type: text/plain;charset=us-ascii Hi, To most folks that number does seem high but I've met many old school techs who can do this easily. One of my first learning experiences was watching a 57 year old woman crank out tons of slides with no errors and who regularly got praises from the pathologists for producing the most beautiful slides. While I have never been required to produce a certain amount within a certain window, I have built up the ability to cut a lot more than 50 per hour. I have even doubled this number. Of course it depends on the tissue type, but assuming properly decalcified bone, nothing popping out of the block, and a cold block of ice, it's very easy for me to produce a high quality slide at 3,4,5 microns. I get compliments all the time of my slides. My methods are quite different from most techs though. When facing, I don't waste movements. I actually count the rotations and spend less than 8 seconds facing each block. I also get the right section usually in about the third or fourth crank and I only put at the most two sections in the water bath to pick up. I don't cut unnecessary ribbons just to have them sit in the water bath and eventually have to wipe away with the Kimwipe, which in my opinion is wasteful of both materials and time. I also make sure I have enough ice to keep the blocks very cold and adequately hydrated. I'm not sure if being in decent physical shape matters but I think it gives me the arm stamina to do this. I use only my wrists and fingers and not my whole arm in the rotational motion. Hope this helps, M www.HistoCare.com From: Dorothy Ragland-Glass techman...@yahoo.com To: Histonet@lists.utsouthwestern.edu Sent: Wednesday, October 24, 2012 8:38 AM Subject: [Histonet] Number of blocks It was annouced by a histo lab manager that techs are expected to cut 40-50 blocks per hour. That seems to me to be rather high. I don't see quality slides being turned out. It is quantity and profit above patient care. I am old school, and I remember something about quality and patient first. Besides what kind of impact on morality of the techs, back problems and carpal tunnel syndrom is laying ahead for the cutter after cranking the microtome repeatedly that many blocks without a break. -- Message: 2 Date: Thu, 25 Oct 2012 16:28:47 + From: Bartlett, Jeanine (CDC/OID/NCEZID) j...@cdc.gov Subject: RE: [Histonet] Number of blocks To: Contact HistoCare cont...@histocare.com, histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Message-ID: df1cba3d83d9a344a7d6a045188e448433a25...@embx-clft1.cdc.gov Content-Type: text/plain; charset=us-ascii You mention how many rotations you use for facing your blocks. That assumes whoever did the embedding did a good job. And even with no unnecessary ribbons.whether there are extra sections or not, you still have to keep the water bath scrupulously clean which means wiping out with a Kimwipe after each block...whether there are ribbons floating or not. Jeanine H. Bartlett Centers for Disease Control and Prevention Infectious Diseases Pathology Branch 404-639-3590 jeanine.bartl...@cdc.hhs.gov ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Unregistered techs
Well said. Everyone should aim for certification. Those that don't will offer myriad excuses, but it should be the standard. With any luck it will be required one day (likely will). Whether OJT or college trained, all should prove competency and the best way is through ASCP certification. Sent from my Windows Phone From: Rick Tiefenauer Sent: 5/26/2012 9:52 AM To: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Unregistered techs Histonetters, I see this subject tends to illicit strong sentiments from professionals who are impacted or have an impact on HT/HTL's (sort of everyone on the net)?. I am still in school, but I want to fully understand how training, certification, and registration work for HT/HTL’s. I realize that ASCP certification is voluntary, and that some States require some sort of license or certification, but I’ve never heard of a “Registry” for HT/HTL’s. -The way I understand through what I’ve been taught at school is that Histology is the study of tissue, And that... -To study tissue there is another science that prepares specimens so they can be studied. And that... -There is a final sequence “Quality Control” that verifies the science that prpares specimens is properly done so the tissue can be studied. And that… In order for this all to happen successfully and consistently, the HT/HTL's make sure that during the whole preparation process, safety is observed, proper adherence to federal and state regulations maintained, plus train other technicians to do the same, and much more. If I understood it all correctly I can’t help but wonder: If HT/HTL's do all of this crucial preparation work to make sure specimens are acceptable for precise microscopic identification of cells, tissue type, diagnosis of disease, and other needs: Why wouldn't we want to have some method that can gage a set of basic skills to indicate a level of competency that HT/HTL's should initially have, in order to enter the field of work that can effect so many people either directly or indirectly? And also... Wouldn’t having NAACLS accredited training and ASCP Certifications serve to gage those basic skills? And also… Would gaging basic skills have a positive impact on the quality of patient care and the efficiency of the HT/HTL’s impact on labs?” I'm not sure but...this fall… when I complete my NAACLS accredited degree program, and voluntarily take the ASCP HTL certification exam, my future employer will be able to expect a certain level of competency that I hope to have established through training and certification. Rick T. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Unregistered techs
Oh someone is going to get BLASTED and I'm so glad it's not me this time! But I have to say Shame shame for suggesting a monkey can do that job. Doesn't speak well of your work, but most techs I know are very talented. I can't do their work, and I like to think I am a little more evolved than a monkey. At least an ape for crying out loud! Sent from my Windows Phone From: Jay Lundgren Sent: 5/24/2012 2:02 PM To: Kim Tournear Cc: histonet Subject: Re: [Histonet] Unregistered techs Scott Lyons sln...@yahoo.com Give me a break, HTs and HTLs do not make diagnoses or treat patients. I am a registered HT and a Florida licensed HTL with 19 years experience, I've done it all in the lab. I believe the certification and licensure of techs is a scam to bleed more money from people. Honestly, you can train a monkey to do our job. And I don't want to hear from everyone saying it's an art form, we are just as much needed as pathologists, blah, blah, blah... I work where they are hiring people from a masters degree program for histology with certification, THEY KNOW NOTHING. Experience it where it's at, whether certified or not, get off your high horse. Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] Unregistered techs
I'm sorry - I cannot let this rest. The comment: we are just as much needed as pathologists, blah, blah, blah... is so upsetting I cannot sit back and listen to that without saying something! Everyone, regardless of their lot in life, is a very worthwhile part of the whole. Let me ask you a question, since you highly undervalue humans that are not MD's - let's say that you are a patient at Hospital X, and you go in to have your toenail removed. Who plays a more important role in your survival - the Podiatrist or the hospital janitor? I would argue that the janitor is more crucial in this instance, for if he/she fails to clean up the MRSA from the last patient you could conceivably die. The doctor solved your fungal problem, but the janitor prevented you from getting a potentially life-threatening infection. Think before you speak like that - everyone involved in your care is critical - and, yes, sometimes the doctor is not the most important person when it comes to keeping you alive and well! On Thu, May 24, 2012 at 2:01 PM, Jay Lundgren jaylundg...@gmail.com wrote: Scott Lyons sln...@yahoo.com Give me a break, HTs and HTLs do not make diagnoses or treat patients. I am a registered HT and a Florida licensed HTL with 19 years experience, I've done it all in the lab. I believe the certification and licensure of techs is a scam to bleed more money from people. Honestly, you can train a monkey to do our job. And I don't want to hear from everyone saying it's an art form, we are just as much needed as pathologists, blah, blah, blah... I work where they are hiring people from a masters degree program for histology with certification, THEY KNOW NOTHING. Experience it where it's at, whether certified or not, get off your high horse. Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet -- *David Costanzo, MHS, PA (ASCP)* Project Manager *Blufrog Path Lab Solutions* 9401 Wilshire Blvd. Ste 650 Beverly Hills, CA 90212 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] RE: CAP vs. CLIA
William, I certainly agree that folks in both histology and pathology disciplines need to work harder at defining who they are as professionals. We, in both departments, are responsible for creating confusion. It is no wonder progress is slow in this area. If we all want to be treated more as professionals, and become better recognized, then we should start correcting the problems we allow to exist. The best place to start is with titles. - A person should not be called a histotech unless they are certified. Anyone practicing histology that is not certified should be called something else - perhaps lab assistant, or histology assistant. Regardless of experience, the tem HT should be reserved for those that are certified. If not, what is the value of certification? - Nobody should use the phrase PA or Pathologists' Assistant if they are not certified. I cannot tell you how many times I hear about the PA at this place, or that place and when I check the registry those folks are not PA's at all. This gets under the skin of each and every one of us that went through years of training, and received graduate degrees to claim that title, and is unfair to all the others that have thier degrees and completed all the requirements set forth by the ASCP and the AAPA. It seems that many like to self-promote themselves to titles they never earned. We cannot take a title simply because it is the closest description to what we do all day. I have a graduate degree in pathology, but I would never think of calling myself a pathologist. And I would be more accurate with that title than most that call themselves PA's. A graduate degree in microbiology? A Microbiologist. Graduate degree in psychology? A Psychologist. Graduate degree in biology? A Biologist. Graduate degree in Pathology? A PA. Why? Because the title Pathologist is reserved for a very specific person, with a very specific training and certification. So too should be the title HT and PA. A widespread problem in medicine is that of folks pretending to be what they are not. Some clarification is in order in all areas of medicine. Why don't we correct the problems in our own little corner and set an example? Everybody can be what they want to be, but today - you are what you are (generalization, not YOU) On Sun, May 20, 2012 at 8:37 PM, WILLIAM DESALVO wdesalvo@hotmail.comwrote: I seemed to have missed something or it might have been all the fresh sea air I got in Tampa at the FSH, but I do not understand the outrage expressed towards CLIA and CAP because we are not listed as testing personnel. I applaud everyone's passion for Histotechnology and the outrage that we are not allowed to fully participate in the test system model, but I think we should be directing more of our outrage to the individuals working in Histotechnology that are not and will not take responsibility to increase the professionalism of our profession and our own acceptance of the current state of Histotechnology. A TEST SYSTEM is the process that includes pre-analytic, analytic, and post-analytic steps used to produce a test result or set of results. As good as we are and as complex parts of the Histotechnology process may be, Histotechnicians, Histotechnologists and Pathology Assistants do not meet the standard stated and do not participate in the post-analytic phase, produce and release patient results. We simply are not able to be credentialed as is the Medical Technologists and Cytotechnologist. I am not saying any one laboratory professional group is better than the other, just that to be considered testing personnel, we must be properly credentialed. Collectively, we as a discipline, science and group should be working to upgrade our education requirements and training so that we can become fully invested partners with the Pathologist. We, not CAP or CLIA, must greatly increase our professionalism before we can truly be considered competent to work in the post-analytical phase. I cannot today accept that every working Histotechnician, Histotechnologist and Pathologist Assistant is able to produce the result and release. I am quite sure that every Medical Technologist and Cytotechnologist is capable and competent to produce and release a patient result. As things stand today, Histotechnology and all of us the working in this discipline are a support function to the one person in our discipline, the Pathologist, that is educated, trained, credentialed and competent to produce and release a patient result. I also believe there are many opportunities within our process available now, such as histochemical staining for organisms, that could allow us to participate in the post-analytic step. There will be many more as personalized medicine continues to transform Histotechnology. That said, how can we honestly promote our participation in the post-analytic phase, when there are far too many
RE: [Histonet] Cassette printer comparison
The General Data is nice, but takes up space with its vacuum canister, which they rarely show in pictures. Be sure you see it and make certain it will fit in the space you have. Cassettes are more costly as they are all pre-printed with black facing, but look great. Thermo is less bulky (no vacuum and waste container to clean) but produces a lower quality print. Cassettes are much cheaper, but they have had some troubles with the print head not lasting long. The Leica is not much better (if at all) than the Thermo with respect to print quality. It also constantly jams (the ones I have used). Personally, I would choose the General Data. Costs more in the long term with pricey cassettes, but looks great! Less troubles with barcode scanning too. There is no comparison between this and the other two. Like a Kia vs a Bentley. I just bought the Thermo, and only because my lab is a Thermo Showcase lab and that is all we use, across the board. I wish I could have the General Data unit. Sent from my Windows Phone From: Morken, Timothy Sent: 4/30/2012 12:19 PM To: Histonet Subject: [Histonet] Cassette printer comparison Hi all, We are looking at cassette printers and have narrowed to three. The printers will be used for 2D code printing so I am wondering what experience anyone has had with reliability of 2D code readability and durability with the output of these three printers Thermo Printmate General Data Leica IP-C Thanks for any info you can give! Tim Morken Department of Pathology UC San Francisco Medical Center 505 Parnassus Ave, Box 1656 Room S570 San Francisco, CA 94132 (415) 353-1266 (ph) (415) 514-3403 (fax) tim.mor...@ucsfmedctr.org ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] RE: Qualifications for grossing
at the dissection bench. It just is not possible. The deal is simple - I will never downplay the value of your education and training by suggesting anyone can do it. All I ask is the same in return. Do not suggest that anyone can be trained on the job to do what it took me many years of college to learn, and perform that work at the same level. And I could not do your job nearly as well as you do. I am always impressed with histotechs - they have a great body of knowledge and do a very detailed, intricate and challenging job. For me to suggest, that given a few minutes here and there of training, that I can do your job as well as you would be very condescending. I don't think for one minute you could make me as good as you are by spending just a little bit of time with me. I know I would make mistakes, and mistakes may be considered part of the learning process, but do we really want to accept that in healthcare? Mistakes should happen in school, not with a real, live patients tissue. We should all be aiming to provide the highest level of care possible. I want my surgical specimen (biopsy or other) grossed by a PA, or MD and I want that specimen cut and stained by an ASCP certified HT. Lowering standards is a slippery slope, and one that should not be embarked upon in the world of medicine. I get crucified on this email server constantly. I have read and re-read the above. I see nothing in this to suggest condescension. For those of you that will see that no matter what, it is clearly personal for you, and for that I am sorry. Nothing here is meant to be offensive, just illustrative. On Wed, Apr 25, 2012 at 7:41 AM, Joanne Clark jcl...@pcnm.com wrote: David, after reading your post I was not at all surprised to see that you are a PA. I am assuming that explains your vitriol towards techs that gross. Yes, CLIA does provide the educational requirements for high complexity testing, but what on earth makes you think that a tech with the proper CLIA qualifications can gross without proper training by a pathologist? CAP requires that as well as extensive documentation of training AND a list of the specimens approved by the Lab Director that a 'non-pathologist' is allowed to gross. I'm sure you can tell that I am a Histotech with an Associates Degree and I do the grossing in my lab. I can assure you that I do a good job and if there is EVER any question regarding how to gross in a specimen I will get a pathologist. To make it clear, just because we tech's that gross do not have a masters as a pathologist assistant, we care just as much about the patients we serve as a PA does. Another point I would like to make is that very often we gross not by choice but because it is what our pathologists demand of us and they wouldn't put us there if we couldn't do the job. Believe me, when I say that I do want to get my masters as a PA, but I haven't been able to find a program that accommodates someone who is working full time and can not afford to quit to go back to school. I am currently finishing up my Bachelors, because I still want to pursue it. Joanne Clark, HT Histology Supervisor Pathology Consultants of New Mexico -- Message: 8 Date: Mon, 23 Apr 2012 16:32:34 -0700 From: Davide Costanzo pathloc...@gmail.com Subject: Re: [Histonet] Qualifications for grossing To: Glen Dawson ihcman2...@hotmail.com Cc: histonet histonet@lists.utsouthwestern.edu Message-ID: ca+f+rhoy4dypx0mpoq65rrrvldxobv_0acspzbgqrpv8ygv...@mail.gmail.com Content-Type: text/plain; charset=ISO-8859-1 Glen, Below are the requirements for high complexity testing, as outline by CLIA. You can reference the CLIA '88 ruling, specifically look at Subpart M, Section 493.1489 The requirements are weak, to say the least. I am not alone in the opinion that just because CLIA allows it, it is not necessarily appropriate for the minimum qualified person to be grossing certain specimens. Having someone other than an M.D., or ASCP certified PA do anything larger than a skin shave is not good medicine. But, in answer to your question - yes, the government allows inadequately trained personnel to perform high complexity testing. Sec. 493.1489 Standard; Testing personnel qualifications. Each individual performing high complexity testing must-- (a) Possess a current license issued by the State in which the laboratory is located, if such licensing is required; and (b) Meet one of the following requirements: (1) Be a doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine licensed to practice medicine, osteopathy, or podiatry in the State in which the laboratory is located or have earned a doctoral, master's or bachelor's degree in a chemical, physical, biological or clinical laboratory science, or medical technology from an accredited institution; (2)(i) Have earned
RE: [Histonet] RE: Qualifications for grossing
Nothing is black and white. Perhaps exceptions are in order where the tech only does one specimen type. Perhaps. But not where techs do a lot more. There are gross techs out there doing colons, mastectomies etc. This is where big trouble brews. This is where people are not adequately trained, by NAACLS standards. CLIA '88 is the problem, not the tech. CLIA is over 20 years old, and at that time PA's were fairly new on the scene and in short supply. That is not the case today. It is time to raise the bar and improve patient care. There are no valid excuses. Today, this is no more than financial greed that accounts for misuse of personnel. Sent from my Windows Phone From: Ingles Claire Sent: 4/25/2012 10:43 AM To: Rene J Buesa; Joanne Clark; Davide Costanzo Cc: histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] RE: Qualifications for grossing You can reprocess, recut, and restain, but never re-gross. I for one also gross, but only skin. And yes, I DO know how to gross an alopecia specimen. Claire From: histonet-boun...@lists.utsouthwestern.edu on behalf of Rene J Buesa Sent: Wed 4/25/2012 11:55 AM To: Joanne Clark; Davide Costanzo Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing For what little it may mean, I wholeheartly agree with Davice Costanzo e-mail. I completely agree with him. In the same way the economic situation we are now was caused by greed, that is the motor guiding those who, to just save money, let a histotech (ologist) to do grossing. Grossing,, especially large complex specimens, is the fundamental initial task in any complex diagnosis. The PA is the one who SELECTS what is going to be processed and used for diagnosis. IF some part of the specimen is not submitted as the result of ignorance caused by poor training, the worst thing could happen, namely, a FALSE NEGATIVE --- On Wed, 4/25/12, Davide Costanzo pathloc...@gmail.com wrote: ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] RE: Qualifications for grossing
Thank you Hazel. Sent from my Windows Phone From: Horn, Hazel V Sent: 4/25/2012 12:18 PM To: Davide Costanzo; Joanne Clark Cc: histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] RE: Qualifications for grossing Well said. Hazel Horn Supervisor of Histology/Autopsy/Transcription Anatomic Pathology Arkansas Children's Hospital 1 Children's Way | Slot 820| Little Rock, AR 72202 501.364.4240 direct | 501.364.1302 office | 501.364.1241 fax hor...@archildrens.org archildrens.org 100 YEARS YOUNG! JOIN THE PARTY AT ach100.org -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Davide Costanzo Sent: Wednesday, April 25, 2012 11:34 AM To: Joanne Clark Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US that I have seen, and I have seen many. Rarely, outside the State of Florida, do I see PA's that do not cut frozens. Now, on to the issue of grossing techs. There are myriad reasons why I, and most of my peers, think it is not appropriate to utilize grossing techs. For starters, and to be clear, the use of such techs serves one principal purpose to the pathologist's and institutions that employ them - to save money and increase their profits. They are not employed because they represent the clear choice for the utmost in patient care, and to suggest that is not just misleading, but completely false. Grossing small specimens is never just about transferring tissue from a container to a block. Many tend to try and downplay the importance of that task, and overlook things that could be problematic without certain training/skills. And, there are many grossing techs that do larger cases, from gallbladders all the way up to mastectomies and beyond - all with no didactic education, no proficiency testing and no rotations through various types of insitutions. I have never seen a study, but perhaps someone on here has, that points out the sharp increase in error rates found when a tech is used to gross, versus a trained pathologists' assistant. There is a drastic difference. It is distinct, and a study is really not needed to see that difference. Now, to be clear again, that is not to say that every tech that grosses does a bad job. No vitriol here. It is just a fact, and a troubling one at that. Imagine the difference in quality you would see if you had me doing all your stains! I am not trained as an HT. You could argue that I could be trained, but do you really want to open that can of worms? Do you want medicine to allow for that, and risk the HT profession? Probably not, and we do not either. Do you think I would be as good as you are, given all the real education you received when getting your HT training? I don't think I would be as good as you are at doing your job. As an example to illustrate, anyone that grosses should know how to answer these very basic questions. These might help shed some light on the issue: 1. What is the most common neoplasm of the gallbladder, what does it look like, and where is it found? Would you know it if you saw it? Is it benign, or malignant? 2. What is the reason that all appendices should have the margin submitted in the initial submission? 3. Would you know the difference between an esophageal bx and a bx from any other part of the GI tract simply by gross appearance? What would you
Re: [Histonet] RE: Histonet Digest, Vol 101, Issue 32
Very well spoken. You will note that neither of us raised this subject, but did respond to a post previously entered. And, as I clarified to another person here privately, the problem with CLIA does not just mean we are going after HT's that gross - CLIA allows ANYONE with those very minimal requirements to gross. Most gross techs are not HT's, most are off the street people with the bare bones required by law, that are taught on the job to toss biopsies into cassettes. And, many of these people do much larger cases as well - all legally under CLIA 88. It's a problem, and it is not meant to upset anyone on here. Most of those techs, as I stated, are not HT's and are not on this site anyway. The proper forum of course is to reach out to government officials and try and get that law changed. Perhaps we will. A lot of progress has been made in the area over the years, now we just need to modify the laws to reflect the times within which we live. I did want to point out one thing though - there was a comment about saving money in healthcare, and that was a valid reason to employ a grossing tech. Let's be clear on this subject - there is a BOAT LOAD of money in the technical component of AP services. This is why you see GI docs and Urologists all over the nation opening their own histo labs. They want to cash in. The reimbursement for technical charges is public knowledge - look it up and you will find the Medicare rates for your area very publicly posted by Medicare. It's not a secret. Take those rates, multiply by 80% because even Medicare does not really pay what they say and then multiply it out for your volume. Be sure to include all your 88305's and other standard charges, and add all the fees for your stains, frozen sections, decalcifying, etc. When you see just what Medicare pays your site, then look at your paycheck and ask yourself Is my lab really suffering financially? Probably not. And that is based upon Medicare rates, the truth is the lab makes more than that because most insurers pay higher than Medicare. Where does the money go? I don't think I have to tell you. On Wed, Apr 25, 2012 at 2:28 PM, Joanne Clark jcl...@pcnm.com wrote: Davide and Rene, you have very valid points and I do not necessarily disagree with you. But the reality is that it is an accepted CAP/CLIA allowed practise and will continue. You both have the right to voice your opinions on the issue, but perhaps histonet which is made up mostly of techs, many of whom gross (not by choice) is not the best place to do it without causing a lot of controversy. You need to take your concerns where they might make a difference, to CAP or CLIA. If you believe in it strongly enough you will try and do something about it. Just know that those of us who do gross, do everything within our power to do the job safely for those patients we serve. Respectfully Joanne Clark, HT Histology Supervisor Pathology Consultants of New Mexico -- Message: 14 Date: Wed, 25 Apr 2012 09:34:29 -0700 From: Davide Costanzo pathloc...@gmail.com Subject: Re: [Histonet] RE: Qualifications for grossing To: Joanne Clark jcl...@pcnm.com Cc: histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Message-ID: ca+f+rhqo7guohqtlxta1ffd2yhda0br1hefi3rdh2woji35...@mail.gmail.com Content-Type: text/plain; charset=ISO-8859-1 Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US
RE: [Histonet] Barcoding specimen tracking, lessons you learned
See Rich Pucci at UCSF Pathology. He would be a great resource. Sent from my Windows Phone From: Morken, Timothy Sent: 4/23/2012 10:31 AM To: Histonet Subject: [Histonet] Barcoding specimen tracking, lessons you learned To anyone who has implemented a barcoding/specimen tracking system in your lab. What lessons did you learn that would make it easier if you did it over? We're starting the process and I would like to get some input on things to look out for! Thanks for any info and comments! Tim Morken Department of Pathology UC San Francisco Medical Center 505 Parnassus Ave, Box 1656 Room S570 San Francisco, CA 94132 (415) 353-1266 (ph) (415) 514-3403 (fax) tim.mor...@ucsfmedctr.org ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] Qualifications for grossing
Glen, Below are the requirements for high complexity testing, as outline by CLIA. You can reference the CLIA '88 ruling, specifically look at Subpart M, Section 493.1489 The requirements are weak, to say the least. I am not alone in the opinion that just because CLIA allows it, it is not necessarily appropriate for the minimum qualified person to be grossing certain specimens. Having someone other than an M.D., or ASCP certified PA do anything larger than a skin shave is not good medicine. But, in answer to your question - yes, the government allows inadequately trained personnel to perform high complexity testing. Sec. 493.1489 Standard; Testing personnel qualifications. Each individual performing high complexity testing must-- (a) Possess a current license issued by the State in which the laboratory is located, if such licensing is required; and (b) Meet one of the following requirements: (1) Be a doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine licensed to practice medicine, osteopathy, or podiatry in the State in which the laboratory is located or have earned a doctoral, master's or bachelor's degree in a chemical, physical, biological or clinical laboratory science, or medical technology from an accredited institution; (2)(i) Have earned an associate degree in a laboratory science, or medical laboratory technology from an accredited institution or-- (ii) Have education and training equivalent to that specified in paragraph (b)(2)(i) of this section that includes-- (A) At least 60 semester hours, or equivalent, from an accredited institution that, at a minimum, include either-- (1) 24 semester hours of medical laboratory technology courses; or (2) 24 semester hours of science courses that include-- (i) Six semester hours of chemistry; (ii) Six semester hours of biology; and (iii) Twelve semester hours of chemistry, biology, or medical laboratory technology in any combination; and (B) Have laboratory training that includes either of the following: (1) Completion of a clinical laboratory training program approved or accredited by the ABHES, the CAHEA, or other organization approved by HHS. (This training may be included in the 60 semester hours listed in paragraph (b)(2)(ii)(A) of this section.) (2) At least 3 months documented laboratory training in each specialty in which the individual performs high complexity testing. (3) Have previously qualified or could have qualified as a technologist under Sec. 493.1491 on or before February 28, 1992 On Mon, Apr 23, 2012 at 1:19 PM, Glen Dawson ihcman2...@hotmail.com wrote: All, Can a histotech perform GROSSING if he/she has an associate's degree in Histotechnology from an accredited institution (Argosy in MN)? Any help would be appreciated. Thank-you, Glen Dawson BS, HT(ASCP) QIHC Histology Technical Specialist Mercy Health System Janesville, WI ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet -- *David Costanzo, MHS, PA (ASCP)* Project Manager *Blufrog Path Lab Solutions* 9401 Wilshire Blvd. Ste 650 Beverly Hills, CA 90212 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Aetna and In-Office Lab Accreditation
Start with reading Dr. Schneider's post. Then read Richard Cartun's post. Those should deal will what you are talking about very well. These in-office labs should not exist, for the very same reason the undertaker is no longer the ambulance driver. There is a very real, and significant conflict of interest. Sent from my Windows Phone From: Nicole Tatum Sent: 4/10/2012 6:45 AM To: Davide Costanzo; histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Aetna and In-Office Lab Accreditation Money is at the root of all finicial decisions, in-house labs and hospitals. There are many over utilization of resources within the health care field. Many gallbladder surgerious are performed unneccesarly by general surgeous who's practice are within hospitals walls. Tonsilectomy. etc. How are those specimens not self reffered to the hospitals AP lab. David you made the comment about specialities staying with there specialty and not branching out. A dermatopathologist specializes in derm specimens so why is it so far fetched that he would read derm specimens from all sources, hospitals or in-house labs. My in-house lab has a higher turn around rate, lower overhead, and cuts courier fees out. We also do a service to our patients by allowing them one stop shopping. We can service all there needs and they do not have to have multiple appointments at different facilities. This cuts down on their copay and billing from multiple doctors. Also, it would cost more for a person to have Mohs surgery in a hospital setting. As we all know cost are higher at a hospital because they have higher overhead. The hospital is self reffering when they let a surgery center or group be affiliated with them. The surgery center was allowed to join the hospital so the hospital could reep the revenue generated and process their specimens. Either way, we are all joined by a common form of employment, and one facility is not better than another. My field provides jobs and creates revenue just like yours. Insurance company are going to make changes to try and make revenue during this change into OBAMA CARE. Remeber we are not the enemy they are. Who are they to dictate how my company runs. Insurance companies have to much power and the decisions they force us to make do not always provide the best patient care. And that is the ultimate goal for any provider, to give best patient care right? This is just another hurdle we all must jump through in these comming changes. I vote we stick together and try our best to protect all our jobs. Wasnt that long ago that each of us we trying to get pay increases and bring the importance of our jobs to the fore front of pathology. The financial squeeze of the helath care system is going to be felt by all. Histology, pathology, radiology, cytology, we all must do our best to role with the punches and ensure quality care and our incomes, as well as our field, reguardless of location. Nicole Tatum, HT ASCP Thank you for that. How are things at Hartford Hospital? One of my favorite places, rotated there many years ago. Very impressive facility! Is Dr. Ricci still there? On Mon, Apr 9, 2012 at 4:43 PM, Richard Cartun rcar...@harthosp.org wrote: This was released today. Richard Statline Special Alert: New Evidence Links Self-Referral Labs to Increased Utilization, Lower Cancer Detection Rates Study co-funded by CAP Appears in April 2012 Issue of Health Affairs April 9Self-referring urologists billed Medicare for nearly 75% more anatomic pathology (AP) specimens compared to non self-referring physicians, according to a study published today in a leading health care policy journal. Furthermore, the study found no increase in cancer detection for the patients of self-referring physicians-in fact, the detection rate was 14% lower than that of non self-referring physicians. These findings, from an independent study co-funded by the CAP, provide the first clear evidence that self-referral of anatomic pathology services leads to increased utilization, higher Medicare spending, and lower rates of cancer detection. The study, led by renowned Georgetown University health care economist Jean Mitchell, PhD, will appear in the April 2012 issue of Health Affairs and is now available on the journals website. Daniel Schneider dlschnei...@gmail.com 4/9/2012 4:47 PM This is all about the money. The rest is rationalization. The reason a group of non-pathologist physicians opens an in-house pathology lab and hires an employee pathologist is first and foremost to harvest profit from pathology reimbursement. Be a fly on the wall in the partners' meetings and you would know that's what they are talking about. To suggest otherwise is disingenuous. And the implication that the generalist anatomic pathologist is unqualified to be signing out skins, prostates, GI's and whatever is reprehensible
RE: [Histonet] Aetna and In-Office Lab Accreditation
Very classy argument. Thank you for your eloquence. Sent from my Windows Phone From: Nicole Tatum Sent: 4/10/2012 8:18 AM To: Davide Costanzo; histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] Aetna and In-Office Lab Accreditation Really, An undertaker. Yea, theres definately a conflict here, you. No since in wasting my time. Nicole Start with reading Dr. Schneider's post. Then read Richard Cartun's post. Those should deal will what you are talking about very well. These in-office labs should not exist, for the very same reason the undertaker is no longer the ambulance driver. There is a very real, and significant conflict of interest. Sent from my Windows Phone From: Nicole Tatum Sent: 4/10/2012 6:45 AM To: Davide Costanzo; histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Aetna and In-Office Lab Accreditation Money is at the root of all finicial decisions, in-house labs and hospitals. There are many over utilization of resources within the health care field. Many gallbladder surgerious are performed unneccesarly by general surgeous who's practice are within hospitals walls. Tonsilectomy. etc. How are those specimens not self reffered to the hospitals AP lab. David you made the comment about specialities staying with there specialty and not branching out. A dermatopathologist specializes in derm specimens so why is it so far fetched that he would read derm specimens from all sources, hospitals or in-house labs. My in-house lab has a higher turn around rate, lower overhead, and cuts courier fees out. We also do a service to our patients by allowing them one stop shopping. We can service all there needs and they do not have to have multiple appointments at different facilities. This cuts down on their copay and billing from multiple doctors. Also, it would cost more for a person to have Mohs surgery in a hospital setting. As we all know cost are higher at a hospital because they have higher overhead. The hospital is self reffering when they let a surgery center or group be affiliated with them. The surgery center was allowed to join the hospital so the hospital could reep the revenue generated and process their specimens. Either way, we are all joined by a common form of employment, and one facility is not better than another. My field provides jobs and creates revenue just like yours. Insurance company are going to make changes to try and make revenue during this change into OBAMA CARE. Remeber we are not the enemy they are. Who are they to dictate how my company runs. Insurance companies have to much power and the decisions they force us to make do not always provide the best patient care. And that is the ultimate goal for any provider, to give best patient care right? This is just another hurdle we all must jump through in these comming changes. I vote we stick together and try our best to protect all our jobs. Wasnt that long ago that each of us we trying to get pay increases and bring the importance of our jobs to the fore front of pathology. The financial squeeze of the helath care system is going to be felt by all. Histology, pathology, radiology, cytology, we all must do our best to role with the punches and ensure quality care and our incomes, as well as our field, reguardless of location. Nicole Tatum, HT ASCP Thank you for that. How are things at Hartford Hospital? One of my favorite places, rotated there many years ago. Very impressive facility! Is Dr. Ricci still there? On Mon, Apr 9, 2012 at 4:43 PM, Richard Cartun rcar...@harthosp.org wrote: This was released today. Richard Statline Special Alert: New Evidence Links Self-Referral Labs to Increased Utilization, Lower Cancer Detection Rates Study co-funded by CAP Appears in April 2012 Issue of Health Affairs April 9Self-referring urologists billed Medicare for nearly 75% more anatomic pathology (AP) specimens compared to non self-referring physicians, according to a study published today in a leading health care policy journal. Furthermore, the study found no increase in cancer detection for the patients of self-referring physicians-in fact, the detection rate was 14% lower than that of non self-referring physicians. These findings, from an independent study co-funded by the CAP, provide the first clear evidence that self-referral of anatomic pathology services leads to increased utilization, higher Medicare spending, and lower rates of cancer detection. The study, led by renowned Georgetown University health care economist Jean Mitchell, PhD, will appear in the April 2012 issue of Health Affairs and is now available on the journals website. Daniel Schneider dlschnei...@gmail.com 4/9/2012 4:47 PM This is all about the money. The rest is rationalization. The reason a group of non-pathologist physicians opens an in-house pathology lab and hires
RE: [Histonet] Aetna and In-Office Lab Accreditation
The words used are rude, and highly uncalled for in a public forum. Not one of my posts talked about techs at all, and very wrong assumptions were made, and quite insulting posts ensued. I have great respect for techs, always have. To suggest otherwise is more wrong than I can say. Sent from my Windows Phone From: Pratt, Caroline Sent: 4/10/2012 10:18 AM To: Nicole Tatum; Davide Costanzo; histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] Aetna and In-Office Lab Accreditation I don't think it was meant as a personal attack, it's a larger conceptual issue on ethics of the business principle behind the model for in-office laboratories and the debate isn't about jobs, it's about the best interest of the patient. I am sure your skill set is exceptional. -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Nicole Tatum Sent: Tuesday, April 10, 2012 11:56 AM To: Davide Costanzo; histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] Aetna and In-Office Lab Accreditation Rude is when you attack someone who is your equal. Yes, your right im a schmuck because I work in private practice. I didnt know that having my education, and completing my internship, and having 12yrs in the field made me a lesser histologist because I work in private practice. Seriouly get a grip. The conflict lies in you, if you cant see that we all are working to support our families. I really dont care where my fellow Histologist work, because I am happy they have a job and our professional is able to grow and that there are other opportunities for Histologist outside of hospitals. These in-house lab have created all new opportunities for Histologist and I back them 100%. Great thing about being an American, is I dont have to agree with you. This field has supported my family and allowed me to live comfortably, I will defend it for myself and others who will be entering the work force. I can only hope they have me for a mentor. I choose to promote my field and work with my collegues to ensure the survival of all of our jobs. Nicole Tatum HT ASCP You're just plain rude. Whenever someone is wrong, it is easy to criticize others. Takes the focus off you. Unlike you, I will not post my personal rude comments on the entire list serv. You are right, I shouldn't argue with a lesser educated schmuck either. Sent from my Windows Phone From: Nicole Tatum Sent: 4/10/2012 8:18 AM To: Davide Costanzo; histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] Aetna and In-Office Lab Accreditation Really, An undertaker. Yea, theres definately a conflict here, you. No since in wasting my time. Nicole Start with reading Dr. Schneider's post. Then read Richard Cartun's post. Those should deal will what you are talking about very well. These in-office labs should not exist, for the very same reason the undertaker is no longer the ambulance driver. There is a very real, and significant conflict of interest. Sent from my Windows Phone From: Nicole Tatum Sent: 4/10/2012 6:45 AM To: Davide Costanzo; histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Aetna and In-Office Lab Accreditation Money is at the root of all finicial decisions, in-house labs and hospitals. There are many over utilization of resources within the health care field. Many gallbladder surgerious are performed unneccesarly by general surgeous who's practice are within hospitals walls. Tonsilectomy. etc. How are those specimens not self reffered to the hospitals AP lab. David you made the comment about specialities staying with there specialty and not branching out. A dermatopathologist specializes in derm specimens so why is it so far fetched that he would read derm specimens from all sources, hospitals or in-house labs. My in-house lab has a higher turn around rate, lower overhead, and cuts courier fees out. We also do a service to our patients by allowing them one stop shopping. We can service all there needs and they do not have to have multiple appointments at different facilities. This cuts down on their copay and billing from multiple doctors. Also, it would cost more for a person to have Mohs surgery in a hospital setting. As we all know cost are higher at a hospital because they have higher overhead. The hospital is self reffering when they let a surgery center or group be affiliated with them. The surgery center was allowed to join the hospital so the hospital could reep the revenue generated and process their specimens. Either way, we are all joined by a common form of employment, and one facility is not better than another. My field provides jobs and creates revenue just like yours. Insurance company are going to make changes to try and make revenue during this change into OBAMA CARE. Remeber we are not the enemy they are. Who are they to dictate how my company runs. Insurance companies have
Re: [Histonet] In House Labs in WSJ
Less screening = fewer biopsies = less revenue = less prostate cancers caught early = more deaths to prostate cancers. Would you not agree? According to the study referenced earlier, just the opposite is true. Increased utilization arising from in-house laboratories has proven to be less effective, and much more costly than their traditional counterparts. No benefit to the patient at all, actually a detriment. The best results still come from outfits owned and operated by pathologists and/or hospitals, and at a significantly lower cost. And for all those advocating closure of private labs, do you also feel the same way about private pathologist owned labs who reep the benefits of getting all the out PT work from affiliated physicians while they also get a fee to serve as medical directors of hospital labs and get the pc portion of hospital work of which they can order as many test they want so they get the pc portion while the hospital gets the tc and all the big bills associated with doing the test making it hard on tax payer as well because so much in a hospital is already subsidize by the gov. Private labs outside of the hospital, owned by pathologists, do not represent the group of non-pathologist owned in-office labs we have discussed. There are no complaints arising over pure pathology labs, operated by pathologists. The complaints are in reference to private labs within a GI clinic, or in a urologists' office, etc. Is what you really want is to have all pathologist as employees of the hospitals? And have the hospital bill global. Doctors in hospital settings are very rarely employed by the hospital, with the exception being academia. In most cases, the pathology group handles their own billing for professional fees. Just like radiologists, surgeons, anaesthesiologists and most others working in a hospital are not employed by that hospital. And a few walmart like reference labs I'm just curious as to the exact position of some on here. Thanks Kim Sent from my iPhone On Apr 10, 2012, at 2:39 PM, Morken, Timothy timothy.mor...@ucsfmedctr.org wrote: 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
Re: [Histonet] Aetna requiring CAP accreditation for non-hospital labs
Kim, I agree that there must be broad based support for all the histotech's working in those offices. Again, several read something into my post that was not in it. Nowhere did I mention the techs, nor express any concern over the quality of those techs. I am quite sure some of the best histotechs in America work in those settings. I would think that the majority of the techs working in those offices would find new jobs popping up all over if those labs were forced to close. The work still needs to get done, so I think assuming there would be hundreds of techs out of work is not realistic. Hopefully someone out there knows the answer to this question - I have heard (cannot confirm) that these types of labs in physician offices are banned in some states already. Pennsylvania was mentioned once at a conference as being one of those states. Does anyone out there know of this, and if it is true? I cannot find info in print, which I prefer to do before commenting. One Medical Director local to me at a major University stated that there is a push now to spread law through some Congressional hearings currently under way to force the closure of physician owned labs of that sort on a Federal level. I cannot confirm this either, however it does seem logical to think that the powers in Pathology would be fighting hard behind closed doors to figure out a way to shut these places down. There are problems in healthcare in this country on so many levels, this is just another example of one of many. The Aetna issue is not entirely related to this scenario, but in the end it still may have the desired effect by those that are pushing for office lab closure if it catches on with other insurance providers. I do think there is a lot going on behind the scenes here that none of us are aware of. Where did this Aetna letter come from? What sparked it? It shouldn't be any surprise to find out that physicians in larger pathology departments, or pathology organizations are behind this in some capacity. I share the opinion of my former medical director that these labs are short-lived, that the government will eventually shut them down. This is kick-back, no matter how you slice it. Loopholes that exist today, are likely to be removed tomorrow. The lucrative business they experience today is enough to keep them in the game, but I think they know the risks, and are aware of the fact that this party will end at some point. It is not pompous, and I resent that allegation. How would dermatologists feel if we decided to do punch biopsies in pathology labs? If a pathologist is not allowed to do colonoscpoy, why is a GI doc allowed to do histology? My comment is simple - they should not be allowed to. Practice of medicine should be limited to what you are trained in, not what makes you the most cash. Greed is a big part of what is destroying healthcare in this country. As for histotechs, I fully support the profession. To suggest otherwise is a tainted opinion, and not factual at all. I have worked alongside techs for 24 years, and clearly value every aspect of what they do. It is not an easy job, it is often thankless and that is unfortunate. This subject has nothing to do with the techs, and for those that love their job in these physician office labs I do feel sorry for, as that is not a job that will be around forever by all indications. On Mon, Apr 9, 2012 at 8:40 AM, Kim Donadio one_angel_sec...@yahoo.comwrote: I agree with Nicole. Davide, personally I think you went over the line. Many Histotechs out here are just as qualified and thier work is just as important as anyone elses. As a person who has worked in both situations, I think this date line is a bit unfair and your comment uncalled for. I spoke with CAP this morning and they agree the time frame is too short. I am told they have contacted Aetna to try and get some kind of leeway for people who have at least applied as they tell me there is no way we can get accreditation by that deadline.They are bombed with calls/applications. With all this said, and my ego now put back in my pocket. We need to support each other as professionals of our feild. These are hard times for healthcare professionals all around with many new regualtions around the bend. So lets try to stick together as a group of professionals and I suggest we all contact Aetna, and any governmental agency's we can regarding this. Because what starts here with one can certainly get out of hand rapidly; and dont always think you'll be on the side thats not getting the hit. Situations change. Best Regards Kim D *From:* Nicole Tatum nic...@dlcjax.com *To:* Davide Costanzo pathloc...@gmail.com; histonet@lists.utsouthwestern.edu *Sent:* Monday, April 9, 2012 8:29 AM *Subject:* Re: [Histonet] Aetna requiring CAP accreditation for non-hospital labs Wow David, I strongly disagree with you. I happen to work and run at Dermatopathology lab and I am a licensed
RE: [Histonet] Aetna and In-Office Lab Accreditation
Amen! Thank you Dr. Schneider. Sent from my Windows Phone From: Daniel Schneider Sent: 4/9/2012 1:47 PM To: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Aetna and In-Office Lab Accreditation This is all about the money. The rest is rationalization. The reason a group of non-pathologist physicians opens an in-house pathology lab and hires an employee pathologist is first and foremost to harvest profit from pathology reimbursement. Be a fly on the wall in the partners' meetings and you would know that's what they are talking about. To suggest otherwise is disingenuous. And the implication that the generalist anatomic pathologist is unqualified to be signing out skins, prostates, GI's and whatever is reprehensible. This is not cardiac bypass surgery, and AP pathologists *are* trained to do all of the above. I eagerly defer to subspecialty expert consultants as needed, but most of the time they're not needed. Hospital labs that see few, if any skins, prostates, GI's, are only in that pickle because of the cherrypicking they've already been subjected to. *in-office AP labs are an emerging frontier of employment for histologists and pathologists. In an era of high unemployment, another source of employment for our professions is a good thing.* Really? The jobs follow the specimens. Given the same number of specimens, there's the same number of jobs, more or less, just under different circumstances and in different locations Unless you're suggesting that in-office labs will generate increased specimens, and thus increased jobs though overutilization, i.e. excessive numbers of unnecessary biopsies and abuse of the patient and the taxpayer. In which case I have to say there's a grain of truth. And the truth hurts. And it's not a good thing. None of this should be taken as criticism of histotechs and pathologists who find themselves working in an in-office lab. I know there's bills to pay, families to take care of, and god knows it's hard for a pathologist to find a job these days with the numbers our residency programs keep churning out (but that's another rant...). Dan Schneider, MD Amarillo, TX On Mon, Apr 9, 2012 at 12:52 PM, jdcoch...@aol.com wrote: Histonetters: In-office AP labs provide a valuable service to the practices they serve by facilitating 1) better communication between pathologists and ordering clinicians, 2) quality metrics that are practice-specific, and 3) high volume, sub-specialization for both histotechnologists and pathologists. In other words, the more of one type of histopathology a lab does (e.g., skin, prostate, GI), the better it gets. Most people would not think of having their cardiac bypass surgery done at a community hospital doing 50/year; you want to go where more than 500/year are done. In histopathology, the kinds of volume you want are in the thousands for each tissue type. Many hospital labs do little skin or prostate histology anymore. Many sub-specialty in-office AP labs may do thousands of cases of one tissue type every year. Aside from that, in-office AP labs are an emerging frontier of employment for histologists and pathologists. In an era of high unemployment, another source of employment for our professions is a good thing. This requirement by an insurer for accreditation will help to validate these in-office AP labs' commitment to quality and put them on the level with their hospital counterparts. John D. Cochran, MD, FCAP ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] Aetna and In-Office Lab Accreditation
Thank you for that. How are things at Hartford Hospital? One of my favorite places, rotated there many years ago. Very impressive facility! Is Dr. Ricci still there? On Mon, Apr 9, 2012 at 4:43 PM, Richard Cartun rcar...@harthosp.org wrote: This was released today. Richard Statline Special Alert: New Evidence Links Self-Referral Labs to Increased Utilization, Lower Cancer Detection Rates Study co-funded by CAP Appears in April 2012 Issue of Health Affairs April 9—Self-referring urologists billed Medicare for nearly 75% more anatomic pathology (AP) specimens compared to non self-referring physicians, according to a study published today in a leading health care policy journal. Furthermore, the study found no increase in cancer detection for the patients of self-referring physicians-in fact, the detection rate was 14% lower than that of non self-referring physicians. These findings, from an independent study co-funded by the CAP, provide the first clear evidence that self-referral of anatomic pathology services leads to increased utilization, higher Medicare spending, and lower rates of cancer detection. The study, led by renowned Georgetown University health care economist Jean Mitchell, PhD, will appear in the April 2012 issue of Health Affairs and is now available on the journal’s website. Daniel Schneider dlschnei...@gmail.com 4/9/2012 4:47 PM This is all about the money. The rest is rationalization. The reason a group of non-pathologist physicians opens an in-house pathology lab and hires an employee pathologist is first and foremost to harvest profit from pathology reimbursement. Be a fly on the wall in the partners' meetings and you would know that's what they are talking about. To suggest otherwise is disingenuous. And the implication that the generalist anatomic pathologist is unqualified to be signing out skins, prostates, GI's and whatever is reprehensible. This is not cardiac bypass surgery, and AP pathologists *are* trained to do all of the above. I eagerly defer to subspecialty expert consultants as needed, but most of the time they're not needed. Hospital labs that see few, if any skins, prostates, GI's, are only in that pickle because of the cherrypicking they've already been subjected to. *in-office AP labs are an emerging frontier of employment for histologists and pathologists. In an era of high unemployment, another source of employment for our professions is a good thing.* Really? The jobs follow the specimens. Given the same number of specimens, there's the same number of jobs, more or less, just under different circumstances and in different locations Unless you're suggesting that in-office labs will generate increased specimens, and thus increased jobs though overutilization, i.e. excessive numbers of unnecessary biopsies and abuse of the patient and the taxpayer. In which case I have to say there's a grain of truth. And the truth hurts. And it's not a good thing. None of this should be taken as criticism of histotechs and pathologists who find themselves working in an in-office lab. I know there's bills to pay, families to take care of, and god knows it's hard for a pathologist to find a job these days with the numbers our residency programs keep churning out (but that's another rant...). Dan Schneider, MD Amarillo, TX On Mon, Apr 9, 2012 at 12:52 PM, jdcoch...@aol.com wrote: Histonetters: In-office AP labs provide a valuable service to the practices they serve by facilitating 1) better communication between pathologists and ordering clinicians, 2) quality metrics that are practice-specific, and 3) high volume, sub-specialization for both histotechnologists and pathologists. In other words, the more of one type of histopathology a lab does (e.g., skin, prostate, GI), the better it gets. Most people would not think of having their cardiac bypass surgery done at a community hospital doing 50/year; you want to go where more than 500/year are done. In histopathology, the kinds of volume you want are in the thousands for each tissue type. Many hospital labs do little skin or prostate histology anymore. Many sub-specialty in-office AP labs may do thousands of cases of one tissue type every year. Aside from that, in-office AP labs are an emerging frontier of employment for histologists and pathologists. In an era of high unemployment, another source of employment for our professions is a good thing. This requirement by an insurer for accreditation will help to validate these in-office AP labs' commitment to quality and put them on the level with their hospital counterparts. John D. Cochran, MD, FCAP ___ Histonet mailing list Histonet@lists.utsouthwestern.edu
Re: [Histonet] Aetna requiring CAP accreditation for non-hospital labs
This is a fascinating thread!! So what are your thoughts on this - It would appear that, if other insurers follow suit, this could pose a huge burden on dermatologists that do their own tissue processing, and all the GI labs across the country that are popping up doing their own in-house histology. It may be hard, and in some cases not possible for those labs to become CAP accredited. In my opinion, that would be a great thing, to see all those physician offices doing histology close their lab doors, and focus on thier own specialty rather than invade the pathology world from which they were not trained. It would seem, to the average witness, that these facilities are treading on very thin ice as it is. It certainly does appear to be a violation of Stark laws that were created for a very good reason. In addition, these offices have stolen the bread and butter from large labs, and hospital pathology departments and left behind the far less profitable work. It would be nice to see that work return to the place it belongs - in Pathology laboratories. It may be a pipe dream at this point, but who knows - maybe this is the start of a very, very good thing. On Fri, Apr 6, 2012 at 2:56 PM, Kim Donadio one_angel_sec...@yahoo.comwrote: Yikes I just 2 sec ago said that lol Sent from my iPhone On Apr 6, 2012, at 4:51 PM, Jesus Ellin jel...@yumaregional.org wrote: There are several frame of minds here, but most closely this aligns with the affordable care act and quality outcomes for patients. I to agree with the statement that other agencies can provide good quality outcomes, but Anatomic pathology is changing so rapidly. From all aspects, but if you look at who bills for most of the CMS testing it falls under hospital based laboratories, yet the government decides reimbursement based on what the large labs make.. In the end we are seeing consolidation,, but I hope someone comes to the forefront to speak for us all. Sent from my iPad On Apr 6, 2012, at 1:41 PM, Carol Torrence ctorre...@kmcpa.com wrote: I too have been through many CAP inspections in the past. Passing is not my concern - how about expense, prep time, time away to inspect a peer. We are a small private lab also so this a bit of a pain. There is no way that CAP will be able to accommodate the workload that will ensue if this becomes a trend. Which I think it will and there will be more insurance companies aligning themselves with the larger labs as preferred. My fear is that local healthcare will be so undercut that it will become more difficult if not impossible for even hospital labs to compete. I will never be convinced that big is better. I believe Aetna will hear from CAP on this issue due to the increased workload to them...deadlines may have to be extended. We are hearing from a CAP member that they will not be able to be accredited in such a short time, according to CAP. -Original Message- From: Kim Donadio [mailto:one_angel_sec...@yahoo.com] Sent: Thursday, April 05, 2012 6:31 PM To: Katelin Lester Cc: Carol Torrence; histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Aetna requiring CAP accreditation for non-hospital labs My lab can pass any inspection I have no fear Bring it on utube.com/index?desktop_uri=%2Fgl=US#/watch?v=gAQCbczCt8s Sent from my iPhone On Apr 5, 2012, at 7:00 PM, Katelin Lester katelin09...@gmail.com wrote: We also received this notice. We contacted our local CLIA office who had heard of it this week as well. We are a small lab, so we are not sure yet how this change will impact us. I'd also be curious to know what smaller, private labs are planning on doing. -- Katelin Lester, HTL Gastroenterology Specialists of Oregon, P.C. Pathology Laboratory (971) 224-2408 On Thu, Apr 5, 2012 at 12:16 PM, Carol Torrence ctorre...@kmcpa.com wrote: We have received notification from AETNA that they now require non-hospital labs to be accredited by CLIA and CAP. The letter makes it obvious that by making such a request that they are not aware that CLIA assigned deemed status to CAP and CLIA is actually the gatekeeper. Secondly we are told to be registered by May 1st and accredited by August 1st (which CAP says is impossible) or we will have to send our lab to either Quest or Ameripath which includes Dermpath Diagnostics division. It fails to mention that there are other CAP accredited non hospital labs in our state. The Aetna contact number is either 'mailbox full or even after leaving a message, no return call. Me thinks me smells a rat. If you are a non-hospital lab, have you heard of this? Does your dematopathologist or pathologist know this is coming? I am interested in your comments. Carol M. Torrence, HT(ASCP)CM ___ Histonet mailing list Histonet@lists.utsouthwestern.edu
Re: [Histonet] FW: Redneck Lent
I, personally, found the joke very funny. I find a lot of distasteful jokes funny - I actually prefer them over anything clean. That does not take away the fact that discussing religion, or politics (with humor or in any other form) has no place in the workplace. Histonet is, in many ways, an extension of the workplace. I also do not discuss religion or politics with strangers, and there certainly are more strangers that read this blog than folks we know. While I was not personally offended by that joke, it is very conceivable to think that some folks would be offended. As I told one replier - had this joke been about Jews it would have been something folks reacted to harshly. And, for good reason. So we cannot joke about Jews or Muslims, but Catholics are fine? I respectfully disagree - ALL religions and posts of humor in reference to a religion on a public listserv is a terrible idea. And, incidentally, this support for those that could be offended is coming from me - a person that thinks ALL religion is a joke in the first place. On Tue, Mar 27, 2012 at 8:08 AM, Boyd, Debbie M dkb...@chs.net wrote: For goodness sakes! It is a joke. First of all it was accidently sent to HistoNet per Joseph's second email. But most of all can't we just loosen up a bit and laugh at/with each other? Every religion, race, gender, etc. has had jokes made about it. Give the guy a break. Debbie M. Boyd HT (ASCP) l Chief Histologist l Southside Regional Medical Center l 200 Medical Park Blvd. l Petersburg, Va. 23805 l PH 804-765-5050 l FAX 804-765-8852 From: histonet-boun...@lists.utsouthwestern.edu [ histonet-boun...@lists.utsouthwestern.edu] on behalf of JOSEPH FRAZEE [ jfra...@hotmail.com] Sent: Monday, March 26, 2012 6:48 PM To: Histonet Server; Taylors Cars; LINDA FRAZEE; mike tony siltman Subject: [Histonet] FW: Redneck Lent Date: Mon, 26 Mar 2012 19:55:27 +0100 From: spoeri...@yahoo.com Subject: Fw: Fwd: Redneck Lent To: karen.green...@hobbylobby.com; stewartdap...@hotmail.com; yvette.fette...@basf.com; footch...@yahoo.com; frazeeli...@hotmail.com; jfra...@hotmail.com; donna.lu...@gmail.com Kerri - Forwarded Message - From: Sharen Pray praysha...@yahoo.com To: Ruth Posey ruthalpo...@yahoo.com; LueAnn Root lar...@ymail.com; Marjorie Norris nursenor...@yahoo.com; Tom Voss, Sr. tomv...@wildblue.net; Taber Stewart texcon.ta...@gmail.com; MONTIE L WINTERS molo...@yahoo.com; Terry Maloney maloney_te...@yahoo.com; kerri spoering spoeri...@yahoo.com; Kenny Debbie Hager kanddha...@att.net Sent: Saturday, 24 March 2012, 21:06 Subject: Fw: Fwd: Redneck Lent Each Friday night after work, Bubba would fire up his outdoor grill and cook a venison steak. But, all of Bubba's neighbors were Catholic. And since it was Lent, they were forbidden from eating meat on Friday. The delicious aroma from the grilled venison steaks was causing such a problem for the Catholic faithful that they finally talked to their priest. The Priest came to visit Bubba, and suggested that he become a Catholic. After several classes and much study, Bubba attended Mass...and as the priest sprinkled holy water over him, he said, You were born a Baptist, and raised a Baptist, but now you are a Catholic. Bubba's neighbors were greatly relieved, until Friday night arrived, and the wonderful aroma of grilled venison filled the neighborhood. The Priest was called immediately by the neighbors, and, as he rushed into Bubba's yard, clutching a rosary and prepared to scold him, he stopped and watched in amazement. There stood Bubba, clutching a small bottle of holy water which he carefully sprinkled over the grilling meat and chanted: You wuz born a deer, you wuz raised a deer, but now you is a catfish. Blessings, love and light, Live simply, love generously, care deeply, speak kindly. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet -- Disclaimer: This electronic message may contain information that is Proprietary, Confidential, or legally privileged or protected. It is intended only for the use of the individual(s) and entity named in the message. If you are not an intended recipient of this message, please notify the sender immediately and delete the material from your computer. Do not deliver, distribute or copy this message and do not disclose its contents or take any action in reliance on the information it contains. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet -- *David Costanzo, MHS, PA (ASCP)* Project Manager *Blufrog Path Lab Solutions* 9401 Wilshire Blvd. Ste 650 Beverly
RE: [Histonet] FW: Redneck Lent
Religious humor on this listserv is remarkably inappropriate. I cannot believe anyone would post this here. Tasteless. Sent from my Windows Phone From: JOSEPH FRAZEE Sent: 3/26/2012 3:49 PM To: Histonet Server; Taylors Cars; LINDA FRAZEE; mike tony siltman Subject: [Histonet] FW: Redneck Lent Date: Mon, 26 Mar 2012 19:55:27 +0100 From: spoeri...@yahoo.com Subject: Fw: Fwd: Redneck Lent To: karen.green...@hobbylobby.com; stewartdap...@hotmail.com; yvette.fette...@basf.com; footch...@yahoo.com; frazeeli...@hotmail.com; jfra...@hotmail.com; donna.lu...@gmail.com Kerri - Forwarded Message - From: Sharen Pray praysha...@yahoo.com To: Ruth Posey ruthalpo...@yahoo.com; LueAnn Root lar...@ymail.com; Marjorie Norris nursenor...@yahoo.com; Tom Voss, Sr. tomv...@wildblue.net; Taber Stewart texcon.ta...@gmail.com; MONTIE L WINTERS molo...@yahoo.com; Terry Maloney maloney_te...@yahoo.com; kerri spoering spoeri...@yahoo.com; Kenny Debbie Hager kanddha...@att.net Sent: Saturday, 24 March 2012, 21:06 Subject: Fw: Fwd: Redneck Lent Each Friday night after work, Bubba would fire up his outdoor grill and cook a venison steak. But, all of Bubba's neighbors were Catholic. And since it was Lent, they were forbidden from eating meat on Friday. The delicious aroma from the grilled venison steaks was causing such a problem for the Catholic faithful that they finally talked to their priest. The Priest came to visit Bubba, and suggested that he become a Catholic. After several classes and much study, Bubba attended Mass...and as the priest sprinkled holy water over him, he said, You were born a Baptist, and raised a Baptist, but now you are a Catholic. Bubba's neighbors were greatly relieved, until Friday night arrived, and the wonderful aroma of grilled venison filled the neighborhood. The Priest was called immediately by the neighbors, and, as he rushed into Bubba's yard, clutching a rosary and prepared to scold him, he stopped and watched in amazement. There stood Bubba, clutching a small bottle of holy water which he carefully sprinkled over the grilling meat and chanted: You wuz born a deer, you wuz raised a deer, but now you is a catfish. Blessings, love and light, Live simply, love generously, care deeply, speak kindly. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] Block Storage-another question
Fellow Histonet Subscribers, I have been noticing a LOT of misinformation being passed around this site, much coming from one respondent in particular. This is very troubling, as our position in healthcare, and the work we do, is so very critical to patient care and patient outcomes. I would hope that before responding to questions, people either know what they are talking about, or make it clear that it is opinion they are expressing, and not necessarily fact. Perhaps including some reference, or web link to information is practical at times. Here I have listed below responses to some questions that are outright false, and the information presented, if followed, in some instances may put a lab in jeopardy when inspected. It also appears that we have techs from marine biology centers, and plant histology labs answering questions pertaining to medicine. I am not sure how appropriate that is. This is, of course, just my opinion. *In Response to the question of where to store blocks this was an answer:* “Both but especially the place where the diagnosis takes place.” It is not possible to store blocks in BOTH locations. Why would you do that? And “especially the place where the diagnosis takes place” is incorrect. The logical place to keep the blocks is where the histology is performed. If space does not permit long term storage, rent a facility that is compliant with your state requirements for doing so. As far as time to keep blocks, CLIA and CAP have different requirements. Check with your State to see if they are even more stringent than CAP. Here is what CLIA, and CAP require: FROM CLIA: Sec. 493.1105 Standard: Retention requirements (a)(3)(ii) Blocks. Retain pathology specimen blocks for at least 2 years from the date of examination. FROM CAP: Retention of Laboratory Records and Materials: *Surgical Pathology (including bone marrows)* Wet tissue 2 weeks after final report Paraffin blocks 10 years Slides 10 years Reports 10 years *In Response to Water Quality this response was noted:* “No small laboratory has the conditions required to perform microbiology cultures” This is an inaccurate statement. Size of a lab, and ability to perform work in a sterile environment are not at all related. When responding to questions as important as breast fixation times, it would be helpful to include information like what I included immediately below – furthermore, as all of you know, breast tissue fixes differently depending upon several factors, especially fat content, and thickness of the sections. The question of best fixation time is not an answerable question – it is specific to the case itself. Is it cores we are talking about? Is it a dense fibrous lumpectomy? Is it a fatty mastectomy? There is no perfect answer to that question. *What are the changes made to minimum fixation times?* The minimum fixation time for HER2 has been clarified and we recommend that samples for HER2 testing be fixed a minimum of 6 hours. The original statement that smaller samples can be fixed for less than 6 hours is not supported by the literature. We recommend that sample for HER2 testing be fixed a minimum of 6 hours regardless of sample size. *WWhat about changes to maximum fixation times? The HER2 fixation time of 6-48 hours is not consistent with that of the ER/PgR fixation time of 6-72 hours.* We are unable to find evidence to support increasing the HER2 fixation time and therefore recommendations for fixation times in neutral buffered formalin are unchanged (6-48 hours for HER2 and 6-72 hours for ER/PgR). The data about the stability of ER and PgR at intervals of 48-72 hours suggest that changing this interval for HER2 testing will not result in adverse testing results. However, there is a lack of specific published studies for HER2 IHC that included specimens with low levels of HER2 expression that would be more vulnerable to fixation time changes. *What are the changes made to minimum fixation times?* The minimum fixation time for HER2 has been clarified and we recommend that samples for HER2 testing be fixed a minimum of 6 hours. The original statement that smaller samples can be fixed for less than 6 hours is not supported by the literature. We recommend that sample for HER2 testing be fixed a minimum of 6 hours regardless of sample size. On Wed, Mar 21, 2012 at 1:27 PM, Rene J Buesa rjbu...@yahoo.com wrote: Both but especially the place where the diagnosis takes place. René J. --- On Wed, 3/21/12, Cynthia Pyse cp...@x-celllab.com wrote: From: Cynthia Pyse cp...@x-celllab.com Subject: RE: [Histonet] Block Storage-another question To: 'Rene J Buesa' rjbu...@yahoo.com, 'Ann Angelo' thisis...@aol.com, histonet@lists.utsouthwestern.edu, 'FeltonNails' flna...@texaschildrens.org Date: Wednesday, March 21, 2012, 11:25 AM If the pod lab is in NJ and the reading lab is in NY, which guide lines do you follow. NYS requires us to save our blocks for
RE: [Histonet] lab. setting up
Dear Mohamed, Please feel free to email me directly. I will gladly assist you. I am currently opening a facility in California, and would be pleased to share with you the equipment decisions we made, and why. Most equipment is made in Germany, England or Japan. As such, I am sure it is all very available in Egypt. Let me know if I can be of help. Sent from my Windows Phone From: mohamed abd el razik Sent: 3/2/2012 12:59 PM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] lab. setting up dear all on histonet I'm going to setup a new histology lab. in Egypt. I need to contact with you to advice me about the best and comfotable facilities microtomes- processors-automatic stainers and so on . Mohamed Ass. Lec. of histology Faculty of Vet. Med. Cairo University Egypt ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Grossing techs
Preserve the profession - hire an ASCP Certified PA. Sent from my Windows Phone From: Bruce Gapinski Sent: 2/24/2012 1:52 PM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Grossing techs We are looking for help with our grossing. Can you help? You must be CLIA qualified to do the high complexity testing we know as grossing. Times have changed as we used to do this work ourselves, but no more. Two of my staff qualify but I need another. We are a small laboratory in Marin County, just north of SF. Respectfully, Bruce Gapinsk HT (ASCP) Chief Histologist Marin Medical Laboratories PathGroup SF Important Notice: This e-mail is intended for the use of the person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient, any disclosure, copying, distribution, or use of the contents of this message is strictly prohibited. If you have received this e-mail in error, please destroy this message and contact the Security Officer at PathGroup, Inc immediately at 615-562-9255. Thank you ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Processor Question
Design flaw in the screen display. It is in the way of the chamber when opening chamber. If your not careful you will break the screen. Happens fairly often. Sent from my Windows Phone From: Gauch, Vicki Sent: 2/21/2012 9:18 AM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Processor Question Hi everyone, We are in the market for new processors...and I was wondering if anyone could give me some pros and cons for the Tissue Tek VIP 6 tissue processor - how reliable are they? Ease of use ? Any known problems? Tissues process well? You knowall the usual questions we all ask for new equipment. Thanks in advance for your help, Vicki Gauch AMCH Albany, NY ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] PA area folks--company to NOT use
Surely, as healthcare professionals, we can derive a better example of American Freedom than obesity and gluttony. Am I the only one offended by Mr. Swanson's quote being used in a forum for medical professionals? Just curious. Sent from my Windows Phone From: Rene J Buesa Sent: 2/4/2012 9:12 AM To: histonet@lists.utsouthwestern.edu; Emily Sours Subject: Re: [Histonet] PA area folks--company to NOT use You should also file a complaint with the Better Business Bureau of your area. René J. --- On Fri, 2/3/12, Emily Sours talulahg...@gmail.com wrote: From: Emily Sours talulahg...@gmail.com Subject: [Histonet] PA area folks--company to NOT use To: histonet@lists.utsouthwestern.edu Date: Friday, February 3, 2012, 4:12 PM Hello histonetters! I am having a great deal of trouble getting a microscope cleaning bill paid. We were overcharged by an hour. I suggest if you ever need your instruments cleaned or repaired, DO NOT USE GEORGE NABLE INSTRUMENTS. He has consistently overcharged us for his work, even after writing down a certain price on a purchase order. Just a warning. He works in the Pittsburgh area. I wish there was a yelp for scientists where I could post this, because I know a lot of people use him. Emily Sours The whole point of this country is if you want to eat garbage, balloon up to 600 pounds and die of a heart attack at 43, you can! You are free to do so. To me, that’s beautiful. --Ron Swanson ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Music in the Laboratory
The F word, among several others is not appropriate in a workplace. It's not appropriate anywhere, but we have control over the workplace. I have never, and will never allow inappropriate music at the workplace. The best way to prevent it, without your staff claimingprejudice as they so love to do, is ban music in the lab altogether. This is work, not a party. Sent from my Windows Phone From: tracz...@aol.com Sent: 1/17/2012 6:37 PM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Music in the Laboratory Greetings. I would like to know what other histology laboratories allow for music players while working. Do you have formal policies about music content or volume? Do you allow lab space doors to remain closed to muffle the volume of what is being played? Are headsets allowed? I am a terrible judge of this because I personally prefer to work in a quiet environment. I am trying to be open minded, as long as the work gets done. However, one of the techs had a song playing today that I believe was inappropriate for general listening in the lab. Am I just out of touch? Is that dang F word just something I'm going to have to learn to accept? Do you have a written policy? When/how/why was it implemented? I should mention that it's a small private lab, with minimal patient traffic. We do see our share of FedEx, UPS, sales service reps. Your ideas on this is very much appreciated. Dorothy ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Cutting speed
Never sacrifice quality for speed. Patient care is priority one, and the lab makes plenty of money. If you are understaffed they need to deal with that, not jeopardize care. You can always contact Healthcare Connections to get vacation coverage, or another agency like that. If you want Healthcare Connections it Comp Health staffing phone numbers feel free to email me. Sent from my Windows Phone From: joelle weaver Sent: 1/3/2012 8:48 AM To: algra...@email.arizona.edu Cc: Histonet Subject: RE: [Histonet] Cutting speed Good advice. Joelle Weaver MAOM, (HTL) ASCP http://www.linkedin.com/in/joelleweaver From: algra...@email.arizona.edu CC: histonet@lists.utsouthwestern.edu Date: Tue, 3 Jan 2012 07:39:47 -0800 Subject: Re: [Histonet] Cutting speed Teresa, Don't trade quality for speed. I once worked for a pathologist who actually told me that he preferred that we took our time cutting so that the sections were as good as we could make them. He said that it took a lot of the stress of making a diagnosis off of him when he got good slides, especially when the diagnosis was a difficult one. He said to treat the tissue like it came from your Mother or your child. I have worked with people who bragged often and loudly about being fast cutters and their slides looked like it. I agree with the person who advised that you sit down and have a talk with the lab manager to voice your concerns. Everyone should be aware that you are going to do the very best you can while your co-worker is away, even if it takes you a bit longer. Good luck with this! Andi On Dec 31, 2011, at 10:18 AM, Kim Donadio wrote: My only advice to you Teresa is to take a deep breath, calm down and do the best you can. Dont take your eye off the specimen you are dealing with. It's someones life. You might hear people screaming about time, they need this, they need that. but You as a healthcare professional have the ONE most importnat task you really need to focus on, and thats making the best slide you can from each specimen you deal with. Focus on that, keep your chin up and know that you are doing the patients a service by being there doing good work while dealing with hard times. Best of wishes Kim D From: Teresa Moore tmoor...@gmail.com To: histonet@lists.utsouthwestern.edu Sent: Saturday, December 31, 2011 8:44 AM Subject: [Histonet] Cutting speed I graduated from a histology program in June/11 and just got a job a week ago. My speed on the microtome is not great. Everyone says it takes time but I feel my technique may be wrong. To make matters worse the only other histotech in the lab is going on vacation the third week of January and I will be alone! I don't have the overall flow of the lab down yet and have no idea how they expect me to handle the cutting all by myself. My biggest concern is my cutting speed right now. How long does it take (approx) to do 40 blocks an hour. Currently, I'm about half that! I'm panicking and I've only been on the job 8 days. Help!!! -- Teresa Moore ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Chemical Recycling - B/R Instruments
Can anyone provide me information on B/R Instruments Pro series recyclers? I am considerning them vs. CBG Biotech. I have heard rumors that the B/R units throw a lot of heat from the lower boiler and damage the underlying flooring. Can anyone confirm this, or any other troubles with their units? Thank you. -- *David Costanzo, MHS, PA (ASCP)* Project Manager *Blufrog Path Lab Solutions* 9401 Wilshire Blvd. Ste 650 Beverly Hills, CA 90212 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Per Diem work in LA - Beverly Hills area
Hello all - We are opening a histology laboratory in the Beverly Hills area, and are in need of per diem histotech's to cover vacation/sickness or upticks in volume. If anyone in the LA area is interested in doing occassional work for a few hours at a time to supplement their current job please contact me, not by reply here but at my office email : da...@blufrogpath.com Thank you. Happy Thanksgiving to all. -- *David Costanzo, MHS, PA (ASCP)* Project Manager *Blufrog Path Lab Solutions* 9401 Wilshire Blvd. Ste 650 Beverly Hills, CA 90212 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] STP420
Final hour - still hoping to find users of the Thermo STP420 to provide me with some feedback. Any comments on this unit?? Thank you. -- *David Costanzo, MHS, PA (ASCP)* Project Manager *Blufrog Path Lab Solutions* 9401 Wilshire Blvd. Ste 650 Beverly Hills, CA 90212 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] STP420 vs. Peloris
Considering both options. Can any STP users out there give me opinions? Please give reasons, not just go with this one. Thanks. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Beverly Hills area Histotech needed
This is a little early, but I would like to announce that we will be soon looking for a histotech in the Beverly Hills area. This is a new lab set to open early 2012. We will be looking for a tech with several years experience, ready to assume the lead. Initially it will be a one tech job, but as volumes rise we will be adding to the staff. Our initial hire should be ready and able to assume the lead as a histo supervisor. If you are interested in learning more please email me directly at pathloc...@gmail.com David Costanzo, MHS, PA(ASCP) Project Manager ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Pathology reports
Is anyone out there familiar with Coretex Medical pathology software? Interested in input from users on what pathology software they use for generating final reports that are high quality, in color with photo capability, web based reporting and EMR interface. W0uld love to hear your thoughts on PowerPath, Coretex, Novopath, Softpath, McKesson and others. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Thermo STP420 and Excelsior
Dear Colleagues, We are in the process of opening a new lab and are looking for a rapid processor, preferably non-microwave, and a standard processor for backup. At present I have been looking into the Thermo STP420 with an Excelsior backup. My concerns are that I have heard some very negative feedback on the Excelsior. Can anyone tell me their experiences, good or bad, with both the STP420 and the Excelsior? If you are using, or have used either one I would greatly appreciate your thoughts. In addition, we are considering alternatives that include the Peloris by Leica. It is somewhat more costly at current time and thus the reason for Thermo STP420 to be in the lead on this one. Should we use the Excelsior as backup givin its reagent savings, or go with the VIP 6? Thank you for sharing your thoughts. David Costanzo Project Manager BluFrog Path Lab ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
