Re: [Histonet] In House Labs in WSJ
On 4/10/2012 5:33 PM, Kim Donadio wrote: Less screening = fewer biopsies = less revenue = less prostate cancers caught early = more deaths to prostate cancers. Would you not agree? No. There is very good scientific evidence that screening does not increase survival rates but it does drive up costs and unnecessary surgery and related complications. I can send the papers from NEJM if you like. Geoff 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. Is what you really want is to have all pathologist as employees of the hospitals? And have the hospital bill global. 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, Timothytimothy.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 from referring patients to most companies in which they have a financial interest, urology groups can enter the pathology business because of an exemption for certain services performed within physicians' offices. The pathologists and other groups are lobbying Congress to end the exemption. At issue in the study is a quirk of billing for lab procedures. Labs get paid based on the number of jars used to hold specimens from a prostate biopsy. Doctors can choose to put several specimens in one jar or put each in its own jar, potentially boosting lab fees, which averaged about $104 a jar in 2010, according to the study. Urologists in practices with in-house pathologists sent 11.4 jars per biopsy for testing versus 5.9 jars per biopsy for other doctors in 2005. Some doctors say that separating the samples can help them better map any cancer
Re: [Histonet] In House Labs in WSJ
Agreed , but the idea in recent health care has been early detection. So as technology increased, more diagnostic test were ordered. But, that is not only pathology, its micro, radiology, ultrasound, chemistry, etc. These early test did drive cost up, but also saved cost. Its kinda no win. If a radical tumor was detected early it could be removed by surgery and the patient could possibly still live a healthy cancer free life. If not detected, the patient could suffer through chemo and expensive radiation, and expensive hospice. Leaving the family devistated with medical bills and the loss of a loved one that a simple diagnostic test could have detected. Also, there is a huge problem with the malpractice suits in our country. If the pateint did suffer or die because a simple test was not ordered that could save their life the physician is held responsible and sued and could possibly lose his license and career. If less test are the answer to cutting cost to our rising health deficit, then doctors should be more protected when they make choices not to order tests that could save your life. Despite cost, in court they will argue it was a simple inexpensive test that could have saved his or her life. The physician is charged with protecting a patients health and he needs tool to do that. Tools that are being taken because they are unaffordable. We must learn how to manage our resources at every level. I for one would be devistated if I had cervical cancer because my OB did not submit a specimen when my pap came back as abnormal. I would be willing to pay the path fee out of pocket to have an answer. But, that's also part of the problem. People do not want to pay for services they recieve. But, they have a really nice flat screen and iphone. This economic crisis is a result of the public and health professional and gas prices, etc. We must stick together and come up with ways to still use diagnostic test effectively. They do save lives and save money, maybe on a small scale compared to those who are not diagnosed with any condition. Our current health care model has been based on detection and prevention. It will have to change for our industry to survive. Resouces will have to be rationed but I fear it is being given the title of over-utilization instead. As current tests decrease and physician are pushed to order less; I fear there will be an increase of misdiagnosises and an increase in malpractice suits. Its becomming scarry out there.. This change will effect each one of us. Nicole Tatum HT ASCP On 4/10/2012 5:33 PM, Kim Donadio wrote: Less screening = fewer biopsies = less revenue = less prostate cancers caught early = more deaths to prostate cancers. Would you not agree? No. There is very good scientific evidence that screening does not increase survival rates but it does drive up costs and unnecessary surgery and related complications. I can send the papers from NEJM if you like. Geoff 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. Is what you really want is to have all pathologist as employees of the hospitals? And have the hospital bill global. 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, Timothytimothy.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
[Histonet] In House Labs in WSJ
The Wall Street Journal served up a timely article for us. You'll see both sides of the argument below. One side is right. DLS HEALTH INDUSTRY April 9, 2012, 7:22 p.m. ET Prostate-Test Fees Challenged By CHRISTOPHER WEAVER Doctors in urology groups that profit from tests for prostate cancer order more of them than doctors who send samples to independent laboratories, according to a study Monday in the journal Health Affairs. The study found that doctors' practices that do their own lab work bill the federal Medicare program for analyzing 72% more prostate tissue samples per biopsy while detecting fewer cases of cancer than counterparts who send specimens to outside labs. Hiring pathologists boosts revenue for a practice and creates a potential incentive to increase the number of tests ordered, said Jean Mitchell, a Georgetown University economist and author of the study. That fewer cancers were detected—21% versus 35% for those sent to external labs, according to the study—suggests financial incentives may play a role in decisions to order the tests, Ms. Mitchell said. Some urologists said the research doesn't necessarily indicate financial motives. Urologists in larger group practices that have in-house pathologists may be more aggressive in testing because they seek to catch cancer earlier, said Steven Schlossberg, a Yale urologist who heads a health-policy panel for the American Urological Association and wasn't involved in the research. Also, Dr. Schlossberg noted, the figures, which cover 36,261 biopsies from 2005 through 2007, are five years old. The study was financed by the College of American Pathologists and the American Clinical Laboratory Association. It is the last salvo in a turf war between laboratory companies and physician groups that have opened their own labs to conduct tests. Regulators and economists scrutinizing the growing costs of health care have targeted a range of related activities by doctors, known as self-referrals. Although a set of 1990s-era laws, named for their proponent, Rep. Pete Stark (D., Calif.), ban doctors from referring patients to most companies in which they have a financial interest, urology groups can enter the pathology business because of an exemption for certain services performed within physicians' offices. The pathologists and other groups are lobbying Congress to end the exemption. At issue in the study is a quirk of billing for lab procedures. Labs get paid based on the number of jars used to hold specimens from a prostate biopsy. Doctors can choose to put several specimens in one jar or put each in its own jar, potentially boosting lab fees, which averaged about $104 a jar in 2010, according to the study. Urologists in practices with in-house pathologists sent 11.4 jars per biopsy for testing versus 5.9 jars per biopsy for other doctors in 2005. Some doctors say that separating the samples can help them better map any cancer. In addition, urologists in recent years have been taking more samples during a biopsy to better identify the location of any cancer, said John Hollingsworth, an assistant professor of urology at the University of Michigan. The standard number of samples taken doubled to 12 over the last decade, he said. The Health Affairs study's conclusions are largely around billing practices, not around clinical practices, said George Kwass, a pathologist based in Massachusetts and board member of the College of American Pathologists. Urologists who team up with pathologists appear to bill more, he said, leading to potential waste. Urology groups are consolidating, and increasingly moving into the pathology business. One large practice based on New York's Long Island, Integrated Medical Professionals, opened its lab in 2010 to control costs and because doctors encountered errors in outside test results, said the group's chairman, Deepak Kapoor. We don't make a fortune on pathology, Dr. Kapoor said. But lab businesses are seeing revenue vanish. Texas pathology group ProPath stopped getting prostate tissue from large urology groups more than four years ago, said executive director Krista Crews, when these clients began doing lab work in-house. The group still gets referrals from small, one and two-doctor practices, she said. Large laboratory companies are worried about the trend, too. Quest Diagnostics Inc. DGX -2.52%said in its latest annual filings that if physicians, including urologists as well as gastroenterologists and skin and cancer doctors, continued to internalize testing services, it could reduce the company's sales. Write to Christopher Weaver at christopher.wea...@wsj.com Copyright 2012 Dow Jones Company, Inc. All Rights Reserved This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit
RE: [Histonet] In House Labs in WSJ
Not surprising since our health care system is biased to pay for tests and treatments, not results. On top of this there are serious questions as to whether the PSA screening that leads to biopsies is useful in the long term. There is a recommendation out there to stop PSA screening for most men since it is largely non-specific. That test is what leads to the biopsies. Less screening = fewer biopsies = less revenue. Tim Morken -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Daniel Schneider Sent: Tuesday, April 10, 2012 11:22 AM To: Histonet Subject: [Histonet] In House Labs in WSJ The Wall Street Journal served up a timely article for us. You'll see both sides of the argument below. One side is right. DLS HEALTH INDUSTRY April 9, 2012, 7:22 p.m. ET Prostate-Test Fees Challenged By CHRISTOPHER WEAVER Doctors in urology groups that profit from tests for prostate cancer order more of them than doctors who send samples to independent laboratories, according to a study Monday in the journal Health Affairs. The study found that doctors' practices that do their own lab work bill the federal Medicare program for analyzing 72% more prostate tissue samples per biopsy while detecting fewer cases of cancer than counterparts who send specimens to outside labs. Hiring pathologists boosts revenue for a practice and creates a potential incentive to increase the number of tests ordered, said Jean Mitchell, a Georgetown University economist and author of the study. That fewer cancers were detected-21% versus 35% for those sent to external labs, according to the study-suggests financial incentives may play a role in decisions to order the tests, Ms. Mitchell said. Some urologists said the research doesn't necessarily indicate financial motives. Urologists in larger group practices that have in-house pathologists may be more aggressive in testing because they seek to catch cancer earlier, said Steven Schlossberg, a Yale urologist who heads a health-policy panel for the American Urological Association and wasn't involved in the research. Also, Dr. Schlossberg noted, the figures, which cover 36,261 biopsies from 2005 through 2007, are five years old. The study was financed by the College of American Pathologists and the American Clinical Laboratory Association. It is the last salvo in a turf war between laboratory companies and physician groups that have opened their own labs to conduct tests. Regulators and economists scrutinizing the growing costs of health care have targeted a range of related activities by doctors, known as self-referrals. Although a set of 1990s-era laws, named for their proponent, Rep. Pete Stark (D., Calif.), ban doctors from referring patients to most companies in which they have a financial interest, urology groups can enter the pathology business because of an exemption for certain services performed within physicians' offices. The pathologists and other groups are lobbying Congress to end the exemption. At issue in the study is a quirk of billing for lab procedures. Labs get paid based on the number of jars used to hold specimens from a prostate biopsy. Doctors can choose to put several specimens in one jar or put each in its own jar, potentially boosting lab fees, which averaged about $104 a jar in 2010, according to the study. Urologists in practices with in-house pathologists sent 11.4 jars per biopsy for testing versus 5.9 jars per biopsy for other doctors in 2005. Some doctors say that separating the samples can help them better map any cancer. In addition, urologists in recent years have been taking more samples during a biopsy to better identify the location of any cancer, said John Hollingsworth, an assistant professor of urology at the University of Michigan. The standard number of samples taken doubled to 12 over the last decade, he said. The Health Affairs study's conclusions are largely around billing practices, not around clinical practices, said George Kwass, a pathologist based in Massachusetts and board member of the College of American Pathologists. Urologists who team up with pathologists appear to bill more, he said, leading to potential waste. Urology groups are consolidating, and increasingly moving into the pathology business. One large practice based on New York's Long Island, Integrated Medical Professionals, opened its lab in 2010 to control costs and because doctors encountered errors in outside test results, said the group's chairman, Deepak Kapoor. We don't make a fortune on pathology, Dr. Kapoor said. But lab businesses are seeing revenue vanish. Texas pathology group ProPath stopped getting prostate tissue from large urology groups more than four years ago, said executive director Krista Crews, when these clients began doing lab work in-house. The group still gets referrals from small, one and two-doctor
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? 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. Is what you really want is to have all pathologist as employees of the hospitals? And have the hospital bill global. 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 from referring patients to most companies in which they have a financial interest, urology groups can enter the pathology business because of an exemption for certain services performed within physicians' offices. The pathologists and other groups are lobbying Congress to end the exemption. At issue in the study is a quirk of billing for lab procedures. Labs get paid based on the number of jars used to hold specimens from a prostate biopsy. Doctors can choose to put several specimens in one jar or put each in its own jar, potentially boosting lab fees, which averaged about $104 a jar in 2010, according to the study. Urologists in practices with in-house pathologists sent 11.4 jars per biopsy for testing versus 5.9 jars per biopsy for other doctors in 2005. Some doctors say that separating the samples can help them better map any cancer. In addition, urologists in recent years have been taking more samples during a biopsy to better identify the location of any cancer, said John Hollingsworth, an assistant
RE: [Histonet] In House Labs in WSJ
From the New York Times: 1) U.S. Panel Says No to Prostate Screening for Healthy Men By GARDINER HARRIS Published: October 6, 2011 Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided. The draft recommendation, by the United States Preventive Services Task Force and due for official release next week, is based on the results of five well-controlled clinical trials and could substantially change the care given to men 50 and older. There are 44 million such men in the United States, and 33 million of them have already had a P.S.A. test - sometimes without their knowledge - during routine physicals. The task force's recommendations are followed by most medical groups. Two years ago the task force recommended that women in their 40s should no longer get routine mammograms, setting off a firestorm of controversy. The recommendation to avoid the P.S.A. test is even more forceful and applies to healthy men of all ages. Unfortunately, the evidence now shows that this test does not save men's lives, said Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chairwoman of the task force. This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does. Article continues 2) Prostate Test Found to Save Few Lives By GINA KOLATA Published: March 18, 2009 The PSA blood test, used to screen for prostate cancer, saves few lives and leads to risky and unnecessary treatments for large numbers of men, two large studies have found. Mortality Results from a Randomized Prostate-Cancer Screening Trial (The New England Journal of Medicine) Screening and Prostate-Cancer Mortality in a Randomized European Study (The New England Journal of Medicine) The findings, the first based on rigorous, randomized studies, confirm some longstanding concerns about the wisdom of widespread prostate cancer screening. Although the studies are continuing, results so far are considered significant and the most definitive to date. The PSA test, which measures a protein released by prostate cells, does what it is supposed to do - indicates a cancer might be present, leading to biopsies to determine if there is a tumor. But it has been difficult to know whether finding prostate cancer early saves lives. Most of the cancers tend to grow very slowly and are never a threat and, with the faster-growing ones, even early diagnosis might be too late. The studies - one in Europe and the other in the United States - are some of the most important studies in the history of men's health, said Dr. Otis Brawley, the chief medical officer of the American Cancer Society. In the European study, 48 men were told they had prostate cancer and needlessly treated for it for every man whose death was prevented within a decade after having had a PSA test. Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center, says one way to think of the data is to suppose he has a PSA test today. It leads to a biopsy that reveals he has prostate cancer, and he is treated for it. There is a one in 50 chance that, in 2019 or later, he will be spared death from a cancer that would otherwise have killed him. And there is a 49 in 50 chance that he will have been treated unnecessarily for a cancer that was never a threat to his life. Article continues -Original Message- From: Kim Donadio [mailto:one_angel_sec...@yahoo.com] Sent: Tuesday, April 10, 2012 2:33 PM To: Morken, Timothy Cc: Daniel Schneider; Histonet Subject: 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? 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. Is what you really want is to have all pathologist as employees of the hospitals? And have the hospital bill global. 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
RE: [Histonet] In House Labs in WSJ
I find it interesting (and slightly amusing) that a professor of pediatrics is chairwoman of the task force on PSA testing. After my early publications on PSA IPXs, I thought that I was over that now I am in a Children's Hospital. Now I am not so sure! Regards Tony Henwood JP, MSc, BAppSc, GradDipSysAnalys, CT(ASC), FFSc(RCPA) Laboratory Manager Senior Scientist Tel: 612 9845 3306 Fax: 612 9845 3318 the children's hospital at westmead Cnr Hawkesbury Road and Hainsworth Street, Westmead Locked Bag 4001, Westmead NSW 2145, AUSTRALIA -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Morken, Timothy Sent: Wednesday, 11 April 2012 7:49 AM To: Kim Donadio Cc: Histonet Subject: RE: [Histonet] In House Labs in WSJ From the New York Times: 1) U.S. Panel Says No to Prostate Screening for Healthy Men By GARDINER HARRIS Published: October 6, 2011 Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided. The draft recommendation, by the United States Preventive Services Task Force and due for official release next week, is based on the results of five well-controlled clinical trials and could substantially change the care given to men 50 and older. There are 44 million such men in the United States, and 33 million of them have already had a P.S.A. test - sometimes without their knowledge - during routine physicals. The task force's recommendations are followed by most medical groups. Two years ago the task force recommended that women in their 40s should no longer get routine mammograms, setting off a firestorm of controversy. The recommendation to avoid the P.S.A. test is even more forceful and applies to healthy men of all ages. Unfortunately, the evidence now shows that this test does not save men's lives, said Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chairwoman of the task force. This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does. Article continues 2) Prostate Test Found to Save Few Lives By GINA KOLATA Published: March 18, 2009 The PSA blood test, used to screen for prostate cancer, saves few lives and leads to risky and unnecessary treatments for large numbers of men, two large studies have found. Mortality Results from a Randomized Prostate-Cancer Screening Trial (The New England Journal of Medicine) Screening and Prostate-Cancer Mortality in a Randomized European Study (The New England Journal of Medicine) The findings, the first based on rigorous, randomized studies, confirm some longstanding concerns about the wisdom of widespread prostate cancer screening. Although the studies are continuing, results so far are considered significant and the most definitive to date. The PSA test, which measures a protein released by prostate cells, does what it is supposed to do - indicates a cancer might be present, leading to biopsies to determine if there is a tumor. But it has been difficult to know whether finding prostate cancer early saves lives. Most of the cancers tend to grow very slowly and are never a threat and, with the faster-growing ones, even early diagnosis might be too late. The studies - one in Europe and the other in the United States - are some of the most important studies in the history of men's health, said Dr. Otis Brawley, the chief medical officer of the American Cancer Society. In the European study, 48 men were told they had prostate cancer and needlessly treated for it for every man whose death was prevented within a decade after having had a PSA test. Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center, says one way to think of the data is to suppose he has a PSA test today. It leads to a biopsy that reveals he has prostate cancer, and he is treated for it. There is a one in 50 chance that, in 2019 or later, he will be spared death from a cancer that would otherwise have killed him. And there is a 49 in 50 chance that he will have been treated unnecessarily for a cancer that was never a threat to his life. Article continues -Original Message- From: Kim Donadio [mailto:one_angel_sec...@yahoo.com] Sent: Tuesday, April 10, 2012 2:33 PM To: Morken, Timothy Cc: Daniel Schneider; Histonet Subject: 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? And for all those advocating closure of private labs, do you also feel the same way about private pathologist owned labs who reep
Re: [Histonet] In House Labs in WSJ
A key government health panel has decided it says. Ok. I give. Sent from my iPhone On Apr 10, 2012, at 5:48 PM, Morken, Timothy timothy.mor...@ucsfmedctr.org wrote: From the New York Times: 1) U.S. Panel Says No to Prostate Screening for Healthy Men By GARDINER HARRIS Published: October 6, 2011 Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided. The draft recommendation, by the United States Preventive Services Task Force and due for official release next week, is based on the results of five well-controlled clinical trials and could substantially change the care given to men 50 and older. There are 44 million such men in the United States, and 33 million of them have already had a P.S.A. test - sometimes without their knowledge - during routine physicals. The task force's recommendations are followed by most medical groups. Two years ago the task force recommended that women in their 40s should no longer get routine mammograms, setting off a firestorm of controversy. The recommendation to avoid the P.S.A. test is even more forceful and applies to healthy men of all ages. Unfortunately, the evidence now shows that this test does not save men's lives, said Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chairwoman of the task force. This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does. Article continues 2) Prostate Test Found to Save Few Lives By GINA KOLATA Published: March 18, 2009 The PSA blood test, used to screen for prostate cancer, saves few lives and leads to risky and unnecessary treatments for large numbers of men, two large studies have found. Mortality Results from a Randomized Prostate-Cancer Screening Trial (The New England Journal of Medicine) Screening and Prostate-Cancer Mortality in a Randomized European Study (The New England Journal of Medicine) The findings, the first based on rigorous, randomized studies, confirm some longstanding concerns about the wisdom of widespread prostate cancer screening. Although the studies are continuing, results so far are considered significant and the most definitive to date. The PSA test, which measures a protein released by prostate cells, does what it is supposed to do - indicates a cancer might be present, leading to biopsies to determine if there is a tumor. But it has been difficult to know whether finding prostate cancer early saves lives. Most of the cancers tend to grow very slowly and are never a threat and, with the faster-growing ones, even early diagnosis might be too late. The studies - one in Europe and the other in the United States - are some of the most important studies in the history of men's health, said Dr. Otis Brawley, the chief medical officer of the American Cancer Society. In the European study, 48 men were told they had prostate cancer and needlessly treated for it for every man whose death was prevented within a decade after having had a PSA test. Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center, says one way to think of the data is to suppose he has a PSA test today. It leads to a biopsy that reveals he has prostate cancer, and he is treated for it. There is a one in 50 chance that, in 2019 or later, he will be spared death from a cancer that would otherwise have killed him. And there is a 49 in 50 chance that he will have been treated unnecessarily for a cancer that was never a threat to his life. Article continues -Original Message- From: Kim Donadio [mailto:one_angel_sec...@yahoo.com] Sent: Tuesday, April 10, 2012 2:33 PM To: Morken, Timothy Cc: Daniel Schneider; Histonet Subject: 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? 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. Is what you really want is to have all pathologist as employees of the hospitals? And 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
