[Histonet] RE: Histonet Digest, Vol 101, Issue 32
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 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
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
