Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends
Mrs. Buesa, I sincerely hope you are not pointing = to me as trying to foment some kind of fear to drive voting in one = direction or another. I did state in my original post that I = hoped we could avoid the political vitriol, but I guess because the future = is somewhat foggy as to what is going to happen, I should have just left = out mention of political parties/presidents in my original post. = We're mere days away from the final reconning, so if people haven't done = their due diligence and research on each candidate and the issues we're = facing, basing your decision on some comments on a forum might be a poor = way to base such an important decision. The trending in POL's is = currently having a DIRECT effect on my employment situation, so that was = the motivation for my original post.I would like to = understand the landscape and ecosystem of private labs, POL's, large = references labs and the like, and I am only just starting to understand = the labrynth that is the medicaire billing system.How this = all plays out is going to effect us all directly, so it is I guess = understandable that opinions and emotions almost can't be filtered out of = the discussion. Our livelihoods are on the line. My sincere = appologies though if I have ruffled too many feathers here. I was merely looking for deeper insight and = knowledge into the topic.One topic that seems to have been = raised though, and wich I tend to agree, is there is some bloat, or = overinflation of procedures going on, which cuts to the heart of the issue = -- monetary incentives to inflate charges and thus revenue, especially if = Pathologists are now able to get an extra cut of the lab-fees involved.Personally I don't think it's a bad idea at all to scrutinize very closely what is going on with this, even if it upsets the = balance and flows of money... if it leads to a more efficient and just = system. _ [1]3D"Smileys Get Free Smileys for Your IM = & Email - Learn more at [2]www.crawler.com/smileys Works with AIM®, = MSN® Messenger, Yahoo!^® Messenger, ICQ®, Google Talk(TM) and most webmails References 1. 3D"http://www.inbox.com/smileys"; 2. 3D"http://www.crawler.com/smileys"; ___ 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
I don't think that the urologist would agree with you. There were several studies that have shown that not sampling adequately from the various areas of the prostate misses cancers. Not to mention that some urologists now treat their patients different. I am not aware of a cost analysis or a benefit to patient but below are just a few examples of why it would be important to sample at least 12. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845759/ Canadian Urologic Association recommendations for prostate biopsies (2010). Can Urol Assoc J. 2010 April; 4(2): 89-94. Sextant biopsy scheme The original systematic biopsy method is the sextant biopsy scheme (1 core from the base, mid, and apex bilaterally).38 With this scheme, the cores were taken through the parasagittal plane, which resulted in some false-negative results39 (Level 2 evidence). Up to 30% of cancers were missed by the standard sextant biopsy40,41 (Level 2 evidence). Presti JC, Jr, Chang JJ, Bhargava V, et al. The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol. 2000;163:163-6. [PubMed] Norberg M, Egevad L, Holmberg L, et al. The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology. 1997;50:562-6. [PubMed] Recommendation: An extended biopsy scheme of 10 to 12 cores is recommended to optimize the ratio of cancer detection to adverse post-biopsy events. Lesion-guided biopsy can be added to further optimize cancer detection (Grade A recommendation). 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: Davide Costanzo [mailto:pathloc...@gmail.com] Sent: Tuesday, October 30, 2012 3:40 PM To: Joe W. Walker, Jr. Cc: Webster, Thomas S.; histonet@lists.utsouthwestern.edu Subject: 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." 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." 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
Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends
To everybody worrying for something that has NOT happen yet and that NOBODY knows if will happen. These are pure speculations. Do not put the cart before the horses. I do not think that this scary scenario is in the near future. René J. From: Brendal Finlay To: "Webster, Thomas S." Cc: "histonet@lists.utsouthwestern.edu" Sent: Wednesday, October 31, 2012 9:39 AM Subject: Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends This is disturbing news. As an employee of an "in-house" lab (which started in 1996/1997) that does mostly skins, GI biopsies, and outpatient surgery specimens I'm pretty disheartened to hear about the 88305 issue. Melanoma excisions, prostates (even lower block # cases, we don't always get 12), breast biopsies, and other more difficult cases can be a lot of work on both the professional & technical end of things. As for prostate biopsies, CMS has already lowered reimbursement with the G codes. This is despite the wording that they are for saturation biopsies. We rarely have saturation biopsies, but Medicare denies us the 88305 charge if more than 5 specimens. Other insurance companies tend to follow their lead after a little time. I believe reimbursement is 50-75% less for 5-20 biopsies, but don't quote me on that. I expect we may see the end of saturation and multi-container prostate biopsies in the near future. Another issue for many outpatient labs in my area is that larger insurances are requiring their patients to go to large multinational labs. We cannot accept many PPOs or Medicare replacement plans because of this. I feel it can be a disservice to the patient because they do not get the same personal, local service with good turn around times. Even my insurance requires me to go to one of these labs where I feel inconvenienced and frustrated at the wait time required to submit my sample and get results to my physician. On Oct 31, 2012, at 8:17 AM, "Webster, Thomas S." wrote: > Here is what CAP has on their website about the issue. > Only the TC of 88305 is being discussed for 2013. We should know fairly soon > the decision. > More codes have been flagged as overvalued as well that could be cut for 2014 > (PC and TC at this point). > > http://www.cap.org/apps/docs/advocacy/advocacy_issues/revaluation.pdf > > > 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] The Rise of Physician Owned/Operated Labs (POLs) and future trends
This is disturbing news. As an employee of an "in-house" lab (which started in 1996/1997) that does mostly skins, GI biopsies, and outpatient surgery specimens I'm pretty disheartened to hear about the 88305 issue. Melanoma excisions, prostates (even lower block # cases, we don't always get 12), breast biopsies, and other more difficult cases can be a lot of work on both the professional & technical end of things. As for prostate biopsies, CMS has already lowered reimbursement with the G codes. This is despite the wording that they are for saturation biopsies. We rarely have saturation biopsies, but Medicare denies us the 88305 charge if more than 5 specimens. Other insurance companies tend to follow their lead after a little time. I believe reimbursement is 50-75% less for 5-20 biopsies, but don't quote me on that. I expect we may see the end of saturation and multi-container prostate biopsies in the near future. Another issue for many outpatient labs in my area is that larger insurances are requiring their patients to go to large multinational labs. We cannot accept many PPOs or Medicare replacement plans because of this. I feel it can be a disservice to the patient because they do not get the same personal, local service with good turn around times. Even my insurance requires me to go to one of these labs where I feel inconvenienced and frustrated at the wait time required to submit my sample and get results to my physician. On Oct 31, 2012, at 8:17 AM, "Webster, Thomas S." wrote: > Here is what CAP has on their website about the issue. > Only the TC of 88305 is being discussed for 2013. We should know fairly soon > the decision. > More codes have been flagged as overvalued as well that could be cut for 2014 > (PC and TC at this point). > > http://www.cap.org/apps/docs/advocacy/advocacy_issues/revaluation.pdf > > > 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
Please share with all. I'd like to know too. Thanks, 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 Daniel Schneider Sent: Wednesday, October 31, 2012 8:34 AM To: Webster, Thomas S. Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends I don't doubt what you're saying, but can you source this info more specifically than "a consultant?" I'm going to discuss this with my colleagues and they're going to ask me. Needless to say, a 10-20% cut in the TC of 88305, coming down the pipe in a month or two, is a big deal. Dan Schneider, MD Sent from my iPhone On Oct 31, 2012, at 6:49 AM, "Webster, Thomas S." wrote: > I am scared to see what is going to happen to the technical component of > 88305 next month. A consultant is telling people to prepare for a 10 to 20 > percent cut. Immunos and cytology enhancement 88112 are going to be slashed > for 2014. It's going to be very difficult for smaller AP labs to survive. The > medicare business helps keep the doors open for some labs with low client > pricing and the other payers will reduce payments as well. > > > 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 e-mail message (including any attachments) is for the sole use of the intended recipient(s) and may contain confidential and privileged information. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this message (including any attachments) is strictly prohibited. If you have received this message in error, please contact the sender by reply e-mail message and destroy all copies of the original message (including attachments). ___ 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
I don't doubt what you're saying, but can you source this info more specifically than "a consultant?" I'm going to discuss this with my colleagues and they're going to ask me. Needless to say, a 10-20% cut in the TC of 88305, coming down the pipe in a month or two, is a big deal. Dan Schneider, MD Sent from my iPhone On Oct 31, 2012, at 6:49 AM, "Webster, Thomas S." wrote: > I am scared to see what is going to happen to the technical component of > 88305 next month. A consultant is telling people to prepare for a 10 to 20 > percent cut. Immunos and cytology enhancement 88112 are going to be slashed > for 2014. It's going to be very difficult for smaller AP labs to survive. The > medicare business helps keep the doors open for some labs with low client > pricing and the other payers will reduce payments as well. > > > 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
It's never made sense to me to submit prostate biopsies A-L in separate containers. I'm not an Interventional Radiologist or a Urologist, but when was the last time you saw a Urologic Surgeon remove 1/12 of a prostate? And even for targeted radiation or prostate brachytherapy (radioactive seeds) I would think localizing the neoplasm in a specific quadrant would be sufficient. I've worked in several labs where multiple prostate bxs would be submitted in one container (after agreement by the Clinician and the Pathologist) to save a non-insured patient money. JW - I've always thought this was for financial gain only... I fussed and fussed at my pathologists because they were being courted by urologists - finally it all fell through, but it just wasn't right for pathology to leave the hospital. Medicare stopped the multiple payments a few years ago tho. In my opinion, this is only the beginning. If the Patient Protection and Affordable Care Act kicks in, I think the 15 member Independent Payment Advisory Board is going to be finding A LOT of procedures like this that the government will refuse to pay for. Even if one could make an argument that a procedure is medically sound, these decisions will be made after a cost/benefit analysis. e.g.: Is it beneficial to submit every appendix when the incidence rate of carcinoid tumor of the appendix is 1 in 100,000? (source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356383/) JW - it does if you're the patient with the carcinoid. Is it worth it to diagnose *Helicobacter *via (highly remunerative) IHC when they can be visualized on an H&E? Especially since there is an inexpensive, simple and safe breath test available. JW - still thinking about this one - if the pathologist is sitting in the courtroom because he/she missed one - it might be. My 2 cents... Joyce Weems Pathology Manager 678-843-7376 Phone 678-843-7831 Fax joyce.we...@emoryhealthcare.org www.saintjosephsatlanta.org 5665 Peachtree Dunwoody Road Atlanta, GA 30342 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 Davide Costanzo Sent: Tuesday, October 30, 2012 4:47 PM To: Jay Lundgren Cc: histonet@lists.utsouthwestern.edu; Webster, Thomas S. Subject: Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends Well said! Sent from my iPhone On Oct 30, 2012, at 1:19 PM, Jay Lundgren wrote: It's never made sense to me to submit prostate biopsies A-L in separate containers. I'm not an Interventional Radiologist or a Urologist, but when was the last time you saw a Urologic Surgeon remove 1/12 of a prostate? And even for targeted radiation or prostate brachytherapy (radioactive seeds) I would think localizing the neoplasm in a specific quadrant would be sufficient. I've worked in several labs where multiple prostate bxs would be submitted in one container (after agreement by the Clinician and the Pathologist) to save a non-insured patient money. In my opinion, this is only the beginning. If the Patient Protection and Affordable Care Act kicks in, I think the 15 member Independent Payment Advisory Board is going to be finding A LOT of procedures like this that the government will refuse to pay for. Even if one could make an argument that a procedure is medically sound, these decisions will be made after a cost/benefit analysis. e.g.: Is it beneficial to submit every appendix when the incidence rate of carcinoid tumor of the appendix is 1 in 100,000? (source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356383/) Is it worth it to diagnose *Helicobacter *via (highly remunerative) IHC when they can be visualized on an H&E? Especially since there is an inexpensive, simple and safe breath test available. Brace yourselves Histonet, winter is coming. Sincerely, Jay A. Lundgren, M.S., HTL (ASCP) ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet This e-mail message (including any attachments) is for the sole use of the intended recipient(s) and may contain confidential and privileged information. If the reader of this message is not the intended recipient, yo
Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends
There is no doubt that health care costs will bankrupt the nation if they continue to grow at the present rate. source: http://www.ssab.gov/documents/TheUnsustainableCostofHealthCare_graphics.pdf The only question is what measures is the government willing to take to bring them down. I think the Histology Laboratory could lose 50% of our specimens very soon. This is on top of the loss of 88305s to Derm, GI, and Urology POLs that has already occurred in most parts of the country. I really think that if the Independent Payment Advisory Board gets going, a Medicare patient who used to get a $40,000.00 total hip replacement will now be given a cane and some Tylenol. There's another specimen the Histology Lab will not receive. Remember, the Patient Protection and Affordable Care Act was pushed though Congress by Executive fiat, not by passing a vote. I foresee that nationalization of medical schools is not out of the question. On the bright side, it should take care of our chronic shortage of histotechs. ;) 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 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 *To:* "Webster, Thomas S." *Cc:* "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." 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] 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 wrote: It's never made sense to me to submit prostate biopsies A-L in separate containers. I'm not an Interventional Radiologist or a Urologist, but when was the last time you saw a Urologic Surgeon remove 1/12 of a prostate? And even for targeted radiation or prostate brachytherapy (radioactive seeds) I would think localizing the neoplasm in a specific quadrant would be sufficient. I've worked in several labs where multiple prostate bxs would be submitted in one container (after agreement by the Clinician and the Pathologist) to save a non-insured patient money. In my opinion, this is only the beginning. If the Patient Protection and Affordable Care Act kicks in, I think the 15 member Independent Payment Advisory Board is going to be finding A LOT of procedures like this that the government will refuse to pay for. Even if one could make an argument that a procedure is medically sound, these decisions will be made after a cost/benefit analysis. e.g.: Is it beneficial to submit every appendix when the incidence rate of carcinoid tumor of the appendix is 1 in 100,000? (source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356383/) Is it worth it to diagnose *Helicobacter *via (highly remunerative) IHC when they can be visualized on an H&E? Especially since there is an inexpensive, simple and safe breath test available. Brace yourselves Histonet, winter is coming. Sincerely, Jay A. Lundgren, M.S., HTL (ASCP) ___ 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
I really agree with those two examples. Do not think only in function of the payment to the practitioner, but on the fact that if we do not find appropriate ways of reducing costs, in just a few years health care will "eat" 50% of the national budget, and something has to be done. Either eliminating unnecessary procedures or reducing "defensive medical practices" fundamentally aimed at covering the "rear end" of physicians threaten by all sorts of "law suits" and liabilities. Along with the reform on medical providing steps, a reform of the tort system should also be included. René J. From: Jay Lundgren To: "Joe W. Walker, Jr." Cc: "histonet@lists.utsouthwestern.edu" ; "Webster, Thomas S." Sent: Tuesday, October 30, 2012 4:19 PM Subject: Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends It's never made sense to me to submit prostate biopsies A-L in separate containers. I'm not an Interventional Radiologist or a Urologist, but when was the last time you saw a Urologic Surgeon remove 1/12 of a prostate? And even for targeted radiation or prostate brachytherapy (radioactive seeds) I would think localizing the neoplasm in a specific quadrant would be sufficient. I've worked in several labs where multiple prostate bxs would be submitted in one container (after agreement by the Clinician and the Pathologist) to save a non-insured patient money. In my opinion, this is only the beginning. If the Patient Protection and Affordable Care Act kicks in, I think the 15 member Independent Payment Advisory Board is going to be finding A LOT of procedures like this that the government will refuse to pay for. Even if one could make an argument that a procedure is medically sound, these decisions will be made after a cost/benefit analysis. e.g.: Is it beneficial to submit every appendix when the incidence rate of carcinoid tumor of the appendix is 1 in 100,000? (source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356383/) Is it worth it to diagnose *Helicobacter *via (highly remunerative) IHC when they can be visualized on an H&E? Especially since there is an inexpensive, simple and safe breath test available. Brace yourselves Histonet, winter is coming. Sincerely, Jay A. Lundgren, M.S., HTL (ASCP) ___ 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
It's never made sense to me to submit prostate biopsies A-L in separate containers. I'm not an Interventional Radiologist or a Urologist, but when was the last time you saw a Urologic Surgeon remove 1/12 of a prostate? And even for targeted radiation or prostate brachytherapy (radioactive seeds) I would think localizing the neoplasm in a specific quadrant would be sufficient. I've worked in several labs where multiple prostate bxs would be submitted in one container (after agreement by the Clinician and the Pathologist) to save a non-insured patient money. In my opinion, this is only the beginning. If the Patient Protection and Affordable Care Act kicks in, I think the 15 member Independent Payment Advisory Board is going to be finding A LOT of procedures like this that the government will refuse to pay for. Even if one could make an argument that a procedure is medically sound, these decisions will be made after a cost/benefit analysis. e.g.: Is it beneficial to submit every appendix when the incidence rate of carcinoid tumor of the appendix is 1 in 100,000? (source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356383/) Is it worth it to diagnose *Helicobacter *via (highly remunerative) IHC when they can be visualized on an H&E? Especially since there is an inexpensive, simple and safe breath test available. Brace yourselves Histonet, winter is coming. Sincerely, Jay A. Lundgren, M.S., HTL (ASCP) ___ 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
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 To: "Webster, Thomas S." Cc: "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." 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] 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." 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." 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
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." 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
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." 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
