[Histonet] Clarification on pod labs

[Daniel Schneider]

What we have here is market distortion by a payment scheme that  
doesn't reflect the real costs.  You have to ask yourself "why would a  
urologist/dermatologist/gastroenterologist want to mess with a  
histology lab?"
Follow the money.  Processing biopsies, I.e. the technical component  
of CPT code 88305, is ridiculously profitable. It's reimbursement is  
way out of proportion to the actual costs involved, which is why these  
clinicians are willing to invest in small inefficient in-office labs  
-- they're still going to clean up. Cha Ching!  Hospital based  
pathologists rely on the profitable biopsy business to make up for the  
time and resources devoted to less profitable sides of their work, for  
example resection specimens ( CPT code 88307's and 88309's)that are  
reimbursed more than a biopsy but not proportionate to the cost of  
processing them ( complex grossing requring more time and expertise  
from  a PA or often a pathologist, as well as many blocks to process,  
embed, and cut,  and more time at the scope reviewing these many  
slides.). When someone else cherry picks the biopsies, hospital labs  
suffer.  But you say, it's just business, it's the American way.  But  
it's only that way because of fat reimbursement for the TC on 88305.  
Cut that significantly, and all these in-office labs become  
liabilities, not profit centers.  The urologists/derms/GI's will then  
close their labs, and their histotechs will get kicked to the curb.   
Given the healthcare climate in this country, and the fact that  
everybody knows the technical component on 88305 is relatively rich,  
how likely do you think that is?


Dan Schneider
(Obligatory Disclosure:  I
a Hospital Based Pathologist.)

Sent from my iPhone

On Feb 7, 2010, at 1:32 PM, "Andrew Burgeson" <napoli <@t> siscom.net> wrote:

> When referring to all labs in the USA being
> "privately-owned," I am, of course, excluding government
> facilities. BUT...even those facilities employ people who
> make $ working in this field and so have some interest in
> the discussions.
>
> Also, due to the fact that MEDICARE is such a big factor in
> US medical reimbursements, anyone with a Medicare ID who
> gets paid by the government is, in a sense, a "government"
> provider. So in this sense, the system is mixed.
>
> My post refers specifically to non-government labs. (with
> the understanding that most everyone bills medicare)
>
> AB
>
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