[Histonet] Aetna and In-Office Lab Accreditation

Daniel Schneider dlschneider <@t> gmail.com
Mon Apr 9 15:47:04 CDT 2012

This is all about the money. The rest is rationalization.

The reason a group of non-pathologist physicians opens an in-house
pathology lab and hires an employee pathologist is first and foremost
to harvest profit from pathology reimbursement. Be a fly on the wall in the
partners' meetings and you would know that's what they are talking about.

To suggest otherwise is disingenuous.

And the implication that the generalist anatomic pathologist is unqualified
to be signing out skins, prostates, GI's and whatever is reprehensible.
This is not cardiac bypass surgery, and AP pathologists *are* trained to do
all of the above. I eagerly defer to subspecialty expert consultants as
needed, but most of the time they're not needed.

Hospital labs that see few, if any skins, prostates, GI's, are only in that
pickle because of the cherrypicking they've already been subjected to.

*"in-office AP labs are an emerging frontier of employment for histologists
and pathologists.  In an era of high unemployment, another source of
employment for our professions is "a good thing.""*

Really? The jobs follow the specimens. Given the same number of specimens,
there's the same number of jobs, more or less, just under different
circumstances and in different locations   Unless you're suggesting that
in-office labs will generate increased specimens, and thus increased jobs
though overutilization, i.e. excessive numbers of unnecessary biopsies and
abuse of the patient and the taxpayer.  In which case I have to say there's
a grain of truth. And the truth hurts.  And it's not " a good thing."

None of this should be taken as criticism of histotechs and pathologists
who find themselves working in an in-office lab. I know there's bills to
pay, families to take care of, and god knows it's hard for a pathologist to
find a job these days with the numbers our residency programs keep churning
out (but that's another rant...).

Dan Schneider, MD
Amarillo, TX

On Mon, Apr 9, 2012 at 12:52 PM, <jdcochran <@t> aol.com> wrote:

> Histonetters:
> In-office AP labs provide a valuable service to the practices they serve
> by facilitating 1) better communication between pathologists and ordering
> clinicians, 2) quality metrics that are practice-specific, and 3) high
> volume, sub-specialization for both histotechnologists and pathologists.
>  In other words, the more of one type of histopathology a lab does (e.g.,
> skin, prostate, GI), the better it gets.  Most people would not think of
> having their cardiac bypass surgery done at a community hospital doing
> 50/year; you want to go where more than 500/year are done.  In
> histopathology, the kinds of volume you want are in the thousands for each
> tissue type.  Many hospital labs do little skin or prostate histology
> anymore.  Many sub-specialty in-office AP labs may do thousands of cases of
> one tissue type every year.
> Aside from that, in-office AP labs are an emerging frontier of employment
> for histologists and pathologists.  In an era of high unemployment, another
> source of employment for our professions is "a good thing."
> This requirement by an insurer for accreditation will help to validate
> these in-office AP labs' commitment to quality and put them on the level
> with their hospital counterparts.
> John D. Cochran, MD, FCAP
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