[Histonet] Aetna and In-Office Lab Accreditation

Richard Cartun Rcartun <@t> harthosp.org
Mon Apr 9 18:43:06 CDT 2012

This was released today.


Statline Special Alert:
New Evidence Links Self-Referral Labs to Increased Utilization, Lower
Cancer Detection Rates
Study co-funded by CAP Appears in April 2012 Issue of Health Affairs 
April 9—Self-referring urologists billed Medicare for nearly 75% more
anatomic pathology (AP) specimens compared to non self-referring
physicians, according to a study published today in a leading health
care policy journal. Furthermore, the study found no increase in cancer
detection for the patients of self-referring physicians-in fact, the
detection rate was 14% lower than that of non self-referring

These findings, from an independent study co-funded by the CAP, provide
the first clear evidence that self-referral of anatomic pathology
services leads to increased utilization, higher Medicare spending, and
lower rates of cancer detection. The study, led by renowned Georgetown
University health care economist Jean Mitchell, PhD, will appear in the
April 2012 issue of Health Affairs and is now available on the
journal’s website.


>>> Daniel Schneider <dlschneider <@t> gmail.com> 4/9/2012 4:47 PM >>>
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
partners' meetings and you would know that's what they are talking

To suggest otherwise is disingenuous.

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

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

*"in-office AP labs are an emerging frontier of employment for
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
there's the same number of jobs, more or less, just under different
circumstances and in different locations   Unless you're suggesting
in-office labs will generate increased specimens, and thus increased
though overutilization, i.e. excessive numbers of unnecessary biopsies
abuse of the patient and the taxpayer.  In which case I have to say
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
who find themselves working in an in-office lab. I know there's bills
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
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
> by facilitating 1) better communication between pathologists and
> clinicians, 2) quality metrics that are practice-specific, and 3)
> volume, sub-specialization for both histotechnologists and
>  In other words, the more of one type of histopathology a lab does
> skin, prostate, GI), the better it gets.  Most people would not think
> having their cardiac bypass surgery done at a community hospital
> 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
> tissue type.  Many hospital labs do little skin or prostate
> 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
> for histologists and pathologists.  In an era of high unemployment,
> source of employment for our professions is "a good thing."
> This requirement by an insurer for accreditation will help to
> these in-office AP labs' commitment to quality and put them on the
> with their hospital counterparts.
> John D. Cochran, MD, FCAP
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