[Histonet] In House Labs in WSJ

Nicole Tatum nicole <@t> dlcjax.com
Wed Apr 11 09:52:36 CDT 2012

Agreed , but the idea in recent health care has been early detection. So
as technology increased, more diagnostic test were ordered. But, that is
not only pathology, its micro, radiology, ultrasound, chemistry, etc.
These early test did drive cost up, but also saved cost. Its kinda no win.
If a radical tumor was detected early it could be removed by surgery and
the patient could possibly still live a healthy cancer free life. If not
detected, the patient could suffer through chemo and expensive radiation,
and expensive hospice. Leaving the family devistated with medical bills
and the loss of a loved one that a simple diagnostic test could have
detected. Also, there is a huge problem with the malpractice suits in our
country. If the pateint did suffer or die because a simple test was not
ordered that could save their life the physician is held responsible and
sued and could possibly lose his license and career. If less test are the
answer to cutting cost to our rising health deficit, then doctors should
be more protected when they make choices not to order tests that could
save your life. Despite cost, in court they will argue it was a "simple"
inexpensive test that could have saved his or her life. The physician is
charged with protecting a patients health and he needs tool to do that.
Tools that are being taken because they are unaffordable. We must learn
how to manage our resources at every level. I for one would be devistated
if I had cervical cancer because my OB did not submit a specimen when my
pap came back as abnormal. I would be willing to pay the path fee out of
pocket to have an answer. But, that's also part of the problem. People do
not want to pay for services they recieve. But, they have a really nice
flat screen and iphone. This economic crisis is a result of the public and
health professional and gas prices, etc. We must stick together and come
up with ways to still use diagnostic test effectively. They do save lives
and save money, maybe on a small scale compared to those who are not
diagnosed with any condition. Our current health care model has been based
on detection and prevention. It will have to change for our industry to
survive. Resouces will have to be rationed but I fear it is being given
the title of over-utilization instead. As current tests decrease and
physician are pushed to order less; I fear there will be an increase of
misdiagnosises and an increase in malpractice suits. Its becomming scarry
out there.. This change will effect each one of us.

Nicole Tatum HT ASCP

 On 4/10/2012 5:33 PM, Kim Donadio wrote:
>>> Less screening = fewer biopsies = less revenue = less prostate cancers
>>> caught early = more deaths to prostate cancers.
>> Would you not agree?
> No. There is very good scientific evidence that screening does not
> increase survival rates but it does drive up costs and unnecessary
> surgery and related complications.
> I can send the papers from NEJM if you like.
> Geoff
>> And for all those advocating closure of private labs, do you also feel
>> the same way about private pathologist owned labs who reep the benefits
>> of getting all the out PT work from affiliated physicians while they
>> also get a fee to serve as medical directors of hospital labs and get
>> the pc portion of hospital work of which they can order as many test
>> they want so they get the pc portion while the hospital gets the tc and
>> all the big bills associated with doing the test making it hard on tax
>> payer as well because so much in a hospital is already subsidize by the
>> gov.
>> Is what you really want is to have all pathologist as employees of the
>> hospitals? And have the hospital bill global.
>> And a few walmart like reference labs
>> I'm just curious as to the exact position of some on here.
>> Thanks
>> Kim
>> Sent from my iPhone
>> On Apr 10, 2012, at 2:39 PM, "Morken,
>> Timothy"<Timothy.Morken <@t> ucsfmedctr.org>  wrote:
>>> Not surprising since our health care system is biased to pay for tests
>>> and treatments, not results. On top of this there are serious questions
>>> as to whether the PSA screening that leads to biopsies is useful in the
>>> long term. There is a recommendation out there to stop PSA screening
>>> for most men since it is largely  non-specific. That test is what leads
>>> to the biopsies. Less screening = fewer biopsies = less revenue.
>>> Tim Morken
>>> -----Original Message-----
>>> From: histonet-bounces <@t> lists.utsouthwestern.edu
>>> [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Daniel
>>> Schneider
>>> Sent: Tuesday, April 10, 2012 11:22 AM
>>> To: Histonet
>>> Subject: [Histonet] In House Labs in WSJ
>>> The Wall Street Journal served up a timely article for us.
>>> You'll see both sides of the argument below. One side is right.
>>> DLS
>>> April 9, 2012, 7:22 p.m. ET
>>> Prostate-Test Fees Challenged
>>> Doctors in urology groups that profit from tests for prostate cancer
>>> order more of them than doctors who send samples to independent
>>> laboratories, according to a study Monday in the journal Health
>>> Affairs.
>>> The study found that doctors' practices that do their own lab work bill
>>> the federal Medicare program for analyzing 72% more prostate tissue
>>> samples per biopsy while detecting fewer cases of cancer than
>>> counterparts who send specimens to outside labs.
>>> Hiring pathologists boosts revenue for a practice and creates a
>>> potential incentive to increase the number of tests ordered, said Jean
>>> Mitchell, a Georgetown University economist and author of the study.
>>> That fewer cancers were detected-21% versus 35% for those sent to
>>> external labs, according to the study-suggests "financial incentives"
>>> may play a role in decisions to order the tests, Ms. Mitchell said.
>>> Some urologists said the research doesn't necessarily indicate
>>> financial motives. Urologists in larger group practices that have
>>> in-house pathologists may be more aggressive in testing because they
>>> seek to catch cancer earlier, said Steven Schlossberg, a Yale urologist
>>> who heads a health-policy panel for the American Urological Association
>>> and wasn't involved in the research. Also, Dr. Schlossberg noted, the
>>> figures, which cover 36,261 biopsies from 2005 through 2007, are five
>>> years old.
>>> The study was financed by the College of American Pathologists and the
>>> American Clinical Laboratory Association. It is the last salvo in a
>>> turf war between laboratory companies and physician groups that have
>>> opened their own labs to conduct tests.
>>> Regulators and economists scrutinizing the growing costs of health care
>>> have targeted a range of related activities by doctors, known as
>>> self-referrals.
>>> Although a set of 1990s-era laws, named for their proponent, Rep. Pete
>>> Stark (D., Calif.), ban doctors from referring patients to most
>>> companies in which they have a financial interest, urology groups can
>>> enter the pathology business because of an exemption for certain
>>> services performed within physicians' offices. The pathologists and
>>> other groups are lobbying Congress to end the exemption.
>>> At issue in the study is a quirk of billing for lab procedures. Labs
>>> get paid based on the number of jars used to hold specimens from a
>>> prostate biopsy. Doctors can choose to put several specimens in one jar
>>> or put each in its own jar, potentially boosting lab fees, which
>>> averaged about $104 a jar in 2010, according to the study.
>>> Urologists in practices with in-house pathologists sent 11.4 jars per
>>> biopsy for testing versus 5.9 jars per biopsy for other doctors in
>>> 2005.
>>> Some doctors say that separating the samples can help them better map
>>> any cancer.
>>> In addition, urologists in recent years have been taking more samples
>>> during a biopsy to better identify the location of any cancer, said
>>> John Hollingsworth, an assistant professor of urology at the University
>>> of Michigan. The standard number of samples taken doubled to 12 over
>>> the last decade, he said.
>>> The Health Affairs study's conclusions are "largely around billing
>>> practices, not around clinical practices," said George Kwass, a
>>> pathologist based in Massachusetts and board member of the College of
>>> American Pathologists. Urologists who team up with pathologists appear
>>> to bill more, he said, leading to potential waste.
>>> Urology groups are consolidating, and increasingly moving into the
>>> pathology business. One large practice based on New York's Long Island,
>>> Integrated Medical Professionals, opened its lab in 2010 to control
>>> costs and because doctors encountered errors in outside test results,
>>> said the group's chairman, Deepak Kapoor.
>>> "We don't make a fortune on pathology," Dr. Kapoor said.
>>> But lab businesses are seeing revenue vanish. Texas pathology group
>>> ProPath stopped getting prostate tissue from large urology groups more
>>> than four years ago, said executive director Krista Crews, when these
>>> clients began doing lab work in-house. The group still gets referrals
>>> from small, one and two-doctor practices, she said.
>>> Large laboratory companies are worried about the trend, too. Quest
>>> Diagnostics Inc. DGX -2.52%said in its latest annual filings that if
>>> physicians, including urologists as well as gastroenterologists and
>>> skin and cancer doctors, continued to "internalize" testing services,
>>> it could reduce the company's sales.
>>> Write to Christopher Weaver at christopher.weaver <@t> wsj.com
>>> Copyright 2012 Dow Jones&  Company, Inc. All Rights Reserved
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