[Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends

[Jay Lundgren]

     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)