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

Rene J Buesa rjbuesa <@t> yahoo.com
Tue Oct 30 15:38:14 CDT 2012

I really agree with those two examples. Do not think only in function of the payment to the practitioner, but on the fact that if we do not find appropriate ways of reducing costs, in just a few years health care will "eat" 50% of the national budget, and something has to be done.
Either eliminating unnecessary procedures or reducing "defensive medical practices" fundamentally aimed at covering the "rear end" of physicians threaten by all sorts of "law suits" and liabilities.
Along with the reform on medical providing steps, a reform of the tort system should also be included.
René J.

From: Jay Lundgren <jaylundgren <@t> gmail.com>
To: "Joe W. Walker, Jr." <joewalker <@t> rrmc.org> 
Cc: "histonet <@t> lists.utsouthwestern.edu" <histonet <@t> lists.utsouthwestern.edu>; "Webster, Thomas S." <twebster <@t> crh.org> 
Sent: Tuesday, October 30, 2012 4:19 PM
Subject: Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends

    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:

    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.


                                                Jay A. Lundgren, M.S., HTL
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