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

[Weems, Joyce K.]

     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.


      JW - I've always thought this was for financial gain only... I fussed and fussed at my pathologists
      because they were being courted by urologists - finally it all fell through, but it just wasn't right
      for pathology to leave the hospital. Medicare stopped the multiple payments a few years ago tho.

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/)

        JW - it does if you're the patient with the carcinoid.

     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.

        JW - still thinking about this one - if the pathologist is sitting in the courtroom because he/she missed one - it might be.

My 2 cents...

Joyce Weems
Pathology Manager
678-843-7376 Phone
678-843-7831 Fax
joyce.weems <@t> emoryhealthcare.org



www.saintjosephsatlanta.org
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Atlanta, GA 30342

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-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Davide Costanzo
Sent: Tuesday, October 30, 2012 4:47 PM
To: Jay Lundgren
Cc: histonet <@t> lists.utsouthwestern.edu; Webster, Thomas S.
Subject: Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends

Well said!

Sent from my iPhone

On Oct 30, 2012, at 1:19 PM, Jay Lundgren <jaylundgren <@t> gmail.com> wrote:

     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)
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