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

[Brendal Finlay]

This is disturbing news. As an employee of an "in-house" lab (which started in 1996/1997) that does mostly skins, GI biopsies, and outpatient surgery specimens I'm pretty disheartened to hear about the 88305 issue. Melanoma excisions, prostates (even lower block # cases, we don't always get 12), breast biopsies, and other more difficult cases can be a lot of work on both the professional & technical end of things.  

As for prostate biopsies, CMS has already lowered reimbursement with the G codes. This is despite the wording that they are for saturation biopsies. We rarely have saturation biopsies, but Medicare denies us the 88305 charge if more than 5 specimens. 

Other insurance companies tend to follow their lead  after a little time.  I believe reimbursement is 50-75% less for 5-20 biopsies, but don't quote me on that.  I expect we may see the end of saturation and multi-container prostate biopsies in the near future. 

Another issue for many outpatient labs in my area is that larger insurances are requiring their patients to go to large multinational labs.  We cannot accept many PPOs or Medicare replacement plans because of this. 

I feel it can be a disservice to the patient because they do not get the same personal, local service with good turn around times. Even my insurance requires me to go to one of these labs where I feel inconvenienced and frustrated at the wait time required to submit my sample and get results to my physician. 

On Oct 31, 2012, at 8:17 AM, "Webster, Thomas S." <twebster <@t> CRH.org> wrote:

> Here is what CAP has on their website about the issue.
> Only the TC of 88305 is being discussed for 2013. We should know fairly soon the decision.
> More codes have been flagged as overvalued as well that could be cut for 2014 (PC and TC at this point).
> 
> http://www.cap.org/apps/docs/advocacy/advocacy_issues/revaluation.pdf
> 
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