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

[Joe W. Walker, Jr.]

I don't think that the urologist would agree with you.   There were several studies that have shown that not sampling adequately from the various areas of the prostate misses cancers.  Not to mention that some urologists now treat their patients different.  I am not aware of a cost analysis or a benefit to patient but below are just a few examples of why it would be important to sample at least 12.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845759/

Canadian Urologic Association recommendations for prostate biopsies (2010).  Can Urol Assoc J. 2010 April; 4(2): 89-94.


Sextant biopsy scheme
The original systematic biopsy method is the sextant biopsy scheme (1 core from the base, mid, and apex bilaterally).38 With this scheme, the cores were taken through the parasagittal plane, which resulted in some false-negative results39 (Level 2 evidence). Up to 30% of cancers were missed by the standard sextant biopsy40,41 (Level 2 evidence).

Presti JC, Jr, Chang JJ, Bhargava V, et al. The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol. 2000;163:163-6. [PubMed]

Norberg M, Egevad L, Holmberg L, et al. The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology. 1997;50:562-6. [PubMed]


Recommendation: An extended biopsy scheme of 10 to 12 cores is recommended to optimize the ratio of cancer detection to adverse post-biopsy events. Lesion-guided biopsy can be added to further optimize cancer detection (Grade A recommendation).

Joe W. Walker, Jr. MS, SCT(ASCP)CM
Anatomical Pathology Manager
Rutland Regional Medical Center
160 Allen Street, Rutland, VT 05701
P: 802.747.1790  F: 802.747.6525
NEW EMAIL: joewalker <@t> rrmc.org
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-----Original Message-----
From: Davide Costanzo [mailto:pathlocums <@t> gmail.com]
Sent: Tuesday, October 30, 2012 3:40 PM
To: Joe W. Walker, Jr.
Cc: Webster, Thomas S.; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] The Rise of Physician Owned/Operated Labs (POLs) and future trends

Because going from 2 parts (left and right only) to 6, and now to
12,18 or even 24 does not seem to have had any effect on quality of care, nor changed outcomes much at all. Do you have any data to demonstrate justification for a six-fold increase in pathology fees?
I'm curious. I was going to do my second masters thesis on cost-benefit analysis of multipart prostate biopsies, when I was told if I did I would lose my job.


Sent from my iPhone

On Oct 30, 2012, at 12:24 PM, "Joe W. Walker, Jr." <joewalker <@t> rrmc.org> wrote:

> Davide,
>
> I'm curious as to why you would characterize a 12 part prostate biopsy billing 88305x12 abuse?
>
> Joe W. Walker, Jr. MS, SCT(ASCP)CM
> Anatomical Pathology Manager
> Rutland Regional Medical Center
> 160 Allen Street, Rutland, VT 05701
> P: 802.747.1790  F: 802.747.6525
> NEW EMAIL: joewalker <@t> rrmc.org
> www.rrmc.org
>
> Our Vision:
> To be the Best Community Healthcare System in New England
>
> Rutland Regional...Vermont's 1st Hospital to Achieve Both ANCC Magnet
> Recognition® and the Governor's Award for Performance Excellence
>
>
> -----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 2:56 PM
> To: Webster, Thomas S.
> Cc: histonet <@t> lists.utsouthwestern.edu
> Subject: Re: [Histonet] The Rise of Physician Owned/Operated Labs
> (POLs) and future trends
>
> We still bill 88305 x 12 on prostates. It is common to do that, despite the obvious abuse this represents.
>
> Sent from my iPhone
>
> On Oct 30, 2012, at 10:38 AM, "Webster, Thomas S." <twebster <@t> crh.org> wrote:
>
>> The technical component of the 88305 CPT code is about to get slashed next month by CMS. This will likely have an impact on the growth of in-office labs I am sure. Other codes are scheduled to be cut in 2014, including immunos and cytology 88112. It wont be nearly as profitable to have an in office lab. Plus Urologists aren't allowed to bill 88305x12 any longer. Some were putting cores in 12 different containers.
>>
>> Just look for more client billing to replace the in office labs.
>>
>>
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