CAP Webinar Summary

[LADoc00]

For those that didnt attend the teleconference/webinar on the 2014 PFS reduction:
Highlights:
1.) Obamacare supposedly gave the CMS "power" (although technically illegal) to completely ignore the RUC recommendations and impose their own pricing for physician services aka G-codes. This is part of the ACA's Correct Coding Initiative to review "overutilized common codes" which they plan to dump CPT coding and replace with G-codes to blockade payments.

2.) Overall Pathology will experience back to back 6% reductions in payments BUT in my own analysis last night, a group with substantial immuno usage will see something on the order of a 10% reduction.

3.) Prostate biopsies reads reduced by 60%. So if you also do this, much more than 10%.

4.) RUC representation now appears to be totally worthless going forward.

5.) I think many of us were directly LIED to about bundling of Pathology services into Medicare Outpatient Prospective Payment System as there are multiple codes I cant see ever getting paid on again including frozen sections and stat cytology reads etc. I feel strongly the idea is that the entire Pathology Fee Schedule will be bundled in 2015 ending the private practice of Pathology completely.

I honestly think this is probably game over unless Obamacare is thrown completely out (which is looking harder and harder) and there is some sanity returned to the CPT/RUC process.

Perhaps a catastrophic Democratic defeat in 2014 could swing this, but I doubt it will come in time.

Oh well, was nice knowing you guys.

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[AZpath]

I listened to the presentation also. You so right.
Our group will be hit by about at least 10 of revenue on the IHC reduction alone.
Many additonal cuts due to the outpatient bundling. This could be another 0-10% depending on your case mix.
I feel sorry for us all.
There is no question the job market will be in even more in the crapper for new grads.

CMS is gunning for any high volume specialty codes. Now they can transfer wealth to primary care via ACA and with these coding revaluations.
It is really the end of fee for service.

Az

 

[levels x3]

I also listened to the webinar. I agree with much of the above and am only beginning to piece together what this means for my group. We are PC-only billers. Cytology is now a waste of my time...52% cut in the 88112. IHC has been destroyed. And I fully expect my private practice to dissolve within 5 years (probably much sooner) once the AP 88300 - 88309 codes are bundled. Better max out your SEPs, solo 401ks, and profit sharing plans now while being a small business owner is still possible.

Couple of questions though.

3.) Prostate biopsies reads reduced by 60%. So if you also do this, much more than 10%.

How often do you get 10 or more specimens (jars) per case? Our urologists usually do between 5 and 7. We had one who did 14 each case, but he left. If I understand correctly, nothing would change for a 6 part biopsy case. If you always get 12 part cases, then I get it.

Frozen sections? I see that the 88332 frozen code has been bundled, but that's for additional blocks. The first block FS 88331 code isn't listed as bundled. Am I missing something? Unless you do a ton of skin frozens, how much are you losing there?

 

[levels x3]

Also, I've been out in practice for 4.5 years and been a partner for 1.5. It is seriously depressing to know that I can expect my work to be valued less and less every year, from here to eternity. What other field is like that? What other field can you go into where your starting "salary" (assuming you don't change the composition of your practice) will be the most you ever earn?

Sorry employee X, you've done a great job, but no raise this year. How about a 4% pay cut?

 

[pathstudent]

There was an opinion in the nytimes 3-4 years ago written by a Columbia university leftist economist that stated that US physicians in particular specialists earned too much money and was out of line with the rest of the world in that the income discrepancy between typical workers and physicians was greater in the US than other countries such Peru, Kazakhstan, chad, and Greece. This economist is one of obama's economic advisers.

I think we can expect these cuts for years to come.

 

[levels x3]

I don't doubt you, but can you be more specific? Name? Link?

 

[levels x3]

And I agree, I think physicians as a whole can expect a beating going forward. And I think it matters not which party is in power.

 

[pathstudent]

And I agree, I think physicians as a whole can expect a beating going forward. And I think it matters not which party is in power.

Disagree. These cuts are a direct consequence of obama.

All we can hope for is a tidal wave of angry voters due to the 50,000,000 that are going to get their small group insurance cancelled next year to come out strong against the democrats.

Here is the article I remembered

http://www.nytimes.com/2011/09/08/us/08docs.html

 

[LADoc00]

They literally said at the start of the webinar this was a DIRECT result of the ACA. These cuts were NOT due to the RUC reassessment aside from the thin prep bloodbath, they were due to a political cadre in DC that decided to a total hatchet job to one profession in order to slip $ to Chiropractics etc.

I think its time we identify the members of both ABP and CAP who supported the ACA and strip them of all membership and board certifications.

 

[levels x3]

I'm certainly no expert, but I would question the premise of that article. Cross country comparisons are frought with confounding factors. Do orthopods make too much here in the U.S.? Probably. Me reading a stereotactic biopsy for microcalcs is of greater significance than a carpal tunnel release. But who gets paid more?

Again I assert that these changes are irreversible. Maybe you're right that Obama hastened this doom, but I doubt it would be much different either way. And now that it's in place, do you really think a Republican resurgence is going to help you? You are an easy target. We have no friends.

 

[2121115]

Here is something I'm still unclear on - do these cuts affect global billers? TC? Or -26 modifiers (PC-only). At some point I was under the impression that the majority of the cuts, particularly for the bundling of payments, would affect only the TC charges. For instance if you are a PC only practice and you bill everything with a -26 then you are getting a 4% increase in 88305 right? Was this distinction made in the webinar?

 

[levels x3]

You're right that the 88305 code is going up by 4% for PC billers, but what else does your group do? Cytology? -52%. IHC? -26% for the first stain, -70% for each additional stain.

 

[2121115]

You're right that the 88305 code is going up by 4% for PC billers, but what else does your group do? Cytology? -52%. IHC? -26% for the first stain, -70% for each additional stain.

That is for -26 charges or global?

 

[pathstudent]

I'm certainly no expert, but I would question the premise of that article. Cross country comparisons are frought with confounding factors. Do orthopods make too much here in the U.S.? Probably. Me reading a stereotactic biopsy for microcalcs is of greater significance than a carpal tunnel release. But who gets paid more?

Again I assert that these changes are irreversible. Maybe you're right that Obama hastened this doom, but I doubt it would be much different either way. And now that it's in place, do you really think a Republican resurgence is going to help you? You are an easy target. We have no friends.

Have you ever had carpal tunnel syndrome?

The difference would be that our taxes wouldn't be going up at the same time our annual income is being decreased at a rate of 6% a year. McCain or Romney would not have advisers on their staff that think it is unfair that some physicians make 400-500k a year. They wouldn't be engaging in entitlement programs as a means of income redistribution. Had the elections gone the other way, you wouldn't be experiencing the best year of your economic life right now knowing things will only get worse..

 

[pathstudent]

That is for -26 charges or global?

Aren't you paying attention? PC is going down 70-80% for IHC after the first IHC. The TC is going down to but not so dramatically.

 

[levels x3]

That is for -26 charges or global?

The percentages I stated above are the PC cuts.

 

[yaah]

. What other field is like that?

Every field in medicine, sadly. Except maybe cosmetics. Unless you're an administrator.

 

[yaah]

And I agree, I think physicians as a whole can expect a beating going forward. And I think it matters not which party is in power.

QFT.

Physicians are "overpaid" and "whiny" according to the media. The only time physicians really make the news is when they do something horrible or fraudulent, or some researcher cures something awful.

 

[levels x3]

Every field in medicine, sadly.

I meant medicine broadly. I don't think we're unique.

 

[Path or bust]

I'm not sure I understand the slide from the CAP webinar: Capping payment rates in the PFS to Hospital outpatient APC rates. What does this mean?
If you are a hospital based pathologist, can you not bill your own PC anymore and get paid by hospital? I do realize that it was averted for 2014, but may come back for 2015. Not sure...

Also, in regard to pathology codes that were bundled, does that mean that the hospital get the bundled payment, regardless of whether we bill for those codes?