New Anti-Self Referral Legislation H.R. 2066 ... Let's take Pathology back

[Arctic Char]

Its about F***ing time some legislative action commenced on this.

Take a look, share your thoughts, and write your Senators and Representatives

H.R. 2066 Promoting Integrity in Medicare Act of 2017 "PIMA 2017"

Text - H.R.2066 - 115th Congress (2017-2018): PIMA of 2017

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[Pathbusiness]

A step in the right direction. In my experience more than 50% of the billings of a big private lab are fraudulent/unnecessary. With Clinicians having a skin in the game makes it worse. GI, Uropathology, and Derm are the biggest culprits. So many biopsies performed, upfront ancillary staining, unnecessary molecular tests, the list keeps going on and on. Time to stop training too many pathologists, do right work independent of influence by the referring physicians, and regain the control of this field back from cheating big labs, and vested interests groups. I find it unbelievable how certain practices go unnoticed for years under the radar of CMS.

 

[AZpath]

What are you talking about.

They have introduced the same bill the last two congresses. Unfortunately, it won't get any further than last time.

 

[Pathbusiness]

Lobbyists are hired and paid handsomely for a reason.

 

[WEBB PINKERTON]

If we eliminate waste in our health care system it would probably put 30 percent of pathologists on the unemployment line. All we are accomplishing by keeping our field in "chronic oversupply" is allowing it to continue. More pathologists out there equals more and more exploitation.

 

[Arctic Char]

What are you talking about.

They have introduced the same bill the last two congresses. Unfortunately, it won't get any further than last time.

What am I talking about? I'm talking about a bill that needs more attention if we want policy changes to be addressed in our favor. I am well aware that it has an uphill battle to even make it to a vote, and thats putting it lightly. But maybe thats because of apathy on the part of people who refuse to utilize democracy? I'm sure this phenomenon had nothing to do with the Presidential election though . . .

Yes, Pinkerton, you are absolutely right about the effect of oversupply. But don't think that is going to change anyone's conviction that policies need to change in the interest of cutting costs. I would rather see the costs/wastes curtailed by outlawing abusive practices that do NOT deserve legal legislative protection, than to see Congress try to solve the problem by putting market pressure on clinicians (c.f. 2012 52% cut in TC), which only 1) encourages them to do it more to make up for the reduced reimbursement, and 2) screws over the entire field of labs, honest or not. The former also encourages the need for more pathologists, if that satisfies your criteria for a problem.

 

[jupiterianvibe]

What am I talking about? I'm talking about a bill that needs more attention if we want policy changes to be addressed in our favor. I am well aware that it has an uphill battle to even make it to a vote, and thats putting it lightly. But maybe thats because of apathy on the part of people who refuse to utilize democracy? I'm sure this phenomenon had nothing to do with the Presidential election though . . .

Yes, Pinkerton, you are absolutely right about the effect of oversupply. But don't think that is going to change anyone's conviction that policies need to change in the interest of cutting costs. I would rather see the costs/wastes curtailed by outlawing abusive practices that do NOT deserve legal legislative protection, than to see Congress try to solve the problem by putting market pressure on clinicians (c.f. 2012 52% cut in TC), which only 1) encourages them to do it more to make up for the reduced reimbursement, and 2) screws over the entire field of labs, honest or not. The former also encourages the need for more pathologists, if that satisfies your criteria for a problem.

The only way to make anything change is to do something about it. Sitting by idly won't help. Write letters to your congresspeople and inundate their offices with daily phone calls.

There's no such thing as being neutral. Being neutral just means you support the status quo.

 

[AZpath]

What am I talking about? I'm talking about a bill that needs more attention if we want policy changes to be addressed in our favor. I am well aware that it has an uphill battle to even make it to a vote, and thats putting it lightly. But maybe thats because of apathy on the part of people who refuse to utilize democracy? I'm sure this phenomenon had nothing to do with the Presidential election though . . .

Yes, Pinkerton, you are absolutely right about the effect of oversupply. But don't think that is going to change anyone's conviction that policies need to change in the interest of cutting costs. I would rather see the costs/wastes curtailed by outlawing abusive practices that do NOT deserve legal legislative protection, than to see Congress try to solve the problem by putting market pressure on clinicians (c.f. 2012 52% cut in TC), which only 1) encourages them to do it more to make up for the reduced reimbursement, and 2) screws over the entire field of labs, honest or not. The former also encourages the need for more pathologists, if that satisfies your criteria for a problem.

I can't agree with you more.

 

[Pathbusiness]

If this gets more attention and is implemented, this could be a big step in right direction. 50% drop in revenue of GI business of big anatomic pathology labs can bring a lot of business back to local pathologists.
Hickory Pathology Lab Agrees To Pay The United States $601,000 To Settle False Claims Act Allegation

 

[jupiterianvibe]

If this gets more attention and is implemented, this could be a big step in right direction. 50% drop in revenue of GI business of big anatomic pathology labs can bring a lot of business back to local pathologists.
Hickory Pathology Lab Agrees To Pay The United States $601,000 To Settle False Claims Act Allegation

As per the justice.gov article:

"The government considers the use of special stains before the analysis of the routine H&E stained specimen to be medically unnecessary"

Holy ****.
I bet many pathologists could make a fortune outing outfits like this.
Essentially any outfit that does reflex stains on gastric bx for HP is making a false claim, according to that statement. Am I reading this wrong??

 

[Dave CX]

As per the justice.gov article:

"The government considers the use of special stains before the analysis of the routine H&E stained specimen to be medically unnecessary"

Holy ****.
I bet many pathologists could make a fortune outing outfits like this.
Essentially any outfit that does reflex stains on gastric bx for HP is making a false claim, according to that statement. Am I reading this wrong??

To be specific, there is nothing wrong with doing the stains, billing for them is the issue. I have H.pylori's done on all antral biopsies, but I only bill if there is gastritis.

 

[Pathbusiness]

Dave CX what percentage of your biopsies have gastritis?

 

[Dave CX]

Dave CX what percentage of your biopsies have gastritis?

If you mean antral biopsies, maybe 15 percent. Gastropathy is more common.

 

[Dave CX]

A few plasma cells doesn't qualify as gastritis in my opinion. I call those normal

 

[Dave CX]

As per the justice.gov article:

"The government considers the use of special stains before the analysis of the routine H&E stained specimen to be medically unnecessary"

Holy ****.
I bet many pathologists could make a fortune outing outfits like this.
Essentially any outfit that does reflex stains on gastric bx for HP is making a false claim, according to that statement. Am I reading this wrong??

Helicobacter stains are just the tip of the iceberg. Many labs do PAS/AB on EVERY duodenal, gastric and esophagus biopsy (even when there are multiples per organ). Imagine doing such stains on a mid esophagus and saying "no evidence of intestinal metaplasia". That's bad stuff. Let me point out though that this practice is no more likely to occur in a clinician owned lab vs hospital based private group or commercial lab. Wherever I work, stains are only billed for when justifiable and justified.

 

[Pathbusiness]

So you do upfront H Pylori on all antral biopsies and bill only 15% of them? In my 15 year experience there is upfront H Pylori and AB/PAS on every gastric and esophagus biopsy and billed for all of them. I know everyone does it but it does not make it right. That is what needs to stop.

 

[Dave CX]

So you do upfront H Pylori on all antral biopsies and bill only 15% of them? In my 15 year experience there is upfront H Pylori and AB/PAS on every gastric and esophagus biopsy and billed for all of them. I know everyone does it but it does not make it right. That is what needs to stop.

Correct. I took that Palmetto opinion very seriously. It looks like those who didn't might have some exposure.

 

[Pathbusiness]

Dave CX you are one of very few exceptions and should be proud of it. The main culprits are big labs. Some of the "so called" experts even publish papers supporting upfront staining. For them it is "productivity per pathologist". Medical necessity is a term they don't have in their dictionary.

 

[stickyshift]

I think I was one of the first to send up the alert on Palmetto issuing guidelines regarding the preordering of special stains. This year, our practice has stopped essentially all preordering and we're slated to take a big hit. It would have been even more jarring had we not already been doing what Dave CX currently does: preordering, but then not billing, for the majority of our H. pyloris.

 

[Pathbusiness]

Doing upfront H Plylori immunostain and AB/PAS on every biopsy and billing for those showing inflammation and intestinal metaplasia is not a cost effective option esp when you have a good volume. We know which ones require a special stain once we look at the H&E. Doing AB/PAS on every prox, mid, distal esophagus, and immuno on every gastric biopsy submitted is fraudulent billing/false claim in my books.

 

[pathstudent]

Correct. I took that Palmetto opinion very seriously. It looks like those who didn't might have some exposure.

If only 15% are positive, why not only order h py on those cases. Why waste on the 85%? The hospital lab still has to pay for the labor and cost of the test?

 

[Dave CX]

If only 15% are positive, why not only order h py on those cases. Why waste on the 85%? The hospital lab still has to pay for the labor and cost of the test?

I don't work at a hospital. I work in GI offices. tissue is processed at an outside lab.

 

[octopusprime]

I don't work at a hospital. I work in GI offices. tissue is processed at an outside lab.

Ok so is the outside lab doing mass Hpy staining free of charge?
Why not just have them cut an unstained?

 

[Dave CX]

Ok so is the outside lab doing mass Hpy staining free of charge?
Why not just have them cut an unstained?

Turn around time. I don't go to every office every day.

 

[Pathbusiness]

Still a lot of wastage IMO

 

[AZpath]

You must work with an outside lab that likes to loose money.

 

[deleted314957]

You must work with an outside lab that likes to loose money.

I suspect he/she has no control over the quality or content of the
slides prepared by the TC lab which, in itself, is kinda sad.
He could not care less about the finances of the TC lab.
What a ****ty business this has become

 

[Dave CX]

I suspect he/she has no control over the quality or content of the
slides prepared by the TC lab which, in itself, is kinda sad.
He could not care less about the finances of the TC lab.
What a ****ty business this has become

The quality is fine and the lab is doing very well. Cut your bellyaching.

 

[deleted314957]

The quality is fine and the lab is doing very well. Cut your bellyaching.

Well, that is certainly fortunate. However, it begs my point; given your situation, I bet you have no control over what you are handed, and that
IS too bad. And I'll bet you can't look at their books.
And, us retirees don't bellyache.

 

[Alteran]

I'd just like to know why there also isn't a law or an insurance policy/position that states you can't bill a CPT code that doesn't match your specialty. I don't see pathologists billing for invasive surgical procedures (pretty sure that would trigger an audit) but somehow clinicians are billing for pathology services. Something seems off there if you ask me...just saying.

 

[Dave CX]

I sense an uprising from the milquetoast martyred saints of community hospital pathologists. Yeah the same ones who earn more than their OB/GYNs and general surgeons while working half their hours.

 

[Dave CX]

I'd just like to know why there also isn't a law or an insurance policy/position that states you can't bill a CPT code that doesn't match your specialty. I don't see pathologists billing for invasive surgical procedures (pretty sure that would trigger an audit) but somehow clinicians are billing for pathology services. Something seems off there if you ask me...just saying.

If you don't like your situation then grow a set and change it like I did. More dignified than groveling like a eunuch and hoping the government gets you your specimens back.

 

[Pathbusiness]

I idea is to address the wrong practices which lead to resource wastage and increased healthcare cost. Once they get noticed and CMS stops paying for these, it automatically brings control back to the physicians instead of corporates.

 

[Dave CX]

I idea is to address the wrong practices which lead to resource wastage and increased healthcare cost. Once they get noticed and CMS stops paying for these, it automatically brings control back to the physicians instead of corporates.

Blah Blah whatever that means

 

[jupiterianvibe]

I get Dave CX's point. There's one tree. Pull the apples from it. Don't just wish for a better tree.

My take is that the CAP's pro-biglab stance causes it to contribute to labor oversupply. Podlabs benefit as an unintended consequence. The PIMA law will not go through because 1. it never does and 2. the lobby forces behind the AUA, ADA et al are more well-funded than CAP's (despite CAP having a revenue of 40 million dollars)