Palmetto sets standards for the workup of stomach, breast cases

[Thrombus]

lmao...if anyone is relying on upfront (read "unnecessary") Hpys, ABs, and PASs to pad their income, there are likely serious organizational / ethical problems at play, or laziness.

Or the GI doc demands it or will take his business elsewhere.

Or pathologist can't get enough business as the market is flooded.

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[octopusprime]

Or the GI doc demands it or will take his business elsewhere.

Or pathologist can't get enough business as the market is flooded.

Which is different than upfront HPYs for the sole purpose of padding one's income.
Listen ending up-front HPYs doesn't mean you can't do them, you just have to wait an extra day, do a late stain run, sign the case and put the HPY in an addendum the next day, etc.... SOOOO many ways around this issue for those that genuinely need to do HPYs for high-maintenance GI groups (I'll add that I've never encountered a GI group that demands PAS and AB on all GE junctions...that one is just padding lazy pathologists)...point is that upfront HPYs on all GI bxs is not legit.

 

[Euchromatin]

This might be what your "GI friend" is referring to. A pathology group in North Carolina recently had to pay over $600k to settle a false claims act allegation made by an ex-employee whistleblower. I've seen a couple of articles in addition to the one linked below. None of them explicitly say what stain, but gastric biopsies are mentioned, so I think the implication that they are referring to H. pylori IHC (or perhaps Warthin starry, Giemsa, diff quik or other special stain) is fairly clear.

Pathology Laboratory Pays the United States $610,000 in False Claims Settlement - Professional Management Inc.

 

[Euchromatin]

More deets:

Hickory Pathology Lab Agrees To Pay The United States $601,000 To Settle False Claims Act Allegation

Looks like that group got in trouble for giving EMRs to referring physicians a few years ago too:

Piedmont Pathology Associates, Inc., and Piedmont Pathology, P.C. Settle False Claims Act Cases for $500,000

 

[Pathbusiness]

Tell me one big lab who doesn't do it.

 

[WEBB PINKERTON]

I remember seeing a presentation called "how to compete when everyone else seems to be cheating" at a pathology meeting many years ago. Only a pathology meeting would have a presentation titled as such. Seeing these fines reminds me of that line in Apocalypse Now -It's like handing out speeding tickets at the Indy 500. Thanks to the oversupply virtually every lab is forced to walk the razor's edge to stay in business and engage in activities that could get them into trouble with some entity. I have lost count of how many times a consultant has said "it's up to us and our legal team" on whether or not we go forward with an initiative. There is a lot of gray area that can get you into trouble.

 

[Pathbusiness]

The way private laboratory business is structured, overheads, sales commissions, competition etc, it is virtually impossible to stay profitable if you don't do this. When I joined work force I used to be amazed. Nothing amazes me anymore.

 

[yaah]

When you use practices like this, you encourage payors or regulators to tell you what to do. You remove physician judgment, which means that they can substitute their own judgment. So, not only is it unethical, it's not smart practice.

I just reviewed an outside case from a physician owned lab of a 12 core prostate biopsy, with cancer in 9 of 12 cores (some cores 100% involved). Outside path did a triple cocktail on 8 separate blocks. This infuriates me because it is the kind of practice that draws attention to pathology as a source for overspending and overutilization. Sadly, a lot of doctors think this is OK for various reasons (like they're not getting adequately paid for something else they are required to do, so they charge other stuff so they get paid for that instead). This is exactly the way to get replaced, because your judgment is less relevant to your practice.

 

[Adrian Cocot]

CAP didn't have the guts to call out big labs overutilizing special studies, and pathologists didn't have the guts to blow the whistle on the bad actors -- often because they were GI docs sending them business. Result? Watch the 88305 and 88342 get cut even further, screwing everyone -- except, of course, for the commodity profiteers who get to keep the gains from their revenue streams.

I would be nice to hear at least one story of a pathologist shivving their rapacious GI/GU/derm "colleagues."

 

[Pathbusiness]

I have regularly seen 16 core prostate biopsies where triple cocktail was done on more than 5 cores when pretty much all were involved with tumor. Plus ERG and PTEN on at least 4 cores(sometimes more).

 

[Pathbusiness]

I think ERG and PTEN is a response to G046!!