Monday, February 4, 2008

Pathologist owned Laboratories

Is it necessary to do triple IHC stains on multiple prostate cores in order to have Absolute Confidence? Do urine cytologies routinely require Giemsa staining in addition to Pap staining? Is it necessary to separate the six cores that some urologists put in one container and give them separate diagnoses so that twelve diagnoses and twelve charges result from the two containers sent to the lab? Is it necessary to perform standard cytology on each FISH UroVysion?

Sure it requires money to compete with Quest and LabCorp so that you can compete with their donations of EMR software. But no one expects publicly traded commercial labs to be concerned with anything other than their bottom line. Laboratories that are owned by pathologists have the opportunity to demonstrate leadership and fiduciary responsibility to the patient. If one does not have any external investors that require a certain return on investment, why squander the rare possibility to show leadership in this industry?

Do we not have a responsibility to use our education and expertise to perform service FOR PATIENTS. Or must we look for every opportunity to do some procedure TO PATIENTS to extract the most revenue from their bodies?


Anonymous said...

Do you know on average the cost to the patient per case??

Jay Oppenheimer said...

No, but I have heard of patient reports with at least five cores having triple stains. That would be fifteen IHC 88342 stains ringing up charges of over $1400 plus the dozen 88305 charges of another $1200 for a total of $2600.

Anonymous said...

Thanks for the information.
It's clear to me that this is the sort of "funny business" that is driving the cost of healthcare out of reach for many people.

Phillip said...

The "funny business" of this same lab appears to include performing a routine special stain 88313on urine cytology preparations. Could this be a Giemsa stain?

mouse said...

Dr. Oppenheimer,
I believe that the hospital I work for (as an employee)charges over $300 for both the technical and the pro fee that they bill on my behalf. We do not get many prostate biopsies. When I do get them in a set of's over $8000. Just for the H and E (I have not needed special stains). I really doubt any insurance is paying this but it makes me sick to know that some guy without insurance would get a bill for such an amount. Have yo ever heard of such huge fees? What can I do to make it right?

Anonymous said...

I actually worked at a lab for a short time that was doing Cytospins on all the prostate biopsies and reading and billing them as cytologies in addition to the 88305s of the biopsies. They also obtained images and included them in the prostate biopsy reports with schematics showing what diagnoses were in which areas of the prostate. I imagine they were able to afford the imaging because they billed all the prostate cytology!