Deja vu All Over Again

I heard a talk this week from an old friend who has been in the pathology world for a long time.  He understands the business side of things very well and is well aware of the issues surrounding the in-sourcing of pathology by specialists.  His take on this trend is that pathologists have brought this on themselves.  He noted several ways that could be used to prevent this from taking place: wait for the government or payers to fix it, wait for it to become unprofitable through payer changes, or simply accept that this it the way it is going to be.  He also noted that maybe one way to stop it would be to stigmatize those pathologists that do this type of work.

This reminds me of another negative payment trend that was accelerated by passivity: the non-payment of Part A compensation.  I remember years ago talking to the College of American Pathologists and others about stepping up and taking a stand against this practice and drawing a line in the sand.  Nobody listened and over time it just became an accepted practice.  No one took a stand and everyone lost.

Now we see the same thing with in-sourcing.  What if the CAP and ASCP decided that these in-sourced pathologists were somehow not eligible for their societies?  I understand this would be a radical notion but would it “stigmatize” these in-sourced pathologists into their own society or ostracize them in some way?

I don’t have the answers, I am only a guy who sees these trends from the 10,000 foot view and I see the downstream results.  Look at what happened in Texas when BCBS tried to decrease payments significantly.  The pathologists decided that this did not work for them and they cancelled their contracts, which in time lead to the payer backing down and paying them what they deserved.  It took guts and a strong leadership by the Texas pathologists, but it worked. 

Compare this to the JVHL plan in Michigan where this “network” has eviscerated pathology payments and no one has stepped up to stop it. Everyone has stood idly by and watched as others profited from their loss. 

Imagine if the urology practice or gastroenterology practice could not find a pathologist to do their work?  Imagine what is going to happen the first time there is a large lawsuit and it is brought to the nation’s attention that this whole urology /pathology relationship is based on a financial incentive. That could get interesting.

Maybe we are heading for a segregation of pathology.  Maybe in ten years there will be a society of sub-specialized pathologists. These pathologists will specialize in one tissue type only and will be very good at their profession.  Unfortunately, these pathologists will make about one half of the current pathology salary and do very simple methodical work; basically it will be what my friend fears the most. The pathologist will become a technician who is a simple commodity to be traded at the lowest price.

Mick Raich is the President / CEO of Vachette Pathology, the nations leading pathology consulting and management firm.  He can be reached at 866-407-0763 or at vachettepathology.com.