The Importance of Integration of Insourced Pathology Services
Posted Jun 14 2010 12:00am
A discussion of insourced pathology services within GU/GI medical groups was launched in two previous notes (see: Continuing Discussion: Insourcing of Pathology Specimens by Specialty Groups ; Consideration of the Underlying Forces that Promote Pathology Insourcing ). Pathology services, for reimbursement purposes, are separated into two components referred to as TC (technical component) and PC (professional component). The term global billing applies if a single fee is used to cover both parts. Joe Plandowski has shared with me a letter that he sent to Mark H. Stoler, M.D., president of the American Society for Clinical Pathology (ASCP), on March 31, 2010. In it he discusses the integration of insourced pathology services as they relate to TC and PC. I quote it below:
Besides eliminating CMS payments to pod labs, I advocate eliminating CMS payments to any in-office anatomic pathology laboratory that is not performing BOTH the technical (TC) and the professional (PC) work on-site....What I am advocating is [that] an in-office anatomic pathology laboratory performing only TC work should not receive CMS payments.I am [also] advocating the same no-payment policy to in-office anatomic pathology laboratories performing only PC work and there [are] lots of those laboratories in existence. The bright light dividing line for CMS payment should be determined by whether or not the in-office anatomic laboratory is performing global work (TC + PC) on-site. It is in these global work laboratories where the patient gets the best of care --- a clinician and a pathologist working side by side.
It goes without saying, therefore, that one of the most basic form of integration, the processing of histology tissue section and their interpretation by pathologists (i.e., TC + PC), needs to occur in the same facility. This enables rapid and efficient interactions between the histotechnologists and the pathologists who interpret the tissue sections (see: Do Histotechnologists Lack Respect? ). Such interactions help to ensure that the quality of this work is optimized. Similarly, pathologists must work in close collaboration with the clinicians who obtains the tissue biopsies and treat the patient for the most effective communication of diagnostic information.
Unfortunately, strong financial forces are now at work that may cause the disassociation of the TC from the PC under the insourced pathology services business model. I suspect that the GI/GU groups will continue to develop in-office labs in order to control tissue processing and also because the TC is more remunerative than the PC. However, there may also be incentives in place for these same GI/GU groups to deploy whole-slide-imaging (WSI) technology and send these images to surgical pathology reference labs for remote interpretation (see: Continuing
Discussion: Insourcing of Pathology Specimens by Specialty Groups ). This relieves the GI/GU groups of the responsibility of employing a "local" pathologist on a contractual basis. However, it also moves away from local service integration and the "global work" approach recommended by Joe Plandowski above.