CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
We do not practice pathology in a vacuum and all of us recognize the value of a second opinion. This is how difficult surgical pathology cases are often handled and it’s the bedrock upon which many experts have built their careers. There are seven pathologists in my group, all with different areas of expertise and fellowship training. We share cases daily and meet around a multi-headed scope as part of a highly valued departmental consensus conference. These timely intradepartmental consults remain an invaluable part of daily quality surgical pathology practice. The value of immediate consultation from a colleague down the hall is generally lost in the world of in-office laboratories, which may be staffed by lone pathologists, signing out cases in isolation.
I do not believe that the overall diagnostic acumen of pathologists working in an in-office lab is substandard. I do believe that in-office laboratories do not have the means to provide the same level of service as a multispecialty pathology group with subspecialty pathologists and master’s level pathology assistants who are integrated into a larger medical system.
In-office pathology labs exist because no one has said they can’t. In my experience, the motivations of the clinicians interested in starting these labs are not altruistic but about enhancing revenue. Their evolution is a consequence of focusing too much on the business side of medicine (I’ve seen it described as the ‘easiest and safest way to add new ancillary revenues to your practice’) and losing sight of the potential impact on patient care. A successful business model does not always translate into better patient care.
We cannot serve two masters—this being nothing new, of course, but it’s especially true in regard to in-office anatomic pathology labs. Physicians cannot stand at the proverbial bedside and make decisions about what is in the best interests of their patients at the same time they are making decisions about what is in the best interest of their bottom line. It is time to choose.
I believe the business model of a non-pathologist earning money on the professional component of pathology services is wrong and unethical. Further, it could not have been the intent of third-party payers when their fee schedules were established or of the in-office exemption of the Stark Law to allow non-pathologists to profit on the backs of anatomic pathologists who do the work. The best medical care results from the pathologist being an equal but independent partner in the care of a patient and not a subservient employee whose professional work serves to enhance a clinician’s income.
It is time to close the loophole.
The views expressed herein are those of Dr. Foster and do not necessarily reflect those of Centra Health Inc. or any of its affiliates.