Update on 25% cuts to pathology by Blue Cross/Blue Shield in Mississippi

BCBS-MS

Last week I included a short story about the announcement made by Blue Cross/Blue Shield in Mississippi (BCBS-MS) that it was cutting reimbursement for some pathology services by 25%, effective May 15.  A pathologist who practices in Mississippi contacted me to provide some information on what has taken place since the announcement.  And I couldn’t help but laugh when I heard some of what he had to tell me.

After the announcement was made, the Mississippi State Medical Association (MSMA) rallied and wrote a letter to the CEO of BCBS-MS making its displeasure with the cuts known.  This immediately caught my reader’s attention, as the MSMA had apparently never lifted a finger to help pathology before.

Now remember, the cuts only involve certain radiology and pathology procedures.  But in the letter, Dr. Steven Demetropoulos, the MSMA president stated (emphasis added):

I believe that BCBS-MS has proceeded with an unnecessarily heavy hand to make major and financially significant cuts to reimbursement to hundreds of physicians practicing radiology, pathology and other specialties.

To what other specialties is he referring?  BCBS-MS only announced cuts to pathology and radiology.

To answer that question, one must remember in-office laboratories and client billing (Mississippi is a client billing state).

From the MS pathologist:

Most of the screamers are the family practice docs and internists who are losing their mark-ups on clinical lab tests.  The PC for 88305 went up.

One group of endocrinologists is thinking of eliminating their lab (and sending to the hospital) because they are losing their mark up and profits from running their labs.

One group of GI physicians has complained that the fees paid by BCBS should not be lowered for 88305-TC.  I wonder why the GI guys are suddenly interested in our codes?

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Carolinas Pathology Group wins appeal in case filed by Dr. Vittal Shenoy

Dr. Vittal Shenoy (Carolina Urology Partners)

Dr. Vittal Shenoy, a pathologist formerly employed by Carolinas Pathology Group (CPG) and now working for Carolina Urology Partners, filed a lawsuit against CPG and Carolinas Healthcare System (CHS) alleging his First Amendment rights were retaliated against by both parties; tortious interference of his employment contract with CPG by CHS; and a False Claims Act retaliation claim against CPG.  A district court dismissed both CPG and CHS from the case.  Dr. Vittal appealed; the appellate … [Continue reading]

Dermatopathologists sue Morgan Stanley and ING for pay-to-play scheme

Skin Pathology Associates (SPA), a five dermatopathologist shop based in Birmingham, Alabama, has filed a class action suit against Morgan Stanley (MS) and ING for engaging in a pay-to-play scheme with its retirement money. Some brief background is necessary here. MS has what it calls an Alliance Partner program (APP), which consists of a group of companies that provide investment/record keeping services.  According to the complaint, some but not all of the APP members pay MS … [Continue reading]

Creighton University pathologist Dr. Roger Brumback and wife murdered

Dr. Roger Brumback

Dr. Roger Brumback, former chairman of the Department of Pathology at Creighton University in Nebraska, was found murdered in his home along with his wife, Mary, on May 14, 2013. Dr. Brumback had just announced his retirement, and he and his wife planned to move to West Virginia next month.  Their bodies were found by a piano mover. What makes this case even more strange is this is not the first time murder has touched the Creighton Department of Pathology.  In March 2008, the 11 … [Continue reading]

A Diagnostic Blind Spot-Malpractice case study from The Doctors Company

This is the second of what I hope will be an extended series of case presentations of actual malpractice lawsuits brought against physicians insured by The Doctors Company (TDC).  I posted the first case presentation on February 21, 2013. Like the first case, this case was also put together by Dr. David Troxel, medical director of TDC.  I am deeply grateful to him for providing us with these interesting cases. Just a quick reminder, Dr. Troxel is also the distinguished presenter at the … [Continue reading]

Pathology Blawg News Roundup for May 16, 2013

News

Business -LabCorp announced that ViroMed Laboratories, a Minnetonka, Minnesota-based subsidiary, will be laying off 79 employees and shutting down a laboratory, beginning July 1, 2013.  This represents 76% of the employees at the facility.  Interestingly, there is no mention of this news in the "News and Events" page of ViroMed's website. -Dignity Health, a California-based hospital system that sold its clinical laboratory outreach services in parts of Nevada and California … [Continue reading]

Thermo Fisher failed to disclose factory it sold was used by drug cartel, lawsuit alleges

Thermo Fisher

Opengate Capital Group, a private buyout firm, filed a lawsuit in Los Angeles District Court on May 10, 2013, alleging Thermo Fisher Scientific, a leading producer of laboratory instruments, equipment and software, failed to disclose that the violent Gulf drug cartel was actively using a Mexican manufacturing facility Thermo sold to Opengate. The factory, located in Reynosa, Mexico, was acquired by Opengate when it bought the Laboratory Workstations Business from Thermo via public … [Continue reading]

Quest Diagnostics fined for refusing to consider applicants with a criminal record

Quest Diagnostics will pay a $70,000 fine to the state of New York for participating in illegal hiring practices.  In addition to the fine, Quest will take steps to prevent future departures from the law with respect to its hiring practices. Obviously this is not the biggest legal development in the world of laboratory medicine, but it is a legal development nonetheless. At issue is that New York: [s]tate law requires that employers consider a number of mitigating factors in making … [Continue reading]

Tuomey Healthcare found guilty of Stark violations, could be penalized up to $357 million

In April 2012, I wrote about a qui tam (whistleblower) lawsuit filed against Tuomey Healthcare System (THS) in 2005 by Dr. Michael Drakeford, a physician employed by THS.  At the time of the post, an appeals court had just ordered the case be re-tried because of the unusual manner in which the trial judge handled the case.  The retrial began on April 16, 2013, and a jury found THS guilty of violating both the Stark Law and the False Claims Act; THS is now on the hook for a maximum $357 … [Continue reading]

Response to post about Oppenheimer Urologic Reference Lab data

A couple of hours after I published my post on the Oppenheimer Urologic Reference Laboratory (OURLab) prostate biopsy data, a comment was posted on the site.  It read: I, Jonathan Oppenheimer, want to state clearly that I disagree with the opions [sic] expressed by Pathology Blawg. It’s author has commented on data from my lab in a very biased manner. Everyone is entitled to interpret data with their own bias and this site clear has demonstrated its own. I have different intepretations … [Continue reading]

Louisiana appeals court upholds $964,000 award against pathologist

Back in November 2012, I wrote a quick post about a medical malpractice lawsuit filed by a woman who had an unnecessary mastectomy because of an erroneous breast biopsy diagnosis.  The plaintiff, Latoya Monroe, sued pathologist Dr. Charles Binford, Leonard J. Chabert Medical Center and the state of Louisiana and was awarded $964,487. After the verdict, the attorney representing Dr. Binford (who apparently died in 2008) and the state felt the award was too high and stated her intent … [Continue reading]

138,000 prostate biopsy cases from Oppenheimer Urologic Reference Lab

A reader recently sent me a link to some data they came across on the website of Oppenheimer Urologic Reference Laboratory (OURLab).  I haven't dealt with prostate biopsies in a little while now, and these data demonstrate some interesting findings, so I thought this might be a good thing to talk about. The data come from 138,005 prostate biopsy cases between 2003-2012 and compare the number of vials in which the biopsy sets were submitted (2 vs. 6 vs. 12-14) to malignancy rate, … [Continue reading]

James Slattery, founder of Millennium Laboratories, out as CEO

James Slattery

James Slattery, founder of Millennium Laboratories (ML), is being replaced as the company's CEO by W. Brock Hardaway.  Mr. Slattery will become chairman of ML's Board of Directors. Immediately prior to being named ML's new CEO, Mr. Hardaway was the EVP of Operations of Kindred Healthcare, a company that runs nursing homes, rehabilitation centers and hospitals. Mr. Hardaway is taking on this job at a somewhat challenging time for ML from a legal standpoint. Readers will recall ML … [Continue reading]

Solutions to IT & LIS Department Constraints

Tired of relying on your busy IT/LIS department to get the critical laboratory data you need? Do you have to rely on your IT department for the reports and information you need to run your department? Is getting error-free data, when you need it and how you want it, a burdensome process? What if there was a fast and intuitive way to get to the information needed to make your job easier? Find out by registering for one of the upcoming demos of Viewics Health Insighter, a solution used by … [Continue reading]

Quest Diagnostics loses bid to deprive LabCorp of $250 million Army contract

In August 2010, the US Army solicited bids for a contract for the provision of clinical laboratory services domestically and abroad for the US military valued at $250 million.  Three bids were received, but only Quest and LabCorp's were considered competitive.  In April 2011, the contracting officer awarded the contract to Quest, but LabCorp filed a protest about three weeks later. In response to the protest, the government amended the bid solicitation and requested resubmission of bids; … [Continue reading]