CEO SUMMARY: One association representing pathologists says new payment rates that Anthem, Inc., is introducing in 14 states do not cover the costs of performing anatomic pathology and clinical lab testing for the tests in question. Another association says the steep payment cuts threaten the viability of small and rural pathology groups. State-by-state, Anthem is
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Anatomic pathology is about diagnosing disease through the examination of organs and tissue samples by using a microscope, or through molecular, biochemical or immunological means.
It differs from clinical pathology, where diseases are diagnosed through analyzing bodily fluids in a lab.
In anatomic pathology, a physician trained in pathology examines surgical specimens (e.g., from a biopsy). This contrasts from clinical pathology, where blood, throat cultures, and urine as sent to a lab for analysis to determine whether a patient either has or is at risk for several biological diseases.
The American Board of Pathology is one of the primary certification organizations for anatomic pathologists. To be certified in anatomic pathology, a physician must complete four years of medical school and three years of residency. To be certified in both anatomic and clinical pathology, a physician must do four years of residency.
Anatomic pathologists typically work in hospitals, and pathology in general is most times practiced in hospitals and academic medical centers, where research is being conducted.
CEO SUMMARY: Now that the FDA has cleared two digital pathology systems for use in primary diagnosis, a growing number of pathology groups are taking up the question of whether and when they should adopt and use a digital pathology system and whole slide imaging. One pathologist with hands-on experience working with different digital pathology
FACED WITH DEEP CUTS in payment for anatomic pathology professional component services from Anthem Inc., pathologist have only a few options in how they can respond, according to consultants who work with AP groups.
“These are dire cuts to anatomic pathology reimbursement,” said one consultant who asked not to be named. He suggested that small regional
CEO SUMMARY: Consultants who work with anatomic pathologists have several theories about why Anthem is enacting deep cuts of 50% to 70% for the professional component of many anatomic pathology services. While they have different ideas about what motivates the nation’s second largest health insurer, they agree that such reductions in payments will have a
IT MAY NOT BE A COINCIDENCE THAT MANY RECENT NEWS CYCLES have more negative pathology news than positive pathology news. After all, laboratory medicine is at the core of most clinical care delivered to patients, so it’s no coincidence that pathology—both clinical and anatomic—is a prime target for government and private payers, along with federal investigators.
CEO SUMMARY: Deep cuts in what Anthem pays pathologists for the professional component for certain AP services are having a harmful effect on the long-standing relationships that dermatologists have with dermatopathologists, some physicians say. By disrupting these relationships, Anthem is harming patient care, they add. Since late last year, in a growing number of states,
This is an excerpt of a 2,576-word article in the July 22, 2019 issue of THE DARK REPORT (TDR). The full articles are available to members of The Dark Intelligence Group.
CEO SUMMARY: Within five years, members of the millennial generation will make up 75% of the physician workforce in the United States,according to a recently
CEO SUMMARY: Within five years, members of the millennial generation will make up 75% of the physician workforce in the United States, rising from about 24% in 2017. That three-fold increase represents a strong demographic trend that will require changes in the steps all clinical laboratories and pathology groups take when seeking to attract and
CEO SUMMARY: Reviewing an AP practice’s expenses is vitally important today when payers are cutting reimbursement. In the past, government and private payers paid more for the technical and professional components of anatomic pathology work, but those rates have eroded. While conversations about revenue tend to obscure the need to talk about expenses, effective financial
CEO SUMMARY: As of Aug. 1, Aetna will stop paying out-of-network pathologists for the professional component review of certain clinical pathology tests. Until now, the health insurer has paid for the professional component when out-of-network labs billed for clinical lab tests using the modifier 26. In a notice to labs, Aetna said it will pay