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R. Lewis Dark: Two Blockbuster Stories to Rock the Lab Industry!
WOW! YOU HAVE TWO BLOCKBUSTER STORIES covered in this issue, which
expanded into extra pages to bring you all the news and detailed analysis.
Our lead story, on the facing page, is first news in the laboratory industry of
criminal indictments of three ex-UroCor executives for laboratory sales and
marketing practices that violated Medicare anti-kickback laws.
However, before knowledge of the federal indictments reached us, we
had planned to devote this entire issue, as well as our August 9th issue,
to a serious trend: specialist physicians taking active steps to capture revenues
from the anatomic pathology services provided to their patients.
It's a phenomenon only now getting serious attention within the pathology
profession. But, until you read our coverage on this topic in this and
our next issue, you probably had no idea about its explosive growth and
its potential to threaten the long-term financial stability of hospital-based
pathology group practices.
It's unusual for a story to break which "rocks" the entire laboratory
industry. In my view, criminal indictments of ex-UroCor executives for
using sales and marketing tactics that violated Medicare anti-kickback
laws certainly qualifies. The federal attorney hopes to convince a jury,
that, among other types of misdeeds, UroCor's use of deeply-discounted
lab test pricing and waiving charges for tests done as an out-of-network
provider were inducements to certain urologist-clients and thus violated
the law. Since lots of labs around the United States commonly offer discounted
pricing to some classes of clients, the outcome of this trial may
trigger considerable changes in compliance policies and enforcement.
The exploding interest by specialist physicians to bring anatomic pathology
revenues in-house is a story which will also "rock" a wide cross section
of the pathology profession. You will read our coverage of this trend beginning
on page 12. Of particular interest to many will be our exclusive intelligence
about a brand new lab scheme adopted by some specialist groups: the
anatomic pathology condominium laboratory complex. Such sites are mushrooming
in Florida and Texas, attracting specialist group lab owners from
states as far away as Missouri and South Carolina. If that sounds odd to you,
then you are sure to be surprised about other details of the pathology condominium
laboratory scheme!
Ex-UroCor Execs Face
Criminal Indictments
Federal prosecutors allege UroCor paid
kickbacks & inducements to urologist-clients
CEO SUMMARY: CEO SUMMARY: Criminal charges filed against ex-UroCor executives center around several marketing practices that have much in common with marketing strategies used by many laboratories today. These include discounted pricing for non-Medicare specimens, offering to waive charges to payers and patients where UroCor was an"out-of-network" provider, and offering"consulting services" payments to client physicians.
UroCor's Sales Tactics
Violated Medicare Laws
It's too soon to determine what new legal
precedents may develop from this case
CEO SUMMARY: By issuing a multi-count criminal indictment against three former UroCor executives, one federal attorney is creating new legal precedents for the laboratory industry. The criminal charges accuse UroCor of inducing physicians through such gambits as deeply-discounted pricing and"free testing" when not a contracted network laboratory. Labs should review compliance with these types of sales practices.
Lawyer Argues: Urocor
Charges Are a Concern
Federal attorney breaks new ground
by attacking UroCor's sales practices
CEO SUMMARY: Criminal charges in the case against three ex-UroCor executives will likely alter existing compliance practices that affect how a lab offers price discounts to physicians and the way a lab uses"waiver of charges" in situations where it is an out-of-network provider. Attorney Jane Pine Wood was one of the first to see the federal indictment and offers a first assessment of its potential impact.
Editor's Perspective: Linking UroCor Indictments
With Specialist Doc Pathology
This trial's outcome may influence interest in
urology/gastroenterology in-house AP labs
Urology & GI Physicians
Bring Pathology In-House
Erodes long-standing business relationships
between local path groups and specialist docs
CEO SUMMARY: Increasing numbers of urology and gastroenterology specialist groups are deciding to bring anatomic pathology services in-house. This phenomenon has gathered speed during the past year and is becoming a threat to the long-term financial and clinical stability of the anatomic pathology profession in the United States. Every pathology group needs a strategy to cope with this trend.
Pathology"Condo Labs"
Are New Business Ploy
Pathologist doc-in-a-box schemes proliferating,
their threat to pathology is still unrecognized
CEO SUMMARY: We call ‘em pathology condominium laboratories. Other names are"pod labs" and"salon labs." Whatever name is used, this new scheme by specialist physicians to capture pathology revenues may be the most significant threat to the anatomic pathology profession since the imposition of hospital DRGs more than 20 years ago. Here's our exclusive analysis of this exploding trend.
In-House Versus Off-Site:
Different Concerns
How much compliance risk do you want?
Each of three options has a downside
CEO SUMMARY: Three methods are available to specialist physician groups to capture antomic pathology revenues generated by their patient population. Two methods have been around a long time. The pathology condo lab method is a new ploy. Of the three, one is generally accepted and more easily meets state and federal compliance requirements. But the other two methods come with greater compliance risk.
Changing Economics
Motivate Urologists & GIs
Specialist docs turn to anatomic pathology
to offset income losses from other sources
CEO SUMMARY: Over the past 18 months, more specialist groups have created their own anatomic pathology laboratories than were created in the past 18 years. It's a gold rush to tap and capture profits generated by the anatomic pathology services provided to their patient populations. This heightened interest in operating in-house anatomic pathology laboratories is directly linked to income cutbacks.
INTELLIGENCE:
Add To: Blood Bank Error
"Continuity of Care
Record" (CCR) Will Precede EHR
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