FYI

 

  _____  

From: ASCP Washington [mailto:ascp@site1.ascpmail.org] 
Sent: Tuesday, January 09, 2007 12:16 PM
To: Patsy G Ruegg
Subject: Legislative Action Needed: Tell New Congress to Stop Pod Labs 

 

   

 


Tell CMS and Congress: 


Pod Labs Undermine Quality Patient Care!

Take a few minutes to help stop pod labs and their abusive billing
practices.

ASCP is urging all members of the laboratory team to demand that the
government "STOP POD LABS NOW!"

Pathology and laboratory medicine was dealt an unexpected blow last November
when the Centers for Medicare & Medicaid Services (CMS) declined to
implement a series of initiatives designed to stop abusive billing practices
by "pod" or "condo" laboratories.  ASCP is asking all laboratory
practitioners to demand CMS take action against these abusive billing
practices. The entire laboratory team is affected by these pods as they
employ both pathologists and medical technologists/technicians in their
scheme.  

"Pod labs and fee splitting threaten the very existence of pathology and
laboratory medicine. ASCP pledges to be relentless in our pursuit to stop
pod labs now." - John S. J. Brooks, M.D., FASCP, ASCP President

What's a pod lab and why are they an issue?
Pod laboratories are facilities structured to enable referring providers to
rent space (such as a cubicle) in a laboratory, to exploit a loophole in
Medicare's in-office ancillary exception rules.  These labs provide a
limited menu of services, such as analyzing biopsies, often at below fair
market value.  In 2005, CMS relaxed its rules for independent contractor
physicians or non-physicians to reassign their Medicare billing rights to
health care entities. Previously, CMS' regulations allowed reassignment of
benefits only for those services performed on-site.  With pod labs, the new
in-office ancillary exception rules can be abused to enable referring
providers to capture revenues generated from pathology services. 

Why are pod labs bad?  
ASCP has condemned these arrangements because they adversely affect patient
care, the quality of laboratory services, and the laboratory industry.  By
charging a fraction of what a full-scale clinical laboratory typically
charges, pod labs empower referring providers to mark-up the cost of the
Medicare laboratory services.  These economic incentives distort rational
medical decisions by enabling providers to be compensated on the volume of
laboratory services referred. It also encourages overutilization of testing
services, which can increase the risk of injury to the patient.  

The Wall Street Journal has run several articles on pod labs, including a
feature on October 23, 2006 that stated "patients, in some cases, are being
referred for tests.at lower-quality labs simply because the referring
physician stands to get a cut of the profits from that work."  These
arrangements also adversely affect the quality laboratory services
industry-wide, because laboratories seeking to remain competitive may
increasingly be forced to focus more on cost than on quality.  

ASCP's policy statement on Fee

Splitting, Mark-Ups and Related Practices, and the American Medical
Association, through its Council on Ethical and Judicial Affairs expressed
strong opposition to fee-splitting and mark-ups.  One of the policy
statements states that "a physician who disregards quality as the primary
criterion or who chooses a laboratory solely because it provides low-cost
laboratory services on which the patient is charged a profit, is not acting
in the best interests of the patient."

Pod labs may also be responsible, in part, for some of CMS' recent efforts
to combat Medicare fraud.  Some of these initiatives, such as the national
correct coding initiative and the medically unlikely (formerly unbelievable)
edits (MUEs) program, have adverse consequences for patient care by
interfering with the ability of pathologists and other laboratory
professionals to provide necessary laboratory services. It can be recalled
that one of CMS' proposed MUEs would have capped reimbursement for the
examination of biopsies at no more than two per patient per day, regardless
of medical necessity. ASCP continues to fight these efforts.

ASCP Advocacy Efforts.  
ASCP is stepping up its advocacy efforts to prevent these entities from
undermining patient care and the quality laboratory services performed by
our nation's hospital and independent reference clinical laboratories.
ASCP's recent comments on the 2007 physician fee schedule urged strong
measures to stop pod labs and similar abusive billing schemes.
Unfortunately, pressure from groups representing those who benefit
financially from these arrangements and comments submitted by a major
medical association raising concern about "unintended consequences" lead the
agency to back off.  ASCP is launching this grassroots advocacy campaign to
change CMS' mind.

What You Can Do


  
Visit ASCP 
's e-Advocacy Center to send CMS and your members of Congress a brief
message urging CMS to stop pod labs from engaging in abusive billing
practices. ASCP's Washington staff has drafted a model email you can send
but we encourage you to personalize your email by noting how these entities
have adversely affected the work you do. This will significantly increase
the effectiveness of your message to CMS. 

It only take a few minutes to help stop pod labs now!!! 

 

 

This alert can be accessed by
 clicking
here.

ASCP's latest coverage of the Anti-Pod Lab Campaign, as written in the
latest edition of ASCP e-Policy News, can be accessed by

clicking here. 
 

Please forward this email to your colleagues to increase the impact your
efforts can have to help stop pod labs. 

 



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Not everyone receives ASCP's Action Alerts, so please forward this message
to your peers and co-workers!

 

   

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