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Jonathan Oppenheimer

I applaud the decision of CMS to slash the reimbursement of prostate biopsies. Instead of going out of business; value-driven labs should thrive! Because excess profit will no longer allow businessmen to finance the legal kickbacks (client-bill, EMR-donations, TC-PC) currently in vogue, urologic pathologists will once again be able to perform the work they love for the benefit of patients. Urologists will be able to sent specimens to labs created to provide medical value rather than return on investment.

The increased number of specimens sent to centers of excellence may allow patient-centric labs more opportunity to develop prognostic algorithms used to select which men need to be rebiopsied, who should be enrolled in active surveillance, who is at high risk and should pursue aggressive treatment, and even who (with the development of novel blood and urine-based tests) may avoid the risks and bother of an invasive biopsy procedure in the first place.

Pathologists practicing their profession for the benefit of patIents. What a concept!


I work for a pathologist-owned private lab - this news is devastating and infuriating; we are going to get KILLED… and this is on top of the Palmetto decision… and this on top of the end of the TC grandfather clause.

So you take pathologists who are already a marginalized under-reimbursed specialty, you let private practitioners who are already well compensated steal our work and force us to work for pennies on the dollar because of some loophole in the Stark Laws, they clearly abuse the system, get in trouble, and now we are the ones that gets hurt in the end?!? This is so unbelievable that it has left my head spinning.

Are pathologist-owned private labs that rare now-a-days? This CMS decision CLEARLY has ZERO regard for pathologist-owned labs; and now we are looking at MAJOR cutbacks.

We've always had to compete with faceless megalabs, but now we are getting marauded from the government too. What a horrific lose-lose situation for everyday honest hard-working pathologists.

Is there any silver-lining here? Is this the end of pathology private practice? Am I still a doctor? I'm really confused and really frustrated and not sure what I should do…

A (The Pathology Blawg)

Mr. Plandowski left out the most likely reason in-office labs are so highly profitable-the owners of the lab are the ones who decide how much work flows to the lab they own.

Using only the data from the OIG studies published in 2007 Misters Plandowski and Ness repeatedly refer to, two of the groups studied increased their biopsy utilization 230 and 699% immediately after starting to self-refer prostate biopsies.

Now we are told this is because these groups simply happened to adopt the new "guidelines" for prostate biopsies (that required each core to be placed in its own container) at the exact same moment they started self-referring. What convenient timing.

These "guidelines" they refer to are a myth.

The NCCN, which writes the most comprehensive guidelines on the planet for the diagnosis, treatment and follow up of prostate cancer, to this day does not say it is necessary to place each core in its own container, let alone in 2004, which is when the OIG studied the urology groups.

In-office labs are only about the money. As evidence of this, Mr. Plandowski immediately advised his urologist clients to close down their in-office labs as soon as the "Palmetto cap" made the labs only break-even from a profit standpoint.

Keep in mind the labs won't be losing money; they just won't be wildly profitable as they were before.

Any urologist who heeds Mr. Plandowski's advice and closes their lab because it is now only break-even will prove the lab was only about the money and never about patient care.

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