Ken Harvey wrote: > What do others think about how best to achieve, "best-practice" > pathology ordering? > > Cheers > Ken
Ken If you want to modify test request patterns then concentrate on the people requesting the tests. I dont think Pathology companies are anywhere near the level of smarts that drug companuies are when it comes to altering referral/prescription patterns and certainly there is a world of difference with "marketing budgets". The medicare budget for pathology goes up but its never as much as pathologists want and the profitability of testing is constantly being eroded (for years), just like general practice rebates. I have no control over what is ordered through my histology service (except to say no i cannot make a frozen etc). Am I thinking of ways to improve the volumes of referrals - of course, but only with an ethical best practice view. I have never ever had any approaches by anyone implying there was any financial or other reason to order more tests inappropriately (when working for a comprehensive testing service) and have not been asked for incentives for work in my current position (but im new and I have no doubt it will happen sometime). Essentially in my opinion people order what they feel is necessary for their patients and doctors for whatever reason are feeling they need more test results to feel diagnostically confident. If referring Drs are ordering more its a consequence of increased knowledge of disease and consequences of failure to diagnose and not some secret nefarious plot by vertically integrated corporates to bleed medicare dry (as much as an independent guy like me would like it to be so). I think its multifactorial and certainly includes some of these things: The expanding indications for anticoagulant therapy springs to mind + PSA testing/monitoring + lipid studies on everyone etc Is collection centre licensing in GP surgeries a factor? It might be given the extreme convenience associated with a computer printed form, a nurse in the next room to take the blood and a rapid turnaround on a result delivered to the surgery (its all "easy"). its also easier to access a service to get a specimen collected too. Surely there are some breakdowns of whose ordering and what specifically? It would be nice to know that. Regarding the comments about Gribbles and vertical integration: Healthscope/gribbles just copped a share price hammering as they havent realised synergies of hospital ownership and pathology testing that they had predicted plus Vict is a backwards market (underperforming) for them of late...kinda conflicts the Age though.. In my opinion the GP skin clinics have "veritcally integrated" their pathology services way better than Mayne or Sonic! All the work in the country is being centralised to path labs in the southern states..."helps them with their statistics and data collection"...Surely a local service is better than an interstate one....certainly it is here on the gold coast (with S&N having one of the 2 leading skin pathologists in the world a phonecall and courier away from the skin clinics -yet they are spurned for our southern brothers and a plane trip for the specimens) As for this bit: "The Australian Medical Association has dismissed concerns that doctors were gaining financially by referring patients to certain pathology labs as "lots of smoke but no real fire". It is illegal for doctors to benefit financially by ordering tests or having a stake in a pathology company. This does not mean that over-servicing, for reasons of financial gain, does not exist. Last year, a review by government lawyers Phillips Fox recommended the Health Insurance Act be tightened to stop pathology companies paying inducements to doctors including personal gifts and benefits and lump sum payments, to win referrals. The review described the existing law as unclear and said there had been no prosecutions since at least the early 1990s "despite there being a perception within the pathology industry that a small number of providers and referring practitioners have breached the prohibitions". If you own $20k Mayne shares is that a conflict with a mayne collection centre in your practice? (not really as your miniscule contribution to Maynes bottom line would not reasonably be expected to alter maynes performance) If you invest 5% of the seed capital in a Dr owned Pathology Lab startup with a token pathologist at the helm and then send them all your work is that a conflict? (I think a sound yes as its clearly a business and profit making investment you are significantly involved in...especially if the ordering patterns alter in the more direction) If you "invest" $20k in a pathology startup with 100 other GPs in the area and the business model is that your 5 suburb radius sends all its work to the lab in question and another company manages the lab then is that a problem? You have no direct control but performance will suffer if your referrals are lost (again I think you have significant effect on the entities performance and it relates to your own personal finances so I think there is a conflict) - for me thats a yes but in some circumstances such as a poorly serviced area where there is no close by lab it might be entirely appropriate to improve access to pathology in this way! (eg when its a 50 min drive to a lab) Somewhere in there it becomes a problem and I dont know quite know where... Thoughts on that?! Finally why is it the College of Pathologists responsibility to over see the ordering patterns of referring Drs anyway (and be responsible for down regulating their numbers of tests)..... Finally, if bulk billing pathology was stopped or dis-incentived and the patients and drs had to make a conscious decision about a test knowing it would cost them out of pocket money I bet $100 to who ever will take the bet the pathology blowout will slow or stop in direct proportion to the out of pocket expense. I guess the question of pathology testing fundholding for GPS comes up like pharmacy budgets (a la NHS) (GPs have a bunch of cash from the HIC for their patients for the year -spend more and its out of the GPs pockets, spend less and the practice wins) /asbestos and kevlar prepared! JD -- ================================================= dr john dooley mbbs frcpa aka "ron" _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
