The June article, “Pathology vs. Dermatology: The Battle Heats Up,” here in Skin & Aging, got me thinking about pathologists and their organized effort to prohibit patients from paying dermatologists for pathology services.
Good Doctors, Bad Legislation
I hold pathologists in high esteem, if not reverence, so it saddens me to watch great doctors promote legislation to limit whom patients can pay for pathology services. While such legislation may be good for pathologists, it is bad for patients.
Background
Let’s review the background on the issue. High-volume, high-quality, specialized dermatopathology laboratories are very efficient and can provide dermatopathology services at a low cost. These laboratories compete for specimens and may offer their services to dermatologists at a discount. If the dermatologist bills the patient for the dermatopathology service and pays the pathologist, pathologists’ costs are reduced because they don’t shoulder the burden or risk for billing the patient. Dermatologists may charge some markup over the cost they pay the pathologist, yet they still offer the patient a low cost for pathology service.
Who Benefits?
The “direct billing” legislation being promoted by pathologists attempts to remove the “middle man” and force patients to directly pay pathologists. My impression is that pathologists think it is unfair that clinicians, who are in direct contact with patients, can negotiate volume discounts from pathologists or mark up the cost for work done by another doctor. Some pathologists may even think that the clinicians who do this do so solely for their own personal economic benefit or would accept low-quality pathology to make an extra dollar.
Yet, I believe that pathologists wouldn’t sacrifice the quality of their services to lower the cost of their operations anymore than dermatologists would choose a low-quality pathology service just to make a buck. They don’t have to. High-volume pathology laboratories become high-volume practices because the doctors that use them recognize the consistently high quality provided; these laboratories are less costly because they are more efficient, not because they provide poorer services.
Dermatologist Billing Less Costly for Patients
It may be that pathologists believe their dermatology colleagues are gouging patients with excessive markups. However, a recent survey on dermatologists’ charges for pathology services (see article on page 64), found that not to be the case; in fact, having the dermatologist do the billing was less costly to the patient/payer than having the pathologist bill directly. So if pathologists are in fact charging patients a fair fee for dermatopathology, then dermatologists have been giving patients a bargain.
Both pathologists and dermatologists are devoted to their patients. The ability to negotiate with a high-volume, high-quality laboratory allows dermatologists to save patients money. It allows dermatologists to work with a single, high-quality pathology laboratory that they are comfortable with instead of a multitude of different labs depending on the patient’s type of insurance.
This arrangement allows dermatologists to provide people of limited means skin cancer and benign mole removal for an affordable fee that otherwise would be too expensive because of pathology charges.
Direct Billing by Pathologists: Bad for Patients
Pathologists are patients’ doctors, too; they probably feel entitled to bill patients directly. They might ask how it would feel to dermatologists if family physicians and internists tried to negotiate lower-cost dermatology services for their patients.
If some dermatologists were capable of providing high-quality, efficient, low-cost service, they probably should be encouraged to participate in such arrangements; they shouldn’t be legally prohibited from choosing to participate. The pathologists who offer lower-cost service through dermatologists do so willingly. Legislation to prevent pathologists from doing so is going to cost patients more money while making it harder for dermatologists to provide good medical care.
Providing patients lower-cost dermatopathology services by contracting with high-quality, high-volume, low-cost dermatopathologists is good for patients.
Legislation to prevent patients from paying through their dermatologist may seem like a good idea to some people, but it is bad medicine. We’re all physicians. Let’s take this issue out of the legislative arena and work together to give patients quality care at fair prices.
The June article, “Pathology vs. Dermatology: The Battle Heats Up,” here in Skin & Aging, got me thinking about pathologists and their organized effort to prohibit patients from paying dermatologists for pathology services.
Good Doctors, Bad Legislation
I hold pathologists in high esteem, if not reverence, so it saddens me to watch great doctors promote legislation to limit whom patients can pay for pathology services. While such legislation may be good for pathologists, it is bad for patients.
Background
Let’s review the background on the issue. High-volume, high-quality, specialized dermatopathology laboratories are very efficient and can provide dermatopathology services at a low cost. These laboratories compete for specimens and may offer their services to dermatologists at a discount. If the dermatologist bills the patient for the dermatopathology service and pays the pathologist, pathologists’ costs are reduced because they don’t shoulder the burden or risk for billing the patient. Dermatologists may charge some markup over the cost they pay the pathologist, yet they still offer the patient a low cost for pathology service.
Who Benefits?
The “direct billing” legislation being promoted by pathologists attempts to remove the “middle man” and force patients to directly pay pathologists. My impression is that pathologists think it is unfair that clinicians, who are in direct contact with patients, can negotiate volume discounts from pathologists or mark up the cost for work done by another doctor. Some pathologists may even think that the clinicians who do this do so solely for their own personal economic benefit or would accept low-quality pathology to make an extra dollar.
Yet, I believe that pathologists wouldn’t sacrifice the quality of their services to lower the cost of their operations anymore than dermatologists would choose a low-quality pathology service just to make a buck. They don’t have to. High-volume pathology laboratories become high-volume practices because the doctors that use them recognize the consistently high quality provided; these laboratories are less costly because they are more efficient, not because they provide poorer services.
Dermatologist Billing Less Costly for Patients
It may be that pathologists believe their dermatology colleagues are gouging patients with excessive markups. However, a recent survey on dermatologists’ charges for pathology services (see article on page 64), found that not to be the case; in fact, having the dermatologist do the billing was less costly to the patient/payer than having the pathologist bill directly. So if pathologists are in fact charging patients a fair fee for dermatopathology, then dermatologists have been giving patients a bargain.
Both pathologists and dermatologists are devoted to their patients. The ability to negotiate with a high-volume, high-quality laboratory allows dermatologists to save patients money. It allows dermatologists to work with a single, high-quality pathology laboratory that they are comfortable with instead of a multitude of different labs depending on the patient’s type of insurance.
This arrangement allows dermatologists to provide people of limited means skin cancer and benign mole removal for an affordable fee that otherwise would be too expensive because of pathology charges.
Direct Billing by Pathologists: Bad for Patients
Pathologists are patients’ doctors, too; they probably feel entitled to bill patients directly. They might ask how it would feel to dermatologists if family physicians and internists tried to negotiate lower-cost dermatology services for their patients.
If some dermatologists were capable of providing high-quality, efficient, low-cost service, they probably should be encouraged to participate in such arrangements; they shouldn’t be legally prohibited from choosing to participate. The pathologists who offer lower-cost service through dermatologists do so willingly. Legislation to prevent pathologists from doing so is going to cost patients more money while making it harder for dermatologists to provide good medical care.
Providing patients lower-cost dermatopathology services by contracting with high-quality, high-volume, low-cost dermatopathologists is good for patients.
Legislation to prevent patients from paying through their dermatologist may seem like a good idea to some people, but it is bad medicine. We’re all physicians. Let’s take this issue out of the legislative arena and work together to give patients quality care at fair prices.
The June article, “Pathology vs. Dermatology: The Battle Heats Up,” here in Skin & Aging, got me thinking about pathologists and their organized effort to prohibit patients from paying dermatologists for pathology services.
Good Doctors, Bad Legislation
I hold pathologists in high esteem, if not reverence, so it saddens me to watch great doctors promote legislation to limit whom patients can pay for pathology services. While such legislation may be good for pathologists, it is bad for patients.
Background
Let’s review the background on the issue. High-volume, high-quality, specialized dermatopathology laboratories are very efficient and can provide dermatopathology services at a low cost. These laboratories compete for specimens and may offer their services to dermatologists at a discount. If the dermatologist bills the patient for the dermatopathology service and pays the pathologist, pathologists’ costs are reduced because they don’t shoulder the burden or risk for billing the patient. Dermatologists may charge some markup over the cost they pay the pathologist, yet they still offer the patient a low cost for pathology service.
Who Benefits?
The “direct billing” legislation being promoted by pathologists attempts to remove the “middle man” and force patients to directly pay pathologists. My impression is that pathologists think it is unfair that clinicians, who are in direct contact with patients, can negotiate volume discounts from pathologists or mark up the cost for work done by another doctor. Some pathologists may even think that the clinicians who do this do so solely for their own personal economic benefit or would accept low-quality pathology to make an extra dollar.
Yet, I believe that pathologists wouldn’t sacrifice the quality of their services to lower the cost of their operations anymore than dermatologists would choose a low-quality pathology service just to make a buck. They don’t have to. High-volume pathology laboratories become high-volume practices because the doctors that use them recognize the consistently high quality provided; these laboratories are less costly because they are more efficient, not because they provide poorer services.
Dermatologist Billing Less Costly for Patients
It may be that pathologists believe their dermatology colleagues are gouging patients with excessive markups. However, a recent survey on dermatologists’ charges for pathology services (see article on page 64), found that not to be the case; in fact, having the dermatologist do the billing was less costly to the patient/payer than having the pathologist bill directly. So if pathologists are in fact charging patients a fair fee for dermatopathology, then dermatologists have been giving patients a bargain.
Both pathologists and dermatologists are devoted to their patients. The ability to negotiate with a high-volume, high-quality laboratory allows dermatologists to save patients money. It allows dermatologists to work with a single, high-quality pathology laboratory that they are comfortable with instead of a multitude of different labs depending on the patient’s type of insurance.
This arrangement allows dermatologists to provide people of limited means skin cancer and benign mole removal for an affordable fee that otherwise would be too expensive because of pathology charges.
Direct Billing by Pathologists: Bad for Patients
Pathologists are patients’ doctors, too; they probably feel entitled to bill patients directly. They might ask how it would feel to dermatologists if family physicians and internists tried to negotiate lower-cost dermatology services for their patients.
If some dermatologists were capable of providing high-quality, efficient, low-cost service, they probably should be encouraged to participate in such arrangements; they shouldn’t be legally prohibited from choosing to participate. The pathologists who offer lower-cost service through dermatologists do so willingly. Legislation to prevent pathologists from doing so is going to cost patients more money while making it harder for dermatologists to provide good medical care.
Providing patients lower-cost dermatopathology services by contracting with high-quality, high-volume, low-cost dermatopathologists is good for patients.
Legislation to prevent patients from paying through their dermatologist may seem like a good idea to some people, but it is bad medicine. We’re all physicians. Let’s take this issue out of the legislative arena and work together to give patients quality care at fair prices.
