Wednesday 7 August 2019, Dominion Pathology Associates (DPA) held a public forum at the Southwest Roanoke County Library. The topic was: the place of diagnostic pathology in American medicine and how it relates to current challenges in health insurance reimbursement.
The central place of hospital-based pathology to cancer care and other serious illnesses is probably underappreciated because patients rarely meet their pathologists who interpret their tissue samples from biopsies or resections. Such cases are often discussed between the patient’s primary clinicians, as well as radiologists, oncologists and other specialists to ensure that the best care is offered to patients-all at the local level. DPA provides local expertise in blood and bone marrow pathology, skin pathology, gastrointestinal pathology, liver pathology, pancreatic pathology, cytology, gynecological pathology and breast pathology, among others. For those who attended, DPA pathologists were available to discuss cancer diagnoses, or any other issues or concern raised by attendees.
Recent severely reduced reimbursement payments by Anthem BC/BS for high volume diagnostic pathology and laboratory services in Virginia and at least 12 other states make it a challenging environment to continue to provide the highly integrated care that we have all come to appreciate, even if we don’t see what goes on behind the scenes. Some of Anthem’s cuts entail up to 65% reductions and are up to one third of current published Medicare allowable reimbursement rates. In some cases, the new proposed rates do not even cover the cost of services. These concerns have been duly noted by the Virginia Society of Pathologists, the College of American Pathologists, the American Society of Clinical Pathologists, as well as many other state pathology societies.
DPA urges all of us, but particularly those with Anthem BC/BS health insurance, to understand how in network providers are selected and how those relationships are maintained. Anthem BC/BS has generated considerable local, regional and national angst in diagnostic pathology and laboratory medicine. The potential long-term adverse impact to the practice of pathology is huge, especially as the number of pathologists in the United States is at an all-time low (JAMA Network Open. 2019;2(5): e194337. doi:10.1001/jamanetworkopen.2019.4337). These challenges will make it difficult to recruit and to retain the most talented young pathologists to southwest Virginia. We are all in this together! So DPA urges a return to the centrality of the patient-clinician relationship, even if that relationship is with your pathologist whom you might have never met. Please visit us at DPApathology.com or call us at any time with your pathology questions at 540-581-0155.