W. STEPHEN BLACK-SCHAFFER, M.D., Massachusetts General Hospital, Boston, MA and REBECCA L. JOHNSON, M.D., Berkshire Medical Center, Pittsfield, MA
Management of a large pathology practice to provide clinical services effectively and efficiently is a complex task. In academic practices, clinical, teaching, and research responsibilities must also be balanced. Changes in health care financing and stringency of health care regulation further complicate this task. This course presents practical current information and organizational models that large and academic pathology practices can use in coping effectively with these constraints. Specific topics are: 1) the regulatory basis and general structure of compliance programs for pathology practices including consultation and teaching services; 2) correct coding for pathology services including complex coding decisions in referral practices; 3) efficient models for the equitable allocation of subspecialty staffing in large pathology practices.
Compliance: seven factors address one or more of the regulatory bases of a compliance program; each will be presented in the context of the practical design of a program. Participant interaction will be encouraged to deal with issues and concerns specific to individual practice settings.
Correct coding in each of two systems (CPT and ICD) is a major factor in compliance as well as a key determinant of reimbursement. Though the present CPT terminology is for the most part clear, important gray areas for large specialized or academic practices will be reviewed, with citation and discussion of authoritative coding information. Application of the ICD coding system to pathology specimens presents some practical difficulties and may be counterintuitive. Appropriate coding guidelines will be presented and discussed.
Decreasing unit reimbursements make efficiency in the practice of surgical pathology and cytopathology more important than ever. Unlike the semi-industrial, high fixed/low variable cost model for clinical laboratories, anatomic pathology offers relatively little volume efficiency, but subspecialization can increase productivity through decreased variability. In the context of an academic practice, this is additionally beneficial in aligning each pathologist's clinical work and academic specialization. Models for the equitable allocation of staffing among a mix of subspecialized services will be presented and discussed.
No materials will be mailed in advance, but a comprehensive syllabus will be distributed at the time of the course.