Biopsy Report Imagery

[Arnon Krongrad, MD]

When men receive a cancer diagnosis they are overwhelmed. They go into denial often. The news hurts. What can a pathology lab do to help in those early hours and days? Can imagery help? If so, what kind?

[Mike]

Steven: You are right. However, I wasn't referring primarily to the doctor. I was referring to the "system." There is nothing to stop the pathology lab developing and providing high quality information which is helpful to the patient and which the patient can take home with him. If the doctor can go through this with the patient in detail, so much the better.

However, on the subject of the doctor, all the urologists who I would let near me with a scalpel if I got prostate cancer (and there are a few) would spend as much time with me as I needed. That's one of the reasons I know that they are any good. If the doc is half-way out of the room before I know what's going on, I'm going to be ALL of the way out of their office and looking elswhere for guidance!

The docs who are overscheduled and stressed are not managing their practice with their patients' interests at heart. Politely, I don't give a you know what about their reimbursement. I don't negotiate that. The average urologist is making in excess of $400,000 a year according to the last set of data I saw. Do I think Dr. K is patient-oriented? Yes I do. Do I think he's the only one? No I don't. There are certainly others. (Pace Arnon!)

[Steven Hess]

Mike
While my initial reaction is to defer to your much greater experience, I will stand my ground--more or less :) You may not give a rat's ass about reimbursement but the physician sure does and I don't blame him or her. They have to be as efficient and mindful of billable hours as does any business person and that does not mean they sacrifice patient care. They just don't make house calls anymore or sit and schmooz more than they have to. The average physician (I exclude plastic surgeons and other "cash up front" specialties) is set upon by government, , insurance companies and the legal system and has a huge overhead. My MD-wife's attorney gets $300+/hour (in Rochester, NY , not NY, NY or LA) but patients complain about a $25 co-pay to a doctor who has three times the educational years invested and works under a much higher risk profile than any lawyer. You know all this. It is not a "vent" or complaint but simply a statement of facts to support my argument that additional "services" (such as imagery) are not going to happen if no one is willing to pay for it or reimburse for it.

An anecdote: My wife was drawing my blood and knowing my cowardly makeup assured me it would be "painless" because she uses "butterfly" needles which are very fine. Well I hardly felt it and asked her why everyone does not use them and she said because they cost a bit (pennies) more. You're kidding, I said. No, she replied, in hospital labs where they use them by the tens of thousands the pennies add up fast. The point (no pun intended) is providers will not enhance services if it adds costs that cannot be recovered

As for doc attitudes, all I can say is that my surgeon spent ten minutes with me pre-op, spent 10 minutes with me post-op (mostly because my wife was there and he was being courteous to a colleague) but his patients sing his praises and you can count me as the loudest voice in the chorus. He doesn't waste a second but is a master of his profession so I am more than willing to forgo a warmer bedside manner

[Mike Fisher]

Steven,

I think you are on track concerning physicians and time management.
There has never been a physician I have used that gave me any patient information. My company supplies thousands of pictures a year for patient education but it seems the pharmas produce most of it and only for the blockbuster drugs. Typically they spend more on B to P[hsyican] information.

Mike I also think you are on the right track with path labs supplying info with the reports but the lottery might be a better bet.

How about medical insurance? Do they have anything to gain by supplying photos, illustrations and text to patients with the billing? Images with keywording and ICD-9 coding can easily be matched to any billing going o the patient. Don't the insurance companies have the best paper route to getting the info to patients and maybe the benefit is a healthier client who just pays into the system but hardly uses it.

Does this have any merit?

[Steven Hess]

Aside from costs the HIPAA dragon can quickly rear its head and present obstacles to what can be sent by whom to whom.

Insurance companies correspond with physicians and not with patients other than occasional summaries of benefits paid.

If imagery is distributed it would have to be, I believe, directly from physician to patient

[Mike Fisher]

Steven,

I can tell by the word "dragon" you've had some experience with HIPAA. I believe the insurance codes keep anonymity at the data entry level. If a patients billing summary/description of benefits documents are generated by ICD-9 then an educational printout with a matching ICD can follow in the printer as another paginated sheet to the print job. I know the whole idea is pushing the envelope for what insurers are willing to do, especially modifying software and all the problems that go along with changes. Seems though they have the most to gain financially if that ACL repair patient knows how to take care of their new lease on stability so the insurer does not pay twice.

[Steven Hess]

Hi Mike
You are way ahead of me on this. I just know that insurers are dedicated to pay as little as they can and paying for extra services if they don't perceive a direct benefit by way of savings is just not in their business model. Thank you for contributing your expertise.

Steve