|By Jim Doyle [email protected] 314-340-8372 Jim Doyle, St. Louis Post-Dispatch|
|McClatchy-Tribune Information Services|
It's also potentially lifesaving. Biopsies such as Pap smears and the analysis of polyps, tumors and skin anomalies are crucial in detecting certain cancers.
But how much a biopsy costs and who pays for it can be complex.
For example, a skin biopsy may cost
These biopsy markups are a hidden profit center in the health care industry, especially in states such as
Unknown to most consumers, there's a running feud over who controls the billing for biopsies -- one stretching back for several years and involving a tug-of-war between physicians, hospitals and laboratories. As consumers pay an increasing share of their medical costs, markups are drawing new attention.
On one side: the
In opposition are referring physicians -- independent clinicians such as dermatologists, gynecologists, gastroenterologists and family medicine practitioners who obtain biopsies from patients and send specimens to outside labs.
At stake is a piece of an extremely lucrative and growing business, one that's helped fuel the growth of nationwide laboratory chains while also providing new profit opportunities for physicians.
"I think both sides really see this as a black-and-white issue, but those in the middle see infinite shades of gray," Holloway said. "In the halls of the Capitol, it's doesn't seem to have enough heft to warrant a lot of attention. It's white-hot to the people involved in it, but it's not sexy enough for everyone else."</p>
Long ago, independent physicians would examine a tissue sample through a microscope to explore signs of disease. With specialization, sophisticated technical analyses and the growth of independent labs, pathologists emerged as expert interpreters of biopsies.
But today, pathology services are often controlled by a referring physician who orders the biopsy, ships a specimen to an external lab, marks up the lab costs, and sends a final bill to the consumer and/or insurer for both the doctor's visit and lab services.
Two national companies --
In the last decade, Quest and
But the two lab companies also have been sued repeatedly by competitors and whistleblowers. Critics, who tout regional labs' high quality and customer service, have chalked up the emergence of Quest and
"The big reference labs have been siphoning off the business by saying to doctors, 'Send it all to us, We'll save you overhead, time and money,'" said