Cost-containment protocols for prostate core needle biopsies: hypothetical scenarios to reduce procedural costs

Background: In recent years, anatomic pathology laboratories have been struck by new revenue policies secondary to the Affordable Care Act. In particular, modifications to compensation for processing prostatic core needle biopsies (PCNBs) have led to important reimbursement cuts. Herein, we explore a hypothetical reduction in the costs for the processing of PCNBs using three simple, hypothetical methods while maintaining high-standard patient care. Materials and methods: We determined the number of blocks and slides used per case on all PCNBs performed at our institution from August 2013 to September 2014 and calculated the total procedural cost for each case and for the total number of cases processed during the study period based on a published estimated procedural cost. We then estimated the procedural cost of three different proposed hypothetical scenarios that consisted in reducing the number of blocks used per case. A Student t test was used to assess the difference between real and hypothetical costs. Results: A total of 4,406 paraffin blocks were used to process 363 PCNBs with a total annual procedural cost of $26,303. By implementing any of the hypothetical scenarios, the annual procedural cost was significantly reduced; the reduction could potentially be as low as $8,978 (P < 0.0001). Conclusions: This study illustrates three hypothetical alternatives that could dramatically reduce the procedural costs of PCNBs while maintaining high-quality care. Implementation of these scenarios at a global scale could potentially have an impact on health-care cost in the USA of several millions of dollars per year.