Here are 7 questions to ask to find the pathology services provider that has the expertise to deliver the most useful analysis, will best serve your clinicians' demands and offers your facility the most efficient and cost-effective solution.

Hospital or outsource? The first question to be addressed is whether your facility will contract for services with the path lab at a local or regional hospital, perhaps one with which you're affiliated, or outsource your lab work to a pathology services company.

This may prove to be a political consideration. If you enjoy a collegial relationship as well as proximity to the hospital, will your secession for outside services weaken your facility's and surgeons' relationship with the hospital? Conversely, a pathology services firm may offer a higher level of service or more cutting-edge technology, but if they're not local, would the possibility of limited access or means of communication hinder your surgeons' relations with them?

A match for your case mix? Another consideration is whether a pathology service specializes in the same fields that your surgeons do. A lab staffed by generalists who examine a broad range of tissue specimen types may provide consistently accurate results, and may be the right fit for a multispecialty surgery center. But if your facility's case mix includes a large percentage of a certain specialty or is a single-specialty center, you may benefit from pathologists with extensive knowledge of that field. The edge that expertise offers will pay off when physicians can call up the pathologist for an in-depth discussion of a biopsy's findings.

Do references check out? As with any outsourced services, the vetting of your selections' qualifications is key. Request and review biographical information on a company's board and key staff to find out whether their subspecialty expertise is backed up by any accreditations or certifications. And consult your professional peers on the company's service track record. In the surgical marketplace, potential buyers are always advised to check a vendor's references, but that advice is particularly critical here. Remember, you're only as good as your weakest vendor.

Turnaround time? A path lab's turnaround time is an important factor to know, even though it might not be an urgent distinction in every case. Services may promote their 24-hour turnarounds, but most of the time your surgeons won't require absolute rapidity. Be sure to ask what results a lab can deliver in a rare event of immediate need. If 1 in 10,000 cases demands analysis within 12 hours, for instance, can a lab guarantee that turnaround?

It's more practical, though, to compare services by how they can deliver their results. As for-profit businesses, pathology firms tend to be service-oriented and may be able to customize their reports to your surgeons' requests, especially if you're sending a significant volume of work their way.

How do the results get into your patient records? While color printouts with cellular-level photographs sent by next-day courier were once considered a pretty slick presentation, some companies now offer electronic availability for pathology reports, for review via secure Web sites or even delivery directly into your EMR system. Also, ascertain the accessibility of the pathologists delivering the results. If physicians require consults or have concerns once they've received the results, can they communicate directly with the designated pathologist? Are the pathologists available by e-mail, telephone or teleconference?

Which insurers does the lab contract with? In most cases, pathology labs bill for their services the same way that anesthesia providers do, by submitting claims to patients or their insurers independent of the surgery center's facility fee and the surgeons' professional fees. An ASC that retains a lab's services may want to find out, for their patients' convenience, which insurers the lab contracts with, especially if it is located out of state. Practically everyone works with Medicare and the Blues, but does the national or regional pathology firm you're considering deal with the fourth- or fifth-most common carriers in your area?

Do they use tracking technology? The bar-coding of tissue specimen containers and their accompanying order sheets lets you track your samples and results like FedEx packages. The ultimate ideal is a closed loop, in which you can easily follow the specimen from its collection and its processing at the lab to a surgeon's receipt of the findings and communication of the results to the patient. If 10,000 specimens were sent out, it's confirmed that 10,000 results were returned. Pathology firms that invest in information technology may also have the ability to automate the ordering system, integrating their services with your facility's electronic medical records platform. This can provide you with an opportunity for increased staffing efficiency.

Consider the advantages that pathology automation may offer. Instead of having an OR nurse transcribe the specimen labels, document patient information in the chart and arrange for collection in the transfer log, a computer workstation would print labels and bar codes for specimen containers, merge documentation into the patient's record and place the order for pathology services. This process also begins tracking the specimen in real time, which can save your staff the effort of chasing the progress and results of pathology orders.

Acupath Laboratories
(888) ACUPATH
www.acupath.com
FYI: Many of this nationally accredited lab's board-certified pathologists have attained subspecialty certifications. The company offers a highly developed line of testing that features molecular assays, FISH probes and profiles, an extensive antibody menu, flow cytometry, cytogenics and digital IHC.

Caris Diagnostics
(800) 979-8292
www.carisdx.com
FYI: Specializes in molecular diagnostics and anatomic pathology services in the fields of oncology, dermatopathology, hematopathology and gastrointestinal pathology. Its team of subspecialty fellowships and expert-trained pathologists provide academic-caliber medical consults, says the company. Its labs in Irving, Texas, Phoenix, Ariz., and Newton, Mass., receive more than 2,700 biopsy specimens from physicians nationwide every day.

CBLPath
(877) CBLPATH
www.cblpath.com
FYI: CBLPath's College of American Pathologists-certified laboratory serves physician clients throughout the U.S. Physicians in metropolitan New York and Florida can take advantage of the company's services in their own facilities through its mobile frozen section service, which is staffed by board-certified anatomic pathologists and experienced technologists, says the company. CBLPath's subspecialties include breast pathology, cytopathology, dermatopathology, gastrointestinal pathology, hematopathology, ophthalmic pathology, podiatric pathology and uropathology.

Cole Diagnostics
(800) 850-7284
www.colediagnostics.com
FYI: This independent dermatopathology firm based in the northwestern U.S. provides surgery centers, dermatologists and oral surgeons with primary and consultative diagnoses for patient biopsies, including in-house immunostaining and direct immunofluorescence. Digital slide preparation lets physicians read their slides sooner and with higher quality than traditional glass slide services. Turnaround of less than 48 hours from anywhere in the country.

EndoChoice
(888) 682-3636
/www.endochoice.com
FYI: This market leader for in-office pathology solutions says it promotes its expertise in assisting the identification and implementation of the best model for a practice, be it global, TC/PC, client billing or building a laboratory. Will provide a customized practice analysis, free of charge, to help physician groups determine optimal pathology service models.

GI Pathology
(888) 244-7284
www.gipath.com
FYI: The only physician-owned lab in the U.S. that is dedicated solely to the practice of gastrointestinal and liver pathology provides high-quality diagnoses delivered only by fellowship-trained gastrointestinal pathologists, says the company. Results are consistently delivered back to the company's clients in the U.S., Canada and the Caribbean within 24 hours.

ProPath
(800) 258-1253
www.propath.com
FYI: One of the largest physician-owned anatomic pathology group practices, it serves clinicians nationwide with more than 35 board-certified pathologists offering subspecialty expertise in dermatopathology, gastrointestinal pathology, hematopathology, cytopathology, breast pathology, urologic pathology, podiatric pathology, surgical pathology, renal pathology and immunohistochemistry.