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Path Lab
Does Your Pathology Service Overdeliver?
V. Raman Sukumar
Publish Date: September 4, 2008

Beyond the core services of testing, consultation and diagnosis, here are three value-added services your pathology service should be offering you to ensure that your surgeons are getting the best service possible.

1. Efficient reporting and speedy turnaround
Waiting for biopsy results is an unpleasant experience for any patient, made worse by delays in specimen pickup, testing and reporting by the pathology lab. Consider this scenario: A woman is identified as having abnormal breast findings by mammogram, and her surgeon sends the breast biopsy to the path lab for diagnosis. She waits for a diagnosis, which on average takes about a week to arrive from an outpatient lab, and it's malignant. She sees an oncologist the following week, only to find out that the oncologist doesn't have all the markers needed on the malignancy to decide the treatment protocol. The patient has to return for a follow-up appointment after the oncologist is able to retrieve the essentials of the pathology diagnosis to decide a course of treatment.

In addition to the psychological strain on the patient, the many steps involved in this process increase the probability of lost paperwork, miscommunication, scheduling conflicts and other problems that can make an already difficult situation even worse for the patient. And many times a lack of detail in the pathology report is one of the main sources of delay in starting the treatment protocol.

Avoid confusing paper trails and delayed treatment by choosing a pathologist close to home who can pick up and examine specimens quickly. If the diagnosis is malignant, your pathologist should be able to do the markers right away and include all the clinical and anatomic test results in one comprehensive report. If your pathologist can do all this, the turnaround time between the identification of abnormal tissue and the complete pathology report can be as little as 48 hours, letting the patient start treatment as soon as possible after the diagnosis.

2. On-call accessibility
Like a telecom provider who promises 24-hour customer service, your pathology service should be available to provide round-the-clock answers to the questions your surgeons, the staff and all physicians treating the patient may have. Intraoperative consultations, in particular, can't always be scheduled in advance. Sometimes the surgeon will encounter something abnormal in the course of surgery, requiring a consultation and diagnosis while the patient is still on the table. This can disrupt the pathologist's schedule, but when the goal is optimal patient care, a quality pathology service will be happy to accommodate you in times of emergency. The quicker your pathology service can respond, the better — you don't want to prolong the patient's time under anesthesia.

Your path service should also be instantaneously accessible for the staff to ask important specimen collection questions during a procedure or to help fix any mistakes made by staff when collecting specimens. Ask your pathologist to attend your facility's quality assessment meetings to ensure there is early detection of errors at every step of the process.

Pathology Pointers

  • DIRECT BILLING Independent laboratories possessing arrangements with hospitals in effect as of July 22, 1999, may continue to bill Medicare directly for the technical component of pathology services provided to inpatients or outpatients of such hospitals, according to the Medicare Improvements for Patients and Providers Act of 2008. The act extended through Dec. 31, 2009, a moratorium on a rule that would bar such labs from billing Medicare directly, requiring them to be paid by the hospitals instead. — Irene Tsikitas
  • TELEMEDICINE When referring your specimens to another state, check your state's telemedicine laws to determine if physician licensure is a requirement. Many states require pathologists to be licensed in the state in which the patient was seen, in addition to the state in which the pathologist rendered the diagnosis. If your state does, ask the lab for a copy of each pathologist's active medical license to practice in your state before you refer tissue.

— Julia Dahl, MD

3. Informational resources
Often, physicians and nursing staff will have additional questions about the details of the pathology report. Patients, in particular, won't want to wait to see an oncologist before getting more details, and they may be more comfortable talking about their diagnosis with the pathologist. Your pathology service can — and should — help keep patients and medical staff informed by providing educational materials about test results and diagnoses. That information can be added to the pathology report, made available on the Web or delivered verbally.

Some pathologists don't want to deal with patients, but by working with a service that is willing to get involved in this type of outreach, you'll be adding value to your facility. Ask about your pathologist's accessibility to patients. Is he willing to talk to patients, either by phone or in person? Older patients, in particular, prefer the comfort of speaking with someone directly and having their questions answered immediately.

Raise the bar
When evaluating any pathology service, whether it's one you currently work with or one you're considering switching to, your No. 1 priority should be getting a diagnosis that's appropriate for the clinical condition. But your pathologist should come as close as possible to being an in-house consultant, available at any time to assist your surgeons and nursing staff in delivering quality care to your patients. If your pathology lab doesn't already provide these value-added services (and you may never know until you ask), consider shopping around for a new one.