Whether you're actively looking for pathology services or you simply want to be prepared for the next pathology sales rep at your doorstep or in your next board meeting, this review of key factors that influence the selection of a pathology services provider will help you prioritize what matters most to your facility.

Diagnostic accuracy. Diagnostic accuracy affects patients' confidence in your facility and their surgeon. Pathologists have varied training and expertise and are not "standardized tests" like a chemistry screen or CBC (complete blood count). Do the procedure physicians have confidence in the pathology diagnoses that are rendered? Are cases routinely sent out for second opinions?

Turnaround time. What's your expectation? Same day? 24 hours? 48 hours? How quickly do your patients expect the results? Many factors impact turnaround time, including delivery time, fixation time, the individual pathologist and general laboratory staffing.

Availability of pathologists and ancillary tests. Sending a tissue specimen is a patient referral. Your pathologist's availability should match the availability of any other clinical consultant. Can you easily reach the pathologist to discuss clinical history or review a case, or is your staff wasting time in an automated phone tree to reach anyone who knows something about your case? If the patient needs additional testing, does the pathology laboratory provide esoteric testing (bone marrow biopsy examinations, lymph node cultures and flow cytometry, for example) or have an existing relationship with a reference laboratory that can?

Impact of pathology services on workflow and staff time. Many facilities opt for a single pathology services provider to eliminate triaging of specimens and the additional work created by multiple specimen logs, couriers and reports from varying sources. But using multiple pathology providers doesn't have to be a nightmare if the pathology company is savvy in facility workflow and has the available tools. Software interfaces to reduce requisition time, auto-printed specimen labels and networked printers can all reduce the staff time required for handling pathology specimens and reports. Also important is the impact of ordering and stocking pathology-related inventory and supplies.

Is the specimen submission process workable? Can it be made more efficient? Is the pathology company vigilant about inventory and supply? How much time does your staff spend calling for lab results? How long is your billing cycle delayed waiting for path results that impact the final code?

Accessibility and availability of reports. Electronically. Online. Paper. As we wrote about last month, you have many options when it comes to pathology report delivery and distribution that may save your facility valuable time and improve record keeping (see "How Would You Like Your Path Reports?" March, page 80).

Customer service for patients. Patients frequently don't know that they've seen the pathologist until, of course, they see the pathologist's bill. A poor customer service experience with the pathology laboratory may reflect poorly on your facility.

Participation in facility education and accreditation processes. Path labs are required for certification to participate in ongoing education with their referring facilities to ensure the quality of specimen handling. Is your pathology services provider proactive in scheduling with your education coordinator? Are annual in-services scheduled? Is there an in-service program for your new hires?

Do you get along well? For some surgical facilities, a good relationship with their pathologist is an essential factor. This is one of the reasons that most pathology specimens remain local — even when a regional pathologist may do more accurate reads. Keep in mind that some labs hire pathologists as independent contractors rather than as employees of the lab.

Case volume per pathologist. How many patients is each pathologist seeing per day on average? Hospital-based pathologists generally review fewer than 5,000 cases per year per pathologist, which equates to fewer than 25 patients per day per pathologist. Large outpatient pathology laboratories have significantly higher case volumes. Will your facility's patients likely be patient No. 100 for the pathologist that day? Does this matter to your procedure physicians? Your patients? Your facility? Every laboratory tracks the case volume for each pathologist. Asking for this information is a means of assessing how important your facility and your patients are to the path lab.

External consultation. Quality assurance literature in pathology recommends that at least 1 percent of all cases (routine or complex) be referred to nationally- or regionally-known specialty pathologists for a second opinion. What is the response to the procedure physician's or patient's request for second opinions? How often do the pathologists request second opinions from experts? What is the rate of diagnostic concordance with the experts? Even within subspecialty pathology practices there is diagnostic variability, and external consultation may still be a useful tool.

In addition to external consultation, each pathology lab must have a defined quality assurance program to retain CLIA certification. What policies are in place to insure that your patient's specimens are received? That they aren't mixed up with another patient? That all of the relevant tissue has been sampled? That the material that the pathologist reviewed was of high quality?

Choose carefully
Despite a rapid increase in the number and type of regional and national path labs, most pathology specimens generated by outpatient surgery centers continue to be referred to local hospital-based pathology groups. The influx of new laboratories has markedly changed the pathology services landscape by offering value-added services aimed at capturing or retaining facility business. Examples include software packages, pathology report interfaces and quality assurance reports as well as such financial arrangements as client billing, technical component/professional component splitting and pod laboratories. In reviewing your facility's pathology services options and needs, remember that each specimen that you send to a pathology laboratory is a patient referral for consultation — and is subject to state and federal laws and regulations.

Unless there's a problem, pathology is fairly "invisible." A busy surgical facility may suffer from the collective inertia of "if it ain't broke, don't fix it." Look around. Maybe something "not broken" could be more accurate, effective and efficient.