The new Aetna requirement for CAP or JCAHO accreditation for in-office pathology labs becomes effective August 1, 2012. The requirement applies to both the technical and professional component of services billed for CPT codes 88300-88314 and 88342.
Finally! A private carrier is standing up for patients and requiring proper accreditation if these docs want to get paid for self referral of anatomic pathology services. In addition, what a great opportunity for the CAP to stand up for the majority of its members and say they will not grant accreditation for an in office anatomic pathology laboratory. After all, if in office labs cannot easily achieve accreditation, then perhaps some in house labs will close, utilization of pathology services will drop, patients will not have unnecessary biopsies done purely for profit, and independent and hospital based pathologists can start to recover specimens that have been taken away for unscrupulous reasons.
Is that what the CAP is doing? It doesn’t appear so, at least not at this point. Instead, they have made a handy dandy web page to help in office lab owners navigate the accreditation process more easily.
Why would they do this? I wonder if it’s because they can make money from it.
CAP says that the application fee for accreditation is $799. In addition, CAP says that its accreditation program costs the typical in-office pathology lab about $1,400 to $1,600 per year, depending on the complexity and volume of tests.
Hopefully we will soon learn why CAP has decided to play ball.
Moving on. Also from the article:
The new accreditation requirement will be a “big stumbling block” for smaller in-office pathology labs (<3,000 cases per year), says John Cochran, MD, chief executive at Chestatee Pathology Associates (Smyrna, GA). But he also says that accreditation is “a major step toward universal acceptance” of the in-office lab model. “It will help legitimize these labs by ensuring that quality patient diagnostics is the main concern, not profit. As both a fellow in CAP and as a physician surveyor with The Joint Commission, I know that both organizations will help ensure CLIA standards compliance and the highest quality patient diagnostics.”
“Many pathologists do appreciate the need that in-office labs serve, but either don’t have the time to voice their opinions or are afraid to, given the vitriolic attacks by the naysayers, who are invariably hospital-based pathologists who have lost business to in-office labs,” adds Cochran.
In my opinion, accreditation of a lab does absolutely nothing to “ensure that quality patient diagnostics is the main concern, not profit.” The two are not mutually exclusive. These in office lab owners will look at the accreditation as merely a $1500 per year decrease in profit. If they were truly concerned about putting quality over profit, wouldn’t these labs have voluntarily sought CAP or Joint Commission accreditation prior to this requirement? Even for the best labs in the world, profit is still a main concern. It has to be. Without meaningful profit, a lab would cease to exist, unless of course it receives funding from somewhere else.
If profit was not a concern, these clinicians would simply find a pathologist that best suits the needs of their patients and allow that pathologist to bill global for their services. But they don’t, so profit is the main concern and will remain so even after they gain accreditation.
I am also interested as to how in house surgical pathology labs contribute to patient care with respect to the intent of the in office ancillary exception to Stark. Are these labs magically able to process and diagnose these biopsies during the same patient visit?
I sent an email to Dr. Cochran asking him some of these questions. I will post his responses when I receive them.
Aetna is pushing for this accreditation to happen very quickly, and many in house labs will not be able to make the deadline. So this makes me wonder whether they really want these labs to be accredited in the first place or if there is another motive at play here. Then I read further:
Aetna says that in-office pathology labs that do not obtain these credentials by August 1 must refer their Aetna patients to other in-network pathology labs. Aetna’s preferred labs are Quest Diagnostics and AmeriPath, including its Dermpath Diagnostics division.
And there it is. This could be just another example of the pull through agreement that Aetna has going with the Quests and LabCorps of the world, for which they are currently under investigation by the federal government. Indeed, according to a recent post on Histonet, Aetna is not even telling people about other CAP accredited non-hospital labs to whom they can send specimens if their current lab fails to meet the deadline–they are telling them to just send them straight to Quest/Ameripath.