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One-Tech-Labs


posts: 15 3 stars user offline United States

From speaking to a very small sampling of folks lately, it seems to me that the small, one cytotech lab could be in trouble due to the cost of the proficiency testing as it stands now. Maybe with CAP and ASCP adding their own in the future, this may change but I see a possible elimination of positions with hospital labs with fewer than 10,000 paps and/or mostly Non-GYN cases.

With this forum, I would ask if anyone has heard the rumblings yet where they work. I don't see how screening will be improved if only the large labs can afford to do it and local slides have to be sent out. I thought CLIA'88 was meant to reduce our dependence on low-quality MEGA-labs and now it may end up feeding into them!

I know some of you at these large labs will disagree and the expense can really hit home for you also.

I think pathologists will have to be creative in certain geographic areas with low population that are isolated somewhat and have several small labs scattered about. I could predict the coming of more regional cooperative labs to save on these fees. There have been those among us who have advocated these kinds of mergers for many years and now I think the time may be ripe.

Please post if you see a move in this direction in your area.



posts: 1 1 stars user offline
:-(


admin posts: 330 5 stars user offline United States

I think you raise several key issues. The cost of PT testing at this time is a HUGE factor that is driving a lot of rethinking about how to conduct cytopathology screening services in the most cost-effective manner possible for not only the "One-Tech-Labs", but for larger laboratories as well. So, one result of this is centralization of cytology services, whether within the same company, or by regional centralization "co-ops", as you suggest. All of this momentum based on the COST.

Let's examine the fee, $1500/site. This seems unreasonably high at first glance. This link refers to the CMS Informational Q&A's addressing how the fee is assessed, http://cytopathnet.org/tiki-index.php?page_ref_id=11&pagenum=9. If one considers plane fare for 1-2 testers, the cost of test grading, slide sendout etc., I can see where the fee may be "reasonable". However, the "test-ees" and "test-ee-labs" don't have the ability to "charge" to cover their expense. Pap smear reimbursement is still not where it should be. Certainly not if one now factors in the cost of PT testing. And there is more expense to the laboratory other than the upfront site fees. There are the "hidden costs" of implementing PT testing. There are additional QA safeguards that will need to implemented within the laboratory QA program, test preparation, and procedure for handling failed test-ees, including retraining. The laboratory is responsible for taking action to assure that their cytotechnolgists and pathologists pass, and if they fail, take appropriate action to help them pass on re-test. In an environment when we already do not receive sufficient reimbursement, this will only become a greater problem.

So what can be done to address these legitimate concerns?

  • Perhaps we need to re-investigate changes to the current reimbursement fees?
  • Should there be a site fee based on volume and not "one fee for all"?
  • Can the cytology market bear any increase in price for pap smear screening? (In any other situation where a product's "cost of production" increases, the price of the product usually goes up. This could result in the cost of the pap smear going up.).
  • What can be done to decrease the cost of testing?


posts: 2 1 stars user offline

> From speaking to a very small sampling of folks lately, it seems to me that the small, one cytotech lab could be in trouble due to the cost of the proficiency testing as it stands now. Maybe with CAP and ASCP adding their own in the future, this may change but I see a possible elimination of positions with hospital labs with fewer than 10,000 paps and/or mostly Non-GYN cases.
>
> With this forum, I would ask if anyone has heard the rumblings yet where they work. I don't see how screening will be improved if only the large labs can afford to do it and local slides have to be sent out. I thought CLIA'88 was meant to reduce our dependence on low-quality MEGA-labs and now it may end up feeding into them!
>
> I know some of you at these large labs will disagree and the expense can really hit home for you also.
>
> I think pathologists will have to be creative in certain geographic areas with low population that are isolated somewhat and have several small labs scattered about. I could predict the coming of more regional cooperative labs to save on these fees. There have been those among us who have advocated these kinds of mergers for many years and now I think the time may be ripe.
>
> Please post if you see a move in this direction in your area.



posts: 2 1 stars user offline

> I think you raise several key issues. The cost of PT testing at this time is a HUGE factor that is driving a lot of rethinking about how to conduct cytopathology screening services in the most cost-effective manner possible for not only the "One-Tech-Labs", but for larger laboratories as well. So, one result of this is centralization of cytology services, whether within the same company, or by regional centralization "co-ops", as you suggest. All of this momentum based on the COST.
>
> Let's examine the fee, $1500/site. This seems unreasonably high at first glance. This link refers to the CMS Informational Q&A's addressing how the fee is assessed, http://cytopathnet.org/tiki-index.php?page_ref_id=11&pagenum=9. If one considers plane fare for 1-2 testers, the cost of test grading, slide sendout etc., I can see where the fee may be "reasonable". However, the "test-ees" and "test-ee-labs" don't have the ability to "charge" to cover their expense. Pap smear reimbursement is still not where it should be. Certainly not if one now factors in the cost of PT testing. And there is more expense to the laboratory other than the upfront site fees. There are the "hidden costs" of implementing PT testing. There are additional QA safeguards that will need to implemented within the laboratory QA program, test preparation, and procedure for handling failed test-ees, including retraining. The laboratory is responsible for taking action to assure that their cytotechnolgists and pathologists pass, and if they fail, take appropriate action to help them pass on re-test. In an environment when we already do not receive sufficient reimbursement, this will only become a greater problem.
>
> So what can be done to address these legitimate concerns?
>
> *Perhaps we need to re-investigate changes to the current reimbursement fees?
> *Should there be a site fee based on volume and not "one fee for all"?
> *Can the cytology market bear any increase in price for pap smear screening? (In any other situation where a product's "cost of production" increases, the price of the product usually goes up. This could result in the cost of the pap smear going up.).
> *What can be done to decrease the cost of testing?



posts: 2 1 stars user offline

Hi

I will watch your cost-related posts in future, thanks. But I am heading a small tech startup with potential cost savings in nucleic acid testing (NAT).

I am puzzled there is no good comparison chart of existing products via Googling, showing the following metrics:

for Research-only test kits (preapproval):
$/specimen
96 well format, how many wells dedicated for each patient sample, for controls, buffer mixing?, etc. (real practice... e.g. how many samples maximum per 96well or 24well plate including controls)

for Clinical test kits (e.g. HIV, HPV):
ditto

 
The figures I have gleaned from others and literature talk about $7/sample in research only, and $20-100 for clinicalss.

Anyone seen a chart or other good apples-to-apples comparisons? I would like to undercut others in our planning documents (we can...)

Thanks if can email to

 



posts: 3 1 stars user offline

redfacewhat do the people reading Gyn and nonGyn Cytology in a Lab do ? thank you very much!!!!!!!!!!!



admin posts: 330 5 stars user offline United States

> redfacewhat do the people reading Gyn and nonGyn Cytology in a Lab do ? thank you very much!!!!!!!!!!!
>
Hi Lily! Thank you for your post.

The people who read GYN and nonGYN cytology in a Lab are cytotechnologists. In its simplest terms, these individuals are "screening" slides to look for cancer. This important job is unique in that as an individual, you have an impact on helping save lives by looking for the early signs of cancer, and of finding cancer early. There is information on the ASCP website for individuals who are considering a career in this field, http://asct.com/poc.html(external link), and on certification at http://ascp.org/Certification/CertifyingExaminations/cert_procedures/eligibility/ct.aspx.(external link) Information about training programs and salary information can be found at http://cytopathology.org/programs/programs.php?type=cytopathology.(external link) at

There are also physicians called pathologists who also read Gyn and nonGyn cytology in a lab...those with special training are called cytopathologists. Those individuals go through a medical school program, residency, and often fellowship training. Please reply back if you need any additional information.

 



posts: 3 1 stars user offline

biggrinHi admin,
Thank you very much.
Now I know both cytotechnologists and pathologists can read Gyn and nonGyn cytology in a lab,then what's the diffrence between them? can cytotechnologists give a diagnoses after reading the slices? what is the meaning of "screening" in "screening" slides?

I'm a foreigner ,so i don't know english very much. My email is

Good luck to you.



admin posts: 330 5 stars user offline United States

> biggrinHi admin,
> Thank you very much.
> Now I know both cytotechnologists and pathologists can read Gyn and nonGyn cytology in a lab,then what's the diffrence between them? can cytotechnologists give a diagnoses after reading the slices? what is the meaning of "screening" in "screening" slides?

> I'm a foreigner ,so i don't know english very much. My email is

> Good luck to you.

A cytotechnologist has a degree, ie. BS degree in the US, and then additional schooling in an accredited cytotechnology school for a year (alternatively, some universities offer a cytotechnology degree program). They sit for ASCP registry examination for cytotechnology upon completion. They are not a physician, but they can sign out negative GYN cytology without review by a physician. A pathologist is a physician, with a BS degree, then additional 4 years of medical school, followed by a 5 year residency program. A cytopathologist has an additional 1-2 years training in cytopathology with successful passing of a special board qualification examination in cytopathology.

 
GYN slides are in most instances PAP smears. The PAP smear test is used for cervical cancer "screening" in women. "Screening" essentially means examining a population for a particular disease/malignancy, in this case, cervical cancer. So, the PAP smears are sent to the lab where a cytotechnologist "screens" all slides for abnormal cells that may represent cancer, or a precursor to cancer (dysplasia, human papillomavirus). If they don't see anything, they can sign out the case themselves, without a pathologist/cytopathologist having to review. If they do find something they consider abnormal, it must be reviewed by a pathologist or cytopathologist.

I hope this helps clarify. Your english is very good mrgreen



posts: 3 1 stars user offline
biggrinThank you very much!!!!!!!


admin posts: 330 5 stars user offline United States

> biggrinThank you very much!!!!!!!

my pleasure


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