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?