Histonetters:

I was informed today by The Joint Commission that an oversight was made in the 
original letter from Aetna regarding a new requirement for in-office AP lab 
accreditation.  
Aetna's Medical Director states in a letter to The Joint Commission: "It can be 
CAP or JCAHO certification of their laboratory.  We want to encourage providers 
to obtain 
either one of these accreditations. We will be updating the physician letter 
with this change..."  To my knowledge, TJC and CAP are the only CMS-deemed 
authorities for 
Anatomic Pathology lab accreditation since a third accreditation organization 
has exited that arena.  

In-office AP labs provide a valuable service to the practices they serve by 
facilitating 1) better communication between pathologists and ordering 
clinicians, 2) quality metrics that are practice-specific, and 3) high volume, 
sub-specialization for both histotechnologists and pathologists.  In other 
words, the more of one type of histopathology a lab does (e.g., skin, prostate, 
GI), the better it gets.  Most people would not think of having their cardiac 
bypass surgery done at a community hospital doing 50/year; you want to go where 
more than 500/year are done.  In histopathology, the kinds of volume you want 
are in the thousands for each tissue type.  Many hospital labs do little skin 
or prostate histology anymore.  Many sub-specialty in-office AP labs may do 
thousands of cases of one tissue type every year.  

Aside from that, in-office AP labs are an emerging frontier of employment for 
histologists and pathologists.  In an era of high unemployment, another source 
of employment for our professions is "a good thing."

This requirement by an insurer for accreditation will help to validate these 
in-office AP labs' commitment to quality and put them on the level with their 
hospital counterparts.

John D. Cochran, MD, FCAP





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