title: Log-in/log-out time: a quality factor for a reference laboratory--prolonged times for skin pathology processing in managed care-authorized laboratories.
abstract: Managed care organizations may divert skin biopsy specimens to commercial laboratories selected on a cost basis. Diversion to these laboratories could result in service of decreased quality for the patient and referring physician. Log-in/log-out dates were collected for all specimens submitted to managed care-authorized laboratories either from a university-based clinic or from a private practitioner's office for a period of 18 months and compared with data obtained from a local dermatopathology laboratory. A subgroup of specimens containing inflammatory diagnoses or nondiagnostic changes was also examined. Mean log-in/log-out times were 1.338 days in the dermatopathology laboratory, 6.123 days in managed care-authorized laboratories from the university site, and 7.798 days in managed care-authorized laboratories from a practitioner's office. The differences between the dermatopathology laboratory log-in/log-out times and those of the managed care-authorized laboratories were statistically significant (p < 0.0001). The conclusion from this study is that a quality indicator defined as time from log in to log out revealed a significant increase in interpretation time at managed care-designated laboratories. Although managed care plans can decrease their financial risk by contracting with national laboratories to provide all services for a set fee, a decreased quality of service can be demonstrated.
authors.affiliation: Department of Dermatology, Saint Louis University Health Sciences Center, MO, USA.
authors.forename: N S
authors.initials: NS
authors.lastname: Penneys
mesh_terms: D001706:Biopsy; D006801:Humans; D007753:Laboratories / Q000592:standards*; D008329:Managed Care Programs / Q000592:standards*; D010338:Pathology, Clinical / Q000592:standards*; D011785:Quality Assurance, Health Care; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000175:diagnosis; D013997:Time Factors