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In simple terms, being CAP (College of American Pathologists) accredited ensures your test results are meeting or exceeding industry standards for clinical laboratory testing.

The Clinical Laboratory Improvement Amendments of 1988 (CLIA) are federal regulations for United States based clinical laboratories to provide industry standards for testing of human samples for diagnostic purposes. Three federal agencies are responsible for ensuring compliance of laboratories to CLIA: the Food and Drug Administration (FDA), Center for Medicaid Services (CMS), and the Center for Disease Control (CDC). Having a CLIA certificate demonstrates that Dominion Pathology Associates and Quest Diagnostics meet the federal regulations for clinical diagnostic testing, ensuring quality and safety in the laboratory and laboratory results.

Further, a laboratory can pursue a higher level of quality by becoming accredited by a recognized accreditation agency. The College of American Pathologists (CAP) is such an agency. The CAP releases its own requirements building upon CLIA ’88 regulations. Compliance is assessed by a peer group site inspection every two years. Meeting these criteria ensures that industry specific standards for laboratory operation are upheld in the lab. These requirements can also point out areas for improvement in order to reach the highest level of quality.  Being able to show our clients that Dominion Pathology Associates and Quest Diagnostics have maintained CAP accreditation for years, only attests to our commitment to laboratory quality.

David P. LeBel II, M.D. is a Diplomate of the American Board of Pathology with qualification in Anatomic and Clinical Pathology.  He received a Bachelor of Science degree from Clemson University in biochemistry.  Prior to his medical training, Dr. LeBel worked in a basic science lab focused on neutrophil transmigration in the setting of inflammatory bowel disease. Dr. LeBel went on to complete medical school and residency at the Medical University of South Carolina (MUSC) in Charleston, South Carolina.  Following this, Dr. LeBel remained at MUSC where he obtained additional fellowship training in surgical pathology with a special emphasis in gastrointestinal pathology. His daily practice includes gastrointestinal, liver, and pancreaticobiliary pathology with additional interests in head and neck, gynecologic and thoracic pathology.  He lives in Roanoke, Virginia with his wife, Anne, and daughter, Madelyn.

DPA’s own practice president, Douglas Grider, has been named vice-chair of the Department of Basic Science Education at the Virginia Tech Carilion School of Medicine.

Making pathology an accessible and vital component of medical students’ understanding of disease is important to Dr. Grider. He will continue this work as the vice-chair of the Department of Basic Science Education, in addition to his continued management and practice with Dominion Pathology Associates.

https://medicine.vtc.vt.edu/news/2019/20191108-grider.html

Wednesday 7 August 2019, Dominion Pathology Associates (DPA) held a public forum at the Southwest Roanoke County Library. The topic was: the place of diagnostic pathology in American medicine and how it relates to current challenges in health insurance reimbursement.

The central place of hospital-based pathology to cancer care and other serious illnesses is probably underappreciated because patients rarely meet their pathologists who interpret their tissue samples from biopsies or resections. Such cases are often discussed between the patient’s primary clinicians, as well as radiologists, oncologists and other specialists to ensure that the best care is offered to patients-all at the local level. DPA provides local expertise in blood and bone marrow pathology, skin pathology, gastrointestinal pathology, liver pathology, pancreatic pathology, cytology, gynecological pathology and breast pathology, among others. For those who attended, DPA pathologists were available to discuss cancer diagnoses, or any other issues or concern raised by attendees.

Recent severely reduced reimbursement payments by Anthem BC/BS for high volume diagnostic pathology and laboratory services in Virginia and at least 12 other states make it a challenging environment to continue to provide the highly integrated care that we have all come to appreciate, even if we don’t see what goes on behind the scenes. Some of Anthem’s cuts entail up to 65% reductions and are up to one third of current published Medicare allowable reimbursement rates. In some cases, the new proposed rates do not even cover the cost of services. These concerns have been duly noted by the Virginia Society of Pathologists, the College of American Pathologists, the American Society of Clinical Pathologists, as well as many other state pathology societies.

DPA urges all of us, but particularly those with Anthem BC/BS health insurance, to understand how in network providers are selected and how those relationships are maintained. Anthem BC/BS has generated considerable local, regional and national angst in diagnostic pathology and laboratory medicine. The potential long-term adverse impact to the practice of pathology is huge, especially as the number of pathologists in the United States is at an all-time low (JAMA Network Open. 2019;2(5): e194337. doi:10.1001/jamanetworkopen.2019.4337). These challenges will make it difficult to recruit and to retain the most talented young pathologists to southwest Virginia. We are all in this together! So DPA urges a return to the centrality of the patient-clinician relationship, even if that relationship is with your pathologist whom you might have never met. Please visit us at DPApathology.com or call us at any time with your pathology questions at 540-581-0155.

Click to read ASCP’s position on the Anthem BCBS pathology cuts

Click here to read the VSP letter in regard to Anthem Fee Schedule revisions

The cancer program at Carilion Clinic is directed by a multidisciplinary committee of physicians and non-physicians who volunteer to improve the care of cancer patients. Dominion Pathology Associates is a key figure in the care of cancer patients at Carilion Clinic and we are participating members of the Cancer Committee at Carilion Clinic.  Currently, the pathology representative on the committee is Dr. Robert Budin.  Dr. Budin currently reviews all cases with a diagnosis of cancer for the committee, ensuring accuracy and compliance with reporting guidelines.  This includes that proper surgical margin assessment has been made and an adequate number of lymph nodes were recovered and reported on, among other items.

The American College of Surgeons Commission on Cancer has standards that must be met to achieve accreditation by the Commission.  The Carilion Clinic cancer program meets these standards and is fully accredited.  There are 5 key areas that are hallmarks of a quality cancer program according to the CoC.

1. Clinical services that provide state of the art pre-treatment, staging, treatment and follow-up care for primary treatment, ongoing care and end of life care.
2. A cancer committee that leads the program, monitors patient outcomes and improves care.
3. Cancer conferences (Tumor Boards), where a panel of physicians meet and discuss the care and treatment of patients dealing with cancer.
4. A Quality Improvement plan in place, evaluating patient care and improving patient outcomes.
5. A hospital cancer registry and database to maintain quality of care.

The Cancer Committee at Carilion Clinic is responsible for:

• Establishing and evaluating annual goals related to cancer care.
• Ensuring frequent participation in hospital Cancer Conferences (Tumor Boards), currently over 20 per month.
• Providing oncology education for the medical staff and allied health professional staff of the Carilion Clinic.
• Monitoring Quality of Care metrics, quality of Bone Marrow specimens and Bone Marrow reporting turn around time.
• Ensuring that all reports conform to current reporting standards of JCAHO and CAP, including the use of synoptic reports when necessary and available.  Synoptic reports ensure completeness of reporting and ease of access to information.
• Providing assistance with outreach programs for cancer screening and educational campaigns, including smoking cessation and weight loss.

The data gathered by and reviewed by the committee is compiled by the Tumor Registry staff and subsequently reported to the CoC.  There is an upcoming inspection of the Carilion Clinic by the CoC in September of 2019.