January 2009 Volume 33 No. 1

Pathologist Daniel A. Arber, Medical Director of Anatomic Pathology and Clinical Laboratory Service.

Clinical Lab medical director Dan Arber answers questions about sale of lab services to LabCorp

After selling its outreach business effective Aug. 1 to LabCorp (Laboratory Corporation of America, based in North Carolina), many physicians accustomed to using SHC laboratory services for their own practices have had questions regarding how to access ongoing clinical lab services for their patients. To help unravel some of the reasons and reality of the changeover, we talked with Daniel A. Arber, who was appointed Medical Director of Anatomic Pathology and Clinical Laboratory Services in November. Arber, who came to Stanford in 2002 from City of Hope in Duarte, also serves as professor of pathology and associate chair for clinical services. Here are some frequently asked questions about lab utilization:

Q: First, can you briefly review the history and rationale for the change in Stanford’s clinical lab services?

ARBER: Essentially, SHC had decided after several years that an outreach lab business was both unprofitable and detracted from core missions. So the hospital made a decision to sell the business, which had been available to anyone for medical purposes, to a national corporation that had sufficient scale and flexibility to efficiently manage this service. Our sales agreement contained a no competition provision that restricted us for five years from soliciting or accepting local lab business for non-SHC or LPCH patients for most tests under most circumstances. The only exceptions to this restriction are for Anatomic Pathology, Hematopathology and some pre-existing clients using our esoteric laboratory services.

Q: Some community physicians have said that the transition seems to focus on them. Can you explain who is affected?

ARBER: Nonfaculty physicians have probably noticed the transition more acutely than faculty members, but the policies focus on patients, not on who is providing care. Since Sept. 15, basic lab testing can be performed only if the patient has an active registration as an outpatient. Then, the results will be reported via the SHC (Epic) or LPCH (Cerner) information systems, and as a backup, by U.S. mail.

Q: What constitutes basic lab services?

ARBER: Clinical laboratory testing, which includes blood chemistries, complete blood cell counts, urinalysis, and bacterial and viral cultures.

Q: Will some tests continue to be conducted regardless of registration?

ARBER: Yes, under our agreement with LabCorp, testing will continue for patients in the following categories:

• Referred for STAT testing
• SHC preoperative patients
• Referrals for SHC and LPCH specialty clinics and obstetric patients planning to deliver at LPCH.

Above patients require active registration.
• Cytopathology
• Hematopathology
• Surgical Pathology and other Anatomic Pathology services
• Certain esoteric testing for existing clients whose names were provided to LabCorp prior to the transfer.

Q: Can physicians sign up now to receive esoteric testing for their patients?

ARBER: Not currently, although we are exploring options with LabCorp. Physicians with questions about specialized testing, including questions regarding whether their patients are eligible and what tests are excluded, should contact Denise Lutz, the lab’s operations manager for outreach, at (650) 725-3866.

Q: Can physicians draw blood and send samples to an SHC lab?

ARBER: Yes, but the physician would have to send the patient to obtain an active registration before the sample is delivered to the SHC or LPCH lab. Physicians are welcome to send their patients to patient registration at either SHC or LPCH. Note that at SHC, registrations are currently for the calendar month and expire the last day of the month. Also note that samples received from a physician from a patient without an active registration cannot be accepted by the laboratory. Such patients should be sent for registration and then the laboratory may draw their blood.

Q: How will patients be billed?

ARBER: Patients registered and drawn as outpatients will be charged the SHC or LPCH outpatient fee schedule for their laboratory work.

Q: Where will SHC blood drawings be available?

ARBER: Basic services continue at SHC’s Clinical labs, Room 1524 in the main hospital. Besides registration at LPCH and SHC, additional sites are available for both registration and blood drawing at the Blake Wilbur and Boswell Clinics, and at 730 Welch Road for pediatric patients. We’d like to note that community physicians can send their patient to LabCorp’s drawsite on Welch Road or to any lab of their own or their patients’ choosing.

Q: If physicians have questions, whom may they contact?

ARBER: As previously noted, Denise Lutz, our operations manager, can handle most details, (650) 725-3866. Physicians with issues that have not been resolved are welcome to contact me at darber@stanford.edu. For pediatric issues, physicians might also contact Sharon Geaghan, co-medical director of the SHC Clinical Laboratory for Pediatrics, sgeaghan@stanfordmed.org