|October 26, 2004
Walldorf, Deputy Chief of Staff
Office of the Governor
P O Box 12267
Columbia, SC 29211
Concerning: Governor's action or inaction on H.3891 by Jan. 2005
Dear Mr. Walldorf:
I greatly appreciated your letter of July 6 acknowledging our letter to
Gov. Sanford and indicating that the Governor would give it careful review.
I have heard that some folks are saying that "client billing" for pathology
and laboratory services is simply a form of subcontracting of services.
Importantly, processing and interpretation of Pap smears (and
biopsies of other tissue) is not contracting or subcontracting a
"service"; it is dealing with a critical, life-affecting technical and
professional decision-making process (often warranting local correlation of
Pap smear and subsequent biopsies for optimal patient care).
Subcontracting of services metaphor: If one were to unwisely deny
that Pap smear interpretation was critical & life-affecting, then:
- The inclination to subcontract services would imply that quality was a
universal "given"; and
- The arrangement must not include any built-in kick-back from the
subcontractor to the contractor.
- The highest risk to both labs and pathologists for malpractice is related
to Pap smears; so,
- Quality from lab to lab is not a "given".
- The built-in "client billing" kick-back arrangement puts quality of
service in the back seat in favor of added income to the contractor. It
does not result in a lowered cost to the patient/insurer.
- The payments by the physician contractor to the large commercial
laboratory subcontractors are on a fee schedule way below market value
(then the contractor turns around and charges full market value to the
- As with all services delivered by physicians, quality is best achieved
when delivered as close as possible ("point of service") to the patient.
- The power of professional and personal relationships serves as a prime
incentive for the local, physician-directed labs to place patient care at
the top of the priority list.
- No such accountability exists with large commercial laboratories.
Politics is a "point of service" effort in behalf of citizens, and our
elected officials have long known how unwise it would be to subcontract
their responsibilities to distant substitutes. I urgently point out that
quality is not a "given" and do so as one who has practiced pathology
at Lexington Medical Center, West Columbia, for 30 years. Maintaining this
"point of service" concept for pathology services is one of the fundamental
keys to quality in pathology and laboratory medicine, as well as in the
entire field of medicine.
Key point: The proposed bill does not
limit the physician's choice
of Pap-smear-services provider. The bill just takes away the incentive to
make the choice primarily on a monitary basis rather than a quality basis.
Ervin B. Shaw, M. D.
Director of Anatomic Pathology