When a patient undergoes a biopsy, the small tissue sample is often sent to a pathologist for analysis, a step that determines whether the patient has cancer or another serious disease.
Sometimes, where that specimen goes can make a difference in how quickly a diagnosis is made.
A bill now awaiting Gov. Abigail Spanberger’s signature aims to keep that decision with physicians and their patients, ensuring patients receive lab results more quickly.
“Currently, there are practices where the insurance company may direct the sample to certain labs,” said Sen. Kannan Srinivasan (D-Loudoun), who is carrying a bill that would prohibit that practice.
“It's pretty stressful if the patient has to wait several days or sometimes even weeks to get the results back,” he said.
The proposal passed the General Assembly unanimously in February.
Theresa Emory, a pathologist practicing in eastern Virginia and a board member of the Virginia Society for Pathology, said pathologists began advocating for the bill after seeing cases where biopsy samples were sent out of the local care system, even when local labs are already in the insurance network.
Emory’s pathology group serves several communities in Eastern Virginia, including Newport News, Williamsburg and the Eastern Shore.
“In some cases, instead of the biopsy going to a laboratory across the street, it’s being shipped across state lines,” Emory said. “For a patient waiting to learn whether they have cancer, that delay can be very significant.”
Emory said the Virginia Society for Pathology looked to the General Assembly after attempts to address the issue through insurance companies and state agencies fell flat.
“We were seeing issues where patients unknowingly were getting harmed by a practice that was occurring with some insurers that was delaying their diagnosis,” she said.
The College of American Pathologists recommends that most diagnostic biopsy results be completed within two business days, but in many cases, waits were much longer.
Emory recalled the case of a woman who went to her doctor because of abnormal bleeding and underwent a cervical biopsy. The physician believed the specimen would be processed locally. Instead, it was routed to another laboratory.
Weeks passed before the results came back.
By the time the cancer diagnosis was confirmed, Emory said, the disease had progressed and the patient’s treatment options had changed from surgery to chemotherapy.
Delays like that are particularly concerning because biopsy results are often the starting point for a patient’s entire treatment plan, she said.
In many hospitals, pathologists work closely with surgeons, oncologists and radiologists as part of coordinated care teams. Specialists often meet in multidisciplinary “tumor boards,” reviewing biopsy results and imaging together to determine the best treatment approach, Emory said.
When specimens are routed outside the local health system, she said that coordination can become more difficult.
“The pathologist is part of the care team,” she said. “If the specimen is sent somewhere else, that relationship can be fractured.”
Srinivasan, the bill’s patron, said the bill will not expand insurance networks or change reimbursement rates.
“By removing ‘exclusive’ referral clauses, the bill encourages fair competition among all in-network labs, which can lead to better service and efficiency rather than higher costs,” said Srinivasan in a statement sent to WHRO.
Sentara, one of the largest health systems in Virginia, said its health plans already allow providers to refer patients to certain specialty laboratories that perform rare or highly specialized tests.
In a statement to WHRO, spokesperson Mike Kafka said the bill is not expected to require changes to provider contracting or network design, as long as those specialty reference laboratory services are not affected.
However, he noted that if the legislation limits the use of those reference labs, costs could increase.
“If reference-based labs are impacted, costs could increase significantly,” Kafka said in a statement sent to WHRO.
