ASCLS Position Paper on Direct Access Testing

The American Society of Clinical Laboratory Scientists (ASCLS) recently published a position paper on direct access testing (DAT) that you can link to here. The ASCLS home page can be found here. This document is well written and contains useful information plus valuable references, some of which are hot links to material on the web. Previous notes about DAT can be found here, here, here, here, here, and here. Below are some excerpts from the paper followed by my comments. Read the whole thing if you have a special interest in this topic. I will comment at greater length about this ASCLS position paper in future notes.

As of 2004, DAT is estimated to be offered by 10-15% of hospital and commercial laboratories, either by internet or in face-to-face encounters, with a broad range of test menus often defined or limited by state regulations. In these instances, the facility advertising the DAT is itself the facility where the testing will take place. In contrast to this, "virtual" laboratories serve as internet brokers for DAT, providing the link between the consumer and the facility actually performing the tests.

Comment: I have never heard or seen the term "virtual lab" used in connection with web-based DAT brokers. It may have some merit but I think that I still prefer the term "DAT broker" because I believe that it is misleading to use the term "lab" to refer to an organization that performs no testing but rather passes its specimens to a reference lab at the back-end. Even clearer, going forward, would be the term "web DAT broker."

A 2003 survey of direct access testing patients from Quest Diagnostics showed the following reasons for having testing done:  early data (18%); doctor visit preparation (18%); convenience (13%); second opinion (10%); saving money (10%);  privacy (6%); obtain tests for which insurance will not pay (4%); "other" (21%).

Comment: These numbers strike me as about what has been observed in the past and also what one might expect. DAT customers skew toward an older and more affluent population so that the first four categories make perfect sense in this context. The category "saving money" does not make really make sense since the cost of DAT must be covered out-of-pocket by consumers. It would be reasonable, however, if the lab testing was a substitute for a visit to the doctor and that was not covered by insurance.

Acknowledgment of the benefit of face-to-face encounters between consumers and laboratory professionals are increasingly occurring with the full backing of some employers. For example, HealthEast Care System in St. Paul, Minnesota has agreed to allow the hospital's "Lab Tests Direct" program to use employee wellness Flex spending accounts. ...the Louisiana Office of Group Benefits will make the Wellness program of [Direct Laboratory Services] available to all plan members [Louisiana State and School system employees], covered dependents and retirees at no cost [link here].

Comment: This is a very important element of the article. Insurance and managed care dollars are key elements in the success of most components of healthcare. Any accelerated phase of growth of DAT testing will be highly dependent on "flex" health plan accounts and wellness programs that provide clients the ability to allocate discretionary funds toward DAT. It must be noted, however, that such examples are very rare at this time.