Managed care organizations may divert skin biopsy specimens to commercial laboratories selected on a cost basis.

Diversion to these laboratories could result in service of decreased quality for the patient and referring physician.

Log-in/log-out dates were collected for all specimens submitted to managed care-authorized laboratories either from a university-based clinic or from a private practitioner's office for a period of 18 months and compared with data obtained from a local dermatopathology laboratory.

A subgroup of specimens containing inflammatory diagnoses or nondiagnostic changes was also examined.

Mean log-in/log-out times were 1.338 days in the dermatopathology laboratory, 6.123 days in managed care-authorized laboratories from the university site, and 7.798 days in managed care-authorized laboratories from a practitioner's office.

The differences between the dermatopathology laboratory log-in/log-out times and thosc of the managed care-authorized laboratories were statistically significant (p<0.0001).

The conclusion from this study is that a quality indicator defined as time from log in to log out revealed a significant increase in interpretation time at managed care-designated laboratories.

Although managed care plans can decrease their financial risk by contracting with national laboratories to provide all services for a set fee, a decreased quality of service can be demonstrated.