Department of Laboratory Medicine and Pathology at the University of Minnesota is anticipating new clinical and operational needs of physicians practicing in ACOs and medical homes
MINNEAPOLIS, MINNESOTA—Academic pathology departments are facing a host of challenges as a direct result of the rapid pace of change happening today in the U.S. healthcare system. Some challenges are financial because of reduced funding. Other challenges are clinical or due to the formation of ACOs and similar types of integrated-care delivery organizations.
Last week, your Dark Daily editor, Robert L. Michel, was at the Department of Laboratory Medicine and Pathology at the University of Minnesota School of Medicine (UMSM) for grand rounds. After addressing the faculty and residents, he spent the day visiting different sections of the pathology department to learn about the newest developments in laboratory medicine, and what new diagnostic technologies are making a difference in clinical care.
Minneapolis Was Among the First Cities to Accept Managed Care
Managed care has a rich history in Minnesota. Going back 25 years, to the era of the closed-panel HMO, hospitals and physicians in Minneapolis-St. Paul were among the first in the nation to reorganize and create care organizations designed to provide more comprehensive care to patients enrolled in HMOs.
The multi-hospital health systems that took shape in the Twin Cities in the mid-1990s typically had substantial numbers of office-based physicians.
“It was during this time that the University of Minnesota Medical Center became part of Fairview Health, one of the largest integrated health systems in the Twin Cities,” stated Leo T. Furcht, M.D., Chair of Laboratory Medicine and Pathology at the UMSM School of Medicine. “This did not alter our mission of training new physicians and laboratory scientists while conducting research and supporting care at our academic center. But it did engage our pathologists and our laboratory more actively in supporting healthcare in the community hospitals and affiliated physician groups.”
In Minneapolis, the Department of Laboratory Medicine and Pathology at the University of Minnesota School of Medicine is moving forward to adopt and use new diagnostic technologies that improve patient care. Department Chair Leo T. Furcht, M.D., said that one of the department’s goals is to better position itself to serve the needs of physicians and pathologists practicing in the community with subspecialty pathology services that can improve patient outcomes and contribute to reducing the cost per episode of care. (Photo copyright University of Minnesota.)
Like every medical school in the United States, there is less money available today to support the academic mission of the UM School of Medicine. Furcht confirmed that fact, and said “Traditional levels of medical school funding from the federal government and other sources are less than in past years. Another important source of funding is grant money, and because of government cutbacks, that source is shrinking as well.”
Ongoing Pathology Residency Program
So far, the UM pathology department has not been required to prune its pathology residency program, nor cut back on important services and lab testing resources. In fact, despite the tighter budgets for the department, Furcht and his colleagues are enthusiastic about the opportunities to develop more added value pathology and clinical laboratory testing services.
Three examples provide insights about the innovations under development:
Within the Pathology Department.,Anthony Killeen, M.D., Ph.D., is a professor and Vice Chair for Clinical Affairs and Director of Clinical Pathology. He has a vision of pathologists and clinical chemists becoming essential consultants to physicians.
“Our model is inspired by what the PharmDs have done,” he explained. “Traditionally, their main activity was compounding medications and simply filling prescriptions. However, oOver the past decade, however, PharmDs have become the ‘go to’ experts for clinicians.
“Today, it is common for physicians to leave it to the PharmDs to recommend and implement the medication plan for a patient, including dosage and other important details,” continued Killeen. “Pathologists and clinical chemists have all the knowledge and expertise to fill a similar function for diagnostic test selection, interpretation, and decisions about appropriate therapies in support of physicians.”
Developing Consultation Services for Pathology and Medical Lab Testing
The laboratory team in Furcht’s department is actively working to develop such consultation services. It is also working with several national medical laboratory associations to define and establish the guidelines needed to establish laboratory- consulting services in this manner.
Over in the molecular diagnostics laboratory, gene sequencing is a fast-growing area of clinical services. Bharat Thyagarajan, M.D., Assistant Professor, said the current emphasis is to use gene sequencing in support of the UM’s Genomics Center. Much of their gene sequencing activity is focused on inherited genetic disorders. Goals for the future are to expand gene- sequencing capabilities in to support of infectious disease testing and oncology testing.
Declining Demand for Blood Products
In the area of blood banking and transfusion services, Jeffrey McCullough, M.D., explained that, similar to other large hospitals across the country, UM Medical Center is experiencing that a decline in demand for transfusions and blood. That is a welcome development because it has contributed to a decline in the annual cost of blood products and, at a time of tight hospital budgets.
These three examples of forward thinking in pathology and clinical laboratory services represent just a small sampling of the activities unfolding within Minnesota’s the UM Department of Laboratory Medicine and Pathology.
The big news is that the UMSM has a new dean who is a pathologist.
At the beginning of last week, Jay Brooks Jackson, M.D., MBA, assumed his responsibilities as the UMSM Dean and Vice President for Health Sciences. He is well known to most pathologists for his time at Johns Hopkins University School of Medicine, where he served as the Chair of Pathology for more than 12 years.
Pathologist Played a Role in HIV Prevention
Among Jackson’s many accomplishments are advances in HIV diagnosis, prevention, and management. A UM press release announcing Jackson’s appointment, stated: “An internationally recognized researcher in HIV diagnostics, prevention and treatment, Jackson and his colleagues revolutionized HIV prevention in developing countries and published approximately 200 peer-reviewed papers about HIV prevention and treatment research conducted in the United States, Uganda and China.
He has also been the principal investigator of the $500 million, NIH-funded International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network. Jackson’s work resulted in new drug development and a project to prevent neonatal HIV transmission. The method has saved thousands of infants from starting life with HIV infection.”
Your Dark Daily Editor,
Robert L. Michel
Related Information:
Video of the University of Minnesota Laboratory Medicine and Pathology
University of Michigan taps Johns Hopkins scholar as new dean for med school
