New molecular diagnostics lab has latest-generation molecular- and gene-sequencing systems to support efforts to deliver precision medicine to local patients
LEBANON, N.H.—This part of upstate New Hampshire may be rural and peaceful, but residents in this region are getting cutting-edge medical laboratory testing services from the clinical laboratory at Dartmouth-Hitchcock Medical Center (DHMC) that include state-of-the-art molecular diagnostics and genetic testing.
Last week, Dark Daily Editor Robert L. Michel was at DHMC to deliver a Grand Rounds lecture to the Department of Pathology and Laboratory Medicine, tour the lab, and meet with the pathologists, residents, and the clinical laboratory team. It was an opportunity to see how an academic medical center in a rural area is responding to all the changes happening in healthcare today.
Dartmouth’s Clinical Laboratory Makes Important Contribution
Like most hospitals and labs throughout the United States, 664-bed Dartmouth-Hitchcock Medical Center is dealing with less reimbursement from payers and the need to become better at delivering integrated care to a region that includes both northern New Hampshire and northern Vermont. Another goal at this health system is to build the infrastructure necessary to deliver personalized care and precision medicine to its patients.
That’s where the clinical laboratory is making an important contribution. In the past year, Dartmouth-Hitchcock opened a new clinical laboratory facility. It includes a new molecular diagnostics laboratory of 10,000 square feet that is stuffed with the latest generation of molecular analyzers and gene-sequencing systems. It also employs genetic counselors who interact with physicians to help them select the most appropriate genetic tests. The counselors also provide information to patients so they understand what the genetic tests can and cannot do.
“We are fortunate to have an administration that understands the importance of having a robust menu of molecular and genetic tests,” stated Gregory J. Tsongalis, PhD, Director, Molecular Pathology and Professor of Pathology at the Geisel School of Medicine, Dartmouth. “Another factor that helped us get access to the capital needed for this project is our clinical laboratory outreach program. Nearly half of total test volume comes from outreach specimens, and that allows our lab to contribute operating margin to our parent health system. Administration recognizes this accomplishment and understands the need to invest in the lab so that it maintains its competitive position in our service region.”
More Molecular Test Orders for Medical Laboratory
The DHMC lab performs more than four million tests per year and physicians’ use of molecular and genetic testing is increasing at a steady pace. “We have not seen much inappropriate ordering of genetic tests,” observed Tsongalis. “Physicians here are current with clinical guidelines. Plus, our lab has genetic counselors who, along with the pathologists and lab scientists, collaborate regularly with the physicians to update them on appropriate use of expensive genetic tests, as well as to consult with them on difficult or unusual cases.”
The DHMC health system does have significant challenges. For example, it was one of the first to participate in Medicare’s Pioneer ACO program in 2012 as a way to gain experience at providing integrated care to a specific population of patients. It made performance gains in the early years of the ACO. However, because there is low utilization in its region, DHMC’s ACO ended up paying money back to Medicare. In 2016, it ended the ACO. The health system also announced layoffs recently in response to its revenue situation.
The laboratory division at DHMC has a challenge that is common to most medical labs today—a shortage of trained technical staff. “We have authorized positions that go unfilled because of the tight labor market for skilled laboratory scientists,” noted Wendy Wells, MD, Chair, Department of Pathology, Professor of Pathology, Geisel School of Medicine, Dartmouth.
Recruiting Medical Technologists to Work in a Rural Area
“The fact that we are an academic medical center laboratory serving a rural region adds to the challenge of recruiting,” she continued. “It’s a lifestyle choice to live and work in a community like ours. Although we do participate with some of the medical technologist training programs in our area, frequently the new graduates decide to accept jobs in bigger cities. That is why we must recruit from out of the area to meet the staffing needs for our various laboratory departments.”
Dartmouth-Hitchcock Medical Center is experiencing many of the same trends as other hospitals and healthcare systems throughout the country. The difficulty of recruiting enough medical technologists and other lab scientists to keep the lab fully staffed is a common issue with nearly all medical laboratories. Similarly, the decline in reimbursement—not just for inpatient services, but also for clinical lab tests, etc.—is not unique to Northern New Hampshire. What is noteworthy is that the lab team at DHMC continues to be enthusiastic about the opportunities to use new diagnostic technologies to help physicians improve patient outcomes and better manage the cost of care.