Jan 30, 2009 | Laboratory Pathology, Management & Operations
BIRMINGHAM, ENGLAND – Here in the United Kingdom, regional laboratory networks are finally catching on. The number of “pathology networks,” as they are called here, has increased in recent years. As was true of Canada in the late 1980s and the United States and Australia during the 1990s, clinical lab leaders in the United Kingdom are finding regional laboratory networks to be effective business models to achieve tight integration of lab services, realize significant cost savings, and eliminate excess lab testing capacity in regional markets.
These achievements were confirmed by presentations delivered yesterday in Birmingham, England, at the sixth annual Frontiers in Laboratory Medicine (FiLM) conference yesterday. Produced jointly by the Association of Clinical Biochemistry and The Dark Report. Your editor, Robert Michel, is here and participating in all the sessions. Four regional laboratory networks presented their accomplishments yesterday.
In the northwest of England, the Greater Manchester Pathology Network, formed in 2005, is composed of laboratories from 16 hospitals and serves a population of 2.5 million people. In his presentation, co-presenters Neil Jenkinson, Ph.D., Network Director, and Keith Hyde, Ph.D., Deputy Director of Laboratory Medicine, reported how participating pathology laboratories (as clinical laboratories are called in this country) are progressively developing integrated lab testing services. One key objective is to develop a common laboratory informatics capability that allows the 16 hospital laboratories to more effectively serve primary care clinics in the region.
Local to the Birmingham area, Coventry and Warwickshire Pathology Services was created in May 2007, by two acute care trusts that had always been wary of each other, According to Neil Anderson, Ph.D., Director, this pathology network has 412 employees and provides lab testing services to a population of 950,000. Steps toward integration and consolidation of lab testing services centered around three areas of lab testing:
- Blood sciences (Chemistry, Hematology, Transfusion medicine and Immunology)
- Microbiology (Microbiology, Virology, and Laboratory Infection Control)
- Cellular Pathology (Histopathology, Cytology and Mortuary services).
Anderson explained that, within two years, the pathology network had delivered £1.9 million (U.S.$2.8 million) in savings to its two parent trusts. As well, steps had been taken to install a common laboratory information system (LIS), and flexibility in staffing was contributing to improved levels of service to clinicians.
Two overseas regional laboratory networks were at FiLM to share their successes learned. In Australia, Sullivan Nicolaides Pathology Laboratories, a division of Sonic Healthcare, LTD, operates a regional laboratory network in Northeastern Australia that serves a population of 3 million people. With a central laboratory in Brisbane, it has 21 other laboratories located across a service area of millions of square miles in the states of Northern Territory, Queensland, and New South Wales. Executive Manager Tony Badrick, Ph.D., observed that, with an operating history of several decades, this regional laboratory network’s current objective is to quality management systems to advance the performance of operations. Sullivan Nicolaides is certified under ISO 9001 and ISO 15189. It is working on its ISO 14000 certification.
The fourth regional laboratory network presented at FiLM Tuesday was Calgary Laboratory Services in Calgary, Alberta, Canada. This case study was presented by Fred Swaine, M.D., Chief Operating Officer. This regional laboratory network was created back in the mid-1990s, when the government of Alberta mandated an immediate reduction of 35% in funding for laboratory services. Swaine described how this regional laboratory network is in the midst of its third cycle of lab consolidation and integration since 1996. It serves 1.2 million people and is currently comprised of one central laboratory, with rapid response labs in four hospitals.
Swaine noted that one notable accomplishment of the early network organization was to install a single laboratory information system (LIS). That has made it easier for Calgary Laboratory Services to collect, store, and provide access to laboratory data across its entire service region.
Dark Daily notes that these four examples of regional laboratory networks demonstrate how this trend has established strong roots. For almost two decades, operational regional lab networks in Australia, Canada, and the United States have proved to be effective providers in their respective service areas. It is expected that the number of pathology networks will continue to expand.
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Jan 29, 2009 | Laboratory Pathology, Management & Operations
Number of Employee Pathologists Grows Even as Private Pathology Groups Do Well
Demand for pathologists is strong and growing. That’s good for the profession, but makes it more challenging for labs and pathology groups to recruit top talent. Lots of bidders for the best pathology talent means that skilled pathologists-particularly those with subspecialty expertise-are commanding more money and richer compensation and benefits packages.
“In certain respects, it is a boom time in pathology,” stated Rich Cornell, President of Santé Consulting of St. Louis, Missouri. Cornell has more than two decades of experience in recruiting pathologists for many of the nation’s leading laboratory companies. “This decade has seen a tremendous increase in opportunities within the anatomic pathology profession. New diagnostic technologies, particularly in oncology, are fueling steady increases in test utilization. That means more work for pathologists, particularly for those with subspecialty skills in molecular diagnostics.
“Two other factors contribute to this the current strong demand for skilled pathologists,” continued Cornell. “One is the impending retirement of the baby boomer generation. Pathology groups recognize the need to recruit pathologists to replace partners who are soon to retire. Second, there is a relative shortage of middle-aged pathologists in today’s market because of the reduced number of pathologists who graduated from medical schools during the 1990s-a time when managed care and other financial pressures made anatomic pathology less attractive.”
Another phenomenon that is reshaping the pathology profession is the growing number of pathologists who are employees. Traditionally, most pathology was performed in private practice settings, typically in community hospitals. “Over the past 15 years, many of the new job opportunities in pathology have been created by national pathology companies and specialized testing laboratories-particularly those with patent-protected or proprietary tests,” observed Cornell. “This is one trend that has deep roots and looks like it will continue for some time in the future.”
Cornell has advice for laboratories actively recruiting pathologists, as well as individual pathologists interested in finding their ideal practice setting and compensation package. “It is important to recognize that today’s supply-demand situation does not reward all pathologists equally,” he noted. “To negotiate a win-win package, both the hiring lab and the candidate pathologist should understand how each of these elements plays a role in the specific partner/employment opportunity being considered.
“First, consider compensation,” said Cornell. “Subspecialists generally can negotiate a higher compensation package than generalists. But there are differences even across the subspecialties in pathology. Also, it is important to recognize the advantages and disadvantages of private practice positions compared to employment positions. Younger pathologists, for example, are much more open to employment opportunities compared to the baby boomer pathologists when they were the same age.
“Second, productivity is now a key factor, more than it has ever been in the past,” explained Cornell. “Sustained downward pressure on reimbursement means that both lab companies and pathology practices are linking compensation ever more tightly to the productivity of the individual pathologist. This trend will intensify with each passing year.
Third, any pathology group or laboratory in the recruiting and hiring mode needs to be smart about the market demand for the particular pathology skills and experience they seek,” he stated. “I often see intense bidding for particularly productive, effective pathologists. That may be good for the candidate, but means the hiring group may end up paying more than it had budget for this position.
“This same advice applies to individual pathologists,” continued Cornell. “If you are looking for a position, you’ll negotiate a better position and compensation package if you understand who else is actively in the market looking for the same opportunities as you.”
Rich Cornell will share these, and other secrets, at the upcoming audio conference titled, “Emerging Trends in Pathologist Compensation, Productivity, and Job Prospects.” It will take place on February 18, 2009 at 1 PM EST, 12 PM, CST, 11 AM MST, 10 AM PST.
This is a high-value conference for both laboratories preparing to hire new pathologists and for pathologists entering the job market. Best of all, your entire laboratory team can listen with you to this important audio conference. Reserve your participation in this highly valuable audio conference by registering today at http://www.darkreport.com/Audio/2.18.09/Improve-Pathologist-Compensation.htm
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Registrations accepted until Wednesday, February 18, 2009, noon EST.
Cancellations before 5:00 p.m. EST on Monday, February 16, 2009 may receive a full refund less a $25 service charge.
Your audio conference registration includes:
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- The opportunity to connect directly with our speakers during the audience Q&A session
Jan 28, 2009 | Laboratory News, Laboratory Pathology
Employers increasingly see wellness programs as effective ways to reduce the money they spend on health benefits. Health insurers are responding to these employer needs by launching wellness programs aimed at better prevention and disease management.
Such wellness programs often have two dimensions. First, most wellness programs encourage beneficiaries to utilize healthcare in a proactive mode. Beneficiaries are encouraged to receive regular medical check ups, along with preventive tests or screenings consistent with “best practice” protocols by age, gender and health status. This creates an opportunity for medical laboratories to develop services that can add value to the wellness programs offered by employers and health insurers. The second dimension involves efforts to improve lifestyles. Smoking cessation support, encouraging more exercise, and helping people lose weight are examples.
Over at Wellpoint, the nation’s largest health insurer, its regional subsidiary plans rolled out a wellness program called “360o Health.” This program bundles health and wellness programs together for employers. It includes Web-based health support and nurse counseling via phone. Online tools remind members when they’re due for routine tests and checkups or provide tips, such as recommendations on how to obtain less expensive medication options.
Wellpoint, which has 34 million members nationwide, also launched an assessment tool to gauge the program’s success. Its Member Health Index measures success of the WellPoint program in 20 clinical areas, including prevention, screening, care management and patient safety.
WellPoint, which tied its employee bonus structure to patient participation, reports it quickly realized a two-for-one return on its investment in the program, including a 10% reduction in hospital stays, according to a report by Modern Healthcare.
A recent survey of 350 employers by PriceWaterhouseCoopers indicated that just 15% of employees currently participate in wellness programs. Employers surveyed were most interested in programs that help employees lose weight, eat healthy, and reduce stress. They say their employees would be more likely to participate if offered incentives like premium reductions or gift cards.
Over at UnitedHealth Group, its OptumHealth subsidiary launched a project that compiles and analyses medical, pharmacy, behavioral health and laboratory data from claims, employer data and other sources. The goal is to use this information to identify the wellness needs of individual members based on health status. The company says its E-Synch Platform allows staff to take a personal approach to wellness, tailoring services to meet individual needs, and health goals.
Clinical lab managers and pathologists should recognize the market shift taking place as more employers and health plans jump on the wellness trend. This is a definite shift in clinical priorities and will require a different type of service support and test menu for laboratories and pathology groups. Patients in wellness programs need appropriate laboratory tests for screening different diseases and for predicting the patient’s likelihood to develop a chronic disease. This is a different emphasis for lab testing than, say, the 1980s, when most patients went to the doctor only after they felt sick.
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Jan 27, 2009 | Digital Pathology, Laboratory News, Laboratory Operations, Laboratory Pathology, News From Dark Daily
How much longer will anatomic pathologists spend the majority of their time in a quiet office, viewing glass slides through a microscope? Will radiologists and pathologists soon collaborate on diagnosing the patient and jointly releasing an integrated patient report to the referring physician?
Should you think these scenarios are several years into the future, you may be surprised to learn that first-mover pathology groups and radiology groups are in the earliest stages of fully-digital (non-glass) pathology and collaborative diagnosis/patient reporting. These pathologists and radiologists will tell you that this is an exciting time and they are advancing patient care because of these innovations.
At University of Kansas, an extraordinary collaboration was launched last summer involving Ossama W. Tawfik, M.D., Ph.D., Director of Anatomic and Surgical Pathology and his colleague; Mark L. Redick, M.D., Assistant Professor of Radiology, University of Kansas. Tawfik and Redick began meeting regularly to jointly review selected breast cancer cases. “It was quickly obvious to us both that, by reviewing each other’s primary clinical data together, there were immediate benefits to the referring physician and the patient,” noted Tawfik. “We’ve learned two things from this collaboration. First, there have been few changes in the diagnostic aspect of the cases we review. Second, on the treatment side, our pathology/radiology integration is driving significant changes in how the patient receives treatment and what therapies are recommended.”
Tawfik and Redick are speaking about their in vivo/in vitro collaboration at the upcoming Molecular Summit on the Integration of In Vivo and In Vitro Diagnostics in Philadelphia on February 10-11, 2009. Location is the Sheraton Society Hill Hotel in Philadelphia, Pennsylvania.
At Molecular Summit 2009, the future of the glass slide versus an all-digital pathology service will be discussed by CEOs from industry-leading firms such as Aperio Technologies, Inc., BioImagene, Inc., and DMetrix, Inc.. One sure sign that pathologists are adopting slide scanning and digital pathology systems is the accelerating rate of sales of digital systems reported by these three companies during the past 24 months.
Pathologists and radiologists wanting to stay at the top of their game and profit from the opportunities unfolding in personalized medicine and vivo/in vitro integration should register to attend Molecular Summit 2009. This year’s top-flight event has a distinguished faculty of 27 international experts and covers the spectrum of advanced molecular diagnostics, imaging, and informatics. Unique case studies provide attendees with everything they need to know to advance their molecular skills and tap new sources of patient referrals and income.
Register today and guarantee your place at this important event for pathology and radiology! The full agenda and speaker line-up for Molecular Summit 2009 on February 10-11 can be viewed here (or paste this URL into your browser: http://www.molecular-summit.com/program.htm )
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Jan 26, 2009 | Laboratory Pathology, Management & Operations
Wall Street has yet to grasp this essential truth of laboratory medicine-lab test quality comes with its own price tag
At this moment in time, Quest Diagnostics Incorporated‘s (NYSE:DGX) advertised value proposition to other labs—”industry-leading quality and technical proficiency”—has diminished credibility with pathologists and lab industry executives. They are questioning how the nation’s largest lab company could allow systemic errors that caused it to report inaccurate Vitamin 25(OH) D test results to tens of thousands of patients for 18 months during 2007 and 2008.
These same pathologists represent an important source of reference and esoteric testing referrals to the nation’s largest lab company. Thus, the disclosure of systemic failures in its Vitamin D testing program may have implications for Quest Diagnostics over the long term. Many health systems, hospitals, and laboratories across the United States refer reference and esoteric tests to Quest Diagnostics. Quality and test result integrity are a primary buying motive for the pathologists and lab directors in these organizations. As scientists, they want confidence in the analytical integrity of the test results they provide to their own clinicians.
Two national reference laboratories with solid reputations for quality and lab test result integrity are ARUP Laboratories and Mayo Medical Laboratories. These reputations for quality and integrity are key assets at ARUP and Mayo. Both firms compete successfully against the two blood brothers because many referring laboratories believe the scientific integrity at ARUP and Mayo is not compromised in ways that may occur in publicly-traded lab companies. Of interest, both these laboratories earn adequate profit margins while competing effectively on price, service, and quality against the national lab companies.
Quest Diagnostics now finds itself facing a tough challenge in the reference/esoteric testing marketplace. Among its peers in the scientific and laboratory medicine communities, the quality and integrity of its lab test results will be seriously questioned. And because pathologists have long memories, this can be an issue for years into the future.
That has been the experience of Specialty Laboratories, Inc. During the 1990s, this was a go-go reference and esoteric testing laboratory. Fast-growing, it had a reputation for first-rank science and regularly introduced new proprietary assays to the medical community. But, in April, 2002, federal and state laboratory regulators yanked Specialty’s license to do business with Medicare. The story centered around internal whistleblowers and regulatory directives that were not fully addressed by Specialty’s executive team. There were questions about the integrity of test results for some lines of lab tests performed at Specialty. (“State, Federal Regulators Target Specialty Labs,” The Dark Report, April 22, 2002.)
Within a few months, Specialty Labs was able to reclaim its Medicare license after fixing deficiencies and passing its inspections. However, loss of its Medicare license was a body blow to Specialty Laboratories. Across the nation, pathologists and laboratory directors stopped sending specimens to Specialty Labs. Overnight, the company experienced a precipitous decline in specimen volume and revenue. Facing grim financial prospects, in January 2006 it was sold to AmeriPath. Ironically, Quest Diagnostics found itself the owner of Specialty Laboratories when it acquired AmeriPath last year.
The example of Specialty Labs illustrates why quality, integrity, and trust matter-a great deal! Pathologists and lab directors face personal liability if their laboratory delivers inaccurate results to patients and physicians. Their personal reputations ride on the performance of their laboratory. As physicians, they understand the consequences to patient care when a laboratory fails to report accurate test results. Their own laboratory must maintain its reputation for integrity and quality if it is to retain the trust of the clinicians and patients it serves.
Further, these same pathologists and lab directors regularly interview and hire scientists and medical technologists from both of the national laboratory companies. They hear lots of stories about the internal operations of these two billion-dollar lab companies. There are few secrets about events that unfold inside the two blood brothers. For example, lab scientists directing Vitamin D testing at their own labs quickly recognized, early in 2007, that Quest Diagnostics was struggling with its home brew mass spectrometry Vitamin D assay.
The lab community has watched both national labs continually cut costs over the past ten years. Competing labs conduct hiring interviews with the wave after wave of terminated employees hunting for jobs after each RIF (reduction in force) trims back staff to save money. Pathologists and lab directors understand the consequences of sustained cost cutting. Eventually, a laboratory’s cost cutting reaches a point where the resources, staff time, and operational capability required to sustain a high level of analytical accuracy and integrity can be compromised.
That is why many laboratory professionals are asking if the inaccurate Vitamin 25(OH) D results performed over an 18-month period on tens of thousands of patients is a sign that should not be ignored. Has Quest Diagnostics reached the threshold where further cost-cutting to satisfy Wall Street will undermine the quality and integrity of its lab test results?
Of all the customers of the two national laboratories, pathologists are the best informed about how constant budget reductions can undermine the quality and integrity of laboratory test results. They know that lab test quality is an expensive proposition.
Thus, no one should be surprised if, going forward, both national laboratories find it more difficult to expand the reference and esoteric business which comes to them from other laboratories across the nation. Should either firm experience even modest declines in the year-over-growth in this business segment, it will be a significant sign. Questions associated with test integrity may be motivating an important source of reference and esoteric testing to steer their specimens to other laboratory providers.
Should this happen, no one should be surprised. If a decade of sustained cost-cutting has finally reached the point where laboratory customers question the quality of the test results produced by major lab companies, it will only be the market imposing its discipline. The market will be reminding Wall Street investors that spending to sustain quality protects market share and profits. After all, as the libertarians say, “There ain’t no such thing as a free lunch (TANSTAAFL)”!
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