Branding an anatomic pathology practice to build revenue

Innovative Pathology Services (IPS) is an Associate Practice of Pathology Service Associates (PSA). PSA is an organization known as the "Business Solution for Pathology." IPS provides pathology services to nine hospitals, including two large tertiary-care medical centers, a progressive and renowned children's hospital, a cancer survival center, five surgery centers, and numerous physician's offices and clinics throughout east Tennessee. We accept specimen referrals from other pathology practices and providers from across the country. The center of operations is in Knoxville, a mid-sized metropolitan district. Until January 1, 2003, we were known as Knoxville Pathology Group (KPG). We renamed our practice because KPG did not reflect our service area, was limiting by perception, barely distinguished us from other groups, and did not describe our culture and philosophy. IPS is a new name for a well-established pathology group with a solid foundation and a long history of providing services at the point-of-care. As such, we offer all services that we offered through our foundation practice, and, in addition, these services were enhanced and new services were added. Our entire "team" and, in particular, the pathologists, were involved in the successful "branding" of IPS. Whether you are an independent anatomic pathology or clinical laboratory or you are hospital based, you may benefit from our experiences detailed in this article.

Best Practice No 177: Best practice guideline: writing a business case for service development in pathology

This guideline reviews the introduction and development of business planning in the National Health Service. A guideline for writing a business case for service development that would form part of a pathology business plan has been developed. This guideline outlines six steps that are required in the preparation of a business case. The format of the guideline has been developed largely from other national guidelines that have been published for the development of capital projects. In view of the publication of these guidelines, the scope of this guideline excludes business cases for information, management, and technology projects and large capital projects.

Establishment of a central laboratory serum tumor marker service on a consolidated immunodiagnostic platform: development of practice standards, service improvements, and operational efficiency

BACKGROUND

Laboratory testing for serum tumor markers traditionally has been performed in low volume in most hospitals. Many markers are sent out to reference laboratories. Over the past decade, serum tumor marker testing in patient management has become more defined, resulting in increasing test volume and wider availability of assays on automated immunodiagnostic platforms.

METHODS

A retrospective review of laboratory operations, test volumes, and budgets over a 10-year period. Results of utilization initiatives as part of a clinical practice management team also were reviewed.

RESULTS

The volume of serum tumor marker requests in our institution increased 2.25-fold over an 8-year period. In contrast, total laboratory test volume increased only 1.3-fold. Implementation of an on-site tumor marker laboratory using a consolidated platform (Elecsys 2010) decreased the average unit cost per test from $12.36/test to $6.79/test. This was accomplished by a combination of insourcing and by consolidation of multiple semi-automated instruments. Total savings were $219,972 per year, including direct budget reductions and cost avoidance due to volume increases. Various institutional practice standards were implemented, and turnaround time was markedly reduced for selected tests.

CONCLUSIONS

Testing for serum tumor markers is becoming more established in large hospital laboratories. Increasing test volumes and the availability of consolidated instrument platforms with a broad menu of tumor marker tests (such as the Elecsys 2010) facilitates consolidation and insourcing of many tumor marker assays. This permits the laboratory to reduce unit and overall cost, to leverage excess capacity on existing instrumentation, and to create an opportunity to add value to the service by reducing turnaround time and implementing practice standards.

Choosing between competing technologies in the cytology laboratory

Technological change often is internal to anatomic pathology services. When new technology requires collaborative development with clinical staff, it is important to systematically approach the rationale for the new technology, and be prepared to deal with its medical, financial, and, sometimes, even personal implications. Such a systematic approach involves sequentially evaluating the acceptability and the potential benefits of technologic alternatives among the laboratory leadership, with each potential vendor, the laboratory staff, and the clinical and institutional leadership, and must ultimately include effective communication with the entire clinical community. Among the benefits of such a systematic approach are resiliency of the process when challenged, and credibility of its leadership, within and outside of the laboratory.

[Cost-benefit analysis of the anatomo-pathological study of tonsillectomy specimens in the pediatric population]

To study the cost-benefit of the histological examination of tonsilar samples, we evaluated 567 cases (547 routine and 20 nonroutine cases) of patients under 14 years of age, operated between 1st January 1996 and 30th November 2000. There were 2 routine cases (0.3%), and 6 nonroutine cases (30%) with a diagnosis different to follicular hyperplasia. In this way, our clinical preoperative sensitivity was 75% and specificity 97%. The average cost per case at our Centro to study the tonsilar samples was 30$. We conclude that the histological examination of tonsilar specimens is economically worth only in nonroutine cases, although additional factors (e.g. training of residents of Pathology and the quality control of the institution must be taken into consideration.

Appropriate use of clinical microbiology tests

Laboratory medicine lacks the tools necessary to define appropriate test use; nonetheless, existing laboratory test characteristics, although inadequate, provide a common starting point for developing definitions of appropriate test use. As Lundberg [1], Szczepura [15], and van Walraven and Naylor [2] have emphasized, developing a process for defining appropriate laboratory use should receive a high priority. There is a particular need to develop methods for standardizing studies [59]. Laboratory medicine does not, however, lack the tools necessary to change test use. Although past interventions were largely ineffective, there is growing evidence that test use can be changed by use of a variety of approaches. By using the existing tools there is much that can be done to change inappropriate test use, such as minimizing redundant testing or the use of tests that have no clinical relevance. The real opportunities will come when there are scientifically and medically sound definitions of appropriate test use that can be used to change test use and improve patient care in a cost-effective way.

The use of ordering protocols and other maneuvers: the Canadian experience

Canada's socialized, single-provider, fee-for-service environment has provided an opportunity for widespread implementation and evaluation of a number of utilization control measures. Enforced consolidation of services certainly eliminates redundancy but the implementation cost and disruption of such a measure is high. Whether noncompetition will eventually eliminate any cost savings achieved is difficult to predict. Risk sharing in which ordering doctors and laboratories are paid from the same source of funds and both groups stand financially responsible for excess utilization seems to be an effective approach. From a fiscal standpoint it is, but such measures can create ill will. Establishing utilization caps has an absolute fiscal effect but, unless very carefully designed and monitored, may create more problems than they solve. Utilization control can be achieved using a minimal list requisition form. Form control is also essential to ensure the success of protocol and CPG implementation. The development of protocols and CPGs has proved to be very effective in reducing laboratory testing while also standardizing aspects of medical practice. Such guidelines work well when (1) dealing with testing areas of high volume (or high cost); and (2) amenable to simple rules on which there generally can be agreement. A collaborative implementation environment is necessary. After about 15 such protocols, however, it becomes increasingly difficult to define new areas to target. Physician chart audits are a useful adjunct to help deal with problem areas and to keep all physicians highly aware of good ordering practices. Utilization problems have not been solved in the Canadian system. Certain ventures, however, have proved to have a positive effect. It is likely that when electronic knowledge support tools become a standard feature of medical practice the protocol-CPG approach will be maximized.

Is pathology examination useful after early surgical abortion?

OBJECTIVE

To study if the pathologist's examination of surgical abortion tissue offers more information than immediate fresh tissue examination by the surgeon. Immediate examination of the fresh tissue aspirate after surgical abortion helps reduce the risk of failed abortion and other complications. Regulations in some states also require a pathologist to analyze abortion specimens at added cost to providers. We conducted this study to evaluate the incremental clinical benefit of pathology examination after surgical abortion at less than 6 weeks' gestation.

METHODS

As part of a prospective case series of women who had early surgical abortions at the Planned Parenthood League of Massachusetts during a 32-month period, we collected data on clinical outcomes and the results of postoperative tissue examinations. Using outcomes verified by in-person follow-up as the "gold standard," we calculated the validity of the tissue examinations by the surgeons and the outside pathologists.

RESULTS

A total of 676 women had documented outcomes and complete tissue examination data. The sensitivity (ability of the examiner to detect an outcome other than complete abortion) was 57% (95% confidence interval [CI] 35, 76) for the surgeons' tissue inspections and 22% (95% CI 8, 44) for the pathologists' examinations. The predictive value of a positive (abnormal) tissue screen was 14% (95% CI 8, 24) and 7% (95% CI 3, 17) for the surgeons and pathologists, respectively.

CONCLUSION

Routine pathology examination of the tissue aspirate after early surgical abortion confers no incremental clinical benefit. Although the surgeons' tissue inspections predicted abnormal outcomes poorly, the pathologists did no better. Our results challenge the rationale for state regulations requiring pathologic analysis of all surgical abortion specimens.

Commissioning laboratory services

Scientists often develop techniques that have obvious benefits for patients but then find great difficulty in introducing them into the National Health Service-usually because the necessary finance does not seem to be available. This article provides a practical guide.

[Present status and future problems of clinical laboratory from view points of an anatomical pathologist]

The medical situation surrounding laboratory examinations has changed remarkably. We, the staff of laboratory divisions, must offer the best medical care for patients and operate efficiently. Fertility management service(FMS) and branch laboratory(Branch Lab.) are examples of useful contributions to our hospital from the perspective of economy and personnel expenditure including staff attrition.