VOLUME 6, ISSUE 5 MAY 2011 Sub-specialization in Anatomic Pathology Drives Consolidation and Quality

had been servicing their hospitals, By Don Howard, M.D., Ph.D. By Pat Cooke physicians and communities for Chairman of the Board and CEO Chief Information Officer CellNetix Pathology & Laboratories CellNetix Pathology & Laboratories over 40 years. No venture capital was involved in startup of Cell- Netix, just some concerned doc- tors who saw where pathology was headed and felt they could better advance patient care and their cho- sen profession as a combined and larger entity.

CellNetix’ core belief is that the future of anatomic pathology is fundamentally tied to the ability to provide sub-specialized diagnos- tics. Here is why:

Training, Experience & Science

Full disclosure - we (CellNetix) who have the depth of knowledge Subspecialization enables patholo- are a large, highly sub-specialized to offer precise and accurate treat- gists to deliver more accurate, pathology group. That said, we ment and diagnosis. Unlike many timely, and precise diagnoses and will explain why pathology sub- other medical specialties, anatom- to consultatively confer with clini- specialization (and larger group ic pathology is partner-focused, in cal colleagues on difficult cases or size) can and will lead to increased that diagnoses are not delivered those requiring correlation of clini- quality, decreased costs, improve- directly to the patient but to the cal and pathology findings. The ments in patient care and safety, referring provider. As medicine in modern practice of pathology re- and is advantageous for hospitals, general becomes more specialized, quires a vast knowledge database medical practices, and provider the demand for sub-specialized pa- and involves complex pattern rec- groups of all sizes. thology diagnostics grows. ognition. Fellowship training/cer- tification melds the broad knowl- Progress in modern medicine is CellNetix is a highly sub-special- edge database and experience of driven by specialization. Serious ized 44 physician and employee- general pathology, with the verti- illness is invariably referred to a owned partnership that emerged cal depth of particular subspecial- specialist or a team of specialists from four Washington groups that ties, required by today’s modern -1- practice of medicine. Accuracy, Cottage Industry of all sorts: genitourinary, gyne- speed, efficiency, cost effective- cologic, breast, gastroenterology, ness, and ultimately, the quality of Like most other specialties, 80% of dermatology, neuropathology, etc. patient care, all increase with spe- anatomic pathology groups in the While this may be interesting for cialized experience and training. country are small – it is essentially the pathologist, it diminishes the a cottage industry. This will not quality of patient diagnosis and Communication last because clinical subspecialties care, delays turn-around time, and such as breast, gynecology, gas- increases cost. Pathology is a relationship-driven troenterology, hematology, urol- medical specialty. Because of this, ogy, dermatology, neurosurgery New Case Allocation Process clinical specialists find it easier to and other specialized hospital and (sub-specialized pathology prac- discuss complex cases with a pa- clinic-based practices are starting tice) thologist who is familiar with the to demand specialized pathology lexicon and who has a relevant partners. Consolidation in pathol- Under this model, cases arrive in depth of experience commensu- ogy will follow radiology, where the pathology laboratory and staff rate with the clinician. Also, when paradigm shifts and fast-growing allocate these by sub-specialty: dealing with a large sub-special- technical requirements quickly Breast cases to breast patholo- ized pathology practice, the pro- changed the profile of a successful gists, gastroenterology (GI) cases viders’ chances of interacting with group. As pathology practices gen- to GI pathologists, genitourinary the same pathologist on many cas- erally serve hospitals as well as out- cases (GU) cases to GU patholo- es are actually increased; this leads reach clients, only large pathology gists, etc. Other types of cases that to improved patient care. groups can successfully accommo- are suitable for general review are date all demands for specialty di- spread out among the pathologists. Standardization agnostics (see table below). Challenges Specialty diagnostic teams pro- Historical Case Allocation Pro- Even in larger groups, the distri- mote knowledge-sharing, internal cess (non-specialized pathology bution of case types can vary on consultation, and allow collabora- practice) a daily basis – this collides with tion and standardization in termi- conflicting conference, vacation, nology and reporting. Only a sole Each day, cases (tissue biopsies, and business schedules to mean at practitioner can promise that the organ resections, Pap smears, etc.) some point the specialty diagnostic same pathologist will sign out ev- arrive in the pathology laboratory. team model is stretched. Having ery pathology report. One of the These are manually allocated to a larger pool of sub-specialists, on inherent challenges of a service- pathologists based on workload, each particular specialty diagnos- driven specialty such as pathology without regard to the type of case. tic team, mitigates this problem. is to deliver a consistent report, On any given day, each patholo- regardless of the author. Sub-spe- gist will diagnose diseases from Commoditization cialization dramatically increases multiple organ systems. Typically, the odds of success. a pathologist will see specimens As a pathology group that has an ac- Common Targets for Anatomic Pathology Sub-specialization Sub-specialty Board Certification or Fellowship Training Number at CellNetix Dermatopathology Yes 4 Hematopathology/Flow Cytometry Yes 5 Gynecological Pathology Yes 3 Breast Pathology Yes 7 Genitourinary Pathology Yes 3 Gastrointestinal Pathology Yes 5 Neuropathology Yes 1 -2- tive sales force, we are often faced to invest in all these things which technologies. Those hospitals and with a sobering reality: no matter bring added value to the practice providers who are aware, demand what we offer hospitals and health of pathology. service and quality commitments care providers in terms of sub-spe- and seek out groups that can meet Telepathology cialty depth, IT capabilities, qual- them. As with many environments ity, service, cost, etc., loyalty to At CellNetix, not all our patholo- from hospitality to retail, there is the incumbent is a very powerful gists are in the same building. We nothing like a demanding client glue (remember pathology is rela- serve large hospitals and small to elevate the level of service! At tionship driven, and unfortunately hospitals and have some hospitals CellNetix we are able to commit relationships sometimes trump where there is only one patholo- to these more demanding clients patient care). Every sale is a dis- gist. Telepathology enables us to because of our size and depth and placement sale, and pathology can provide sub-specialty expertise to sometimes because not everyone be perceived as a commodity, or all our sites while still maintaining makes the same demands at once. as a black box from If they did, we would which “lab results” adapt and the rate of emerge. The real- change in pathol- ity is that in these ogy would acceler- changing times, pa- ate! There is no thology practices, such thing as a prop- their lab capabilities erly run pathology and overall qual- practice being “too ity can and do vary large”. In fact, large greatly; all pathol- is the idea! Our ogy is not the same. “high-maintenance” M o s t p a t h o l o g y clients communi- groups and/or or- cate to an increas- ganizations choose ingly savvy patient not to invest in sci- base that they lever- ence, informatics, age sub-specialized telepathology and pathology exper- sub-specialists, and tise. This is happen- have staffing plans ing today, and some g e a r e d t o w a r d s hospitals and clinics economy and not CellNetix New Case Allocation Process readily perceive the towards quality, pa- patient care and part- tient safety or turn-around time. a local presence and local relation- nership advantages of engaging a These groups preferring instead to ships. Within seconds, any of our highly sub-specialized pathology increase the per-pathologist profit pathologists can consult with a group. They are seeing more pa- distribution or shareholder stock sub-specialist for a second opinion tients, higher profits, and lower appreciation. Unusual is the group at no cost to the patient or client. costs because of it. or organization which invests in technology, expanded test menus, Keeping Track of Promises The Patient specimen tracking, quality control, and sub-specialization. Both cost The reality of this fast emerging It is important to stress that the the same to the patient. Which sub-specialization trend is that primary beneficiary of the -move would be your preference for pa- during the transition period, hos- ment towards sub-specialization in thology services? We would ar- pitals and providers who do not pathology is the patient. Typically, gue that “quality will out” and that appreciate, or who are indifferent the patient takes the diagnosis they longevity will be the reward for to the difference, are okay with are given by their clinical physi- groups and organizations willing generalist service and 20th century cian and does not know enough to -3- question whether it is excellence ing and subsequent experience sub-specialization in anatomic pa- or inertia that governs the direc- that sub-specialization brings. We thology can save lives and reduce tion of their pathology work. We encourage our hospital and clinic healthcare costs and that this trend believe the chances of a “positive clients to place higher expectations will continue to direct pathology outcome affecting pathology re- and demands on us and their other groups toward consolidation. port” are increased by the train- pathology partners. We believe Reprinted with permission from the Washington Healthcare News. To learn more about the Washington Healthcare News visit wahcnews.com.

between and general sub-specialty pathology expertise

44 Board Certified Pathologists Over 25 Sub-Specialty Areas of Expertise Over 40 Years of Pathology Experience

Anatomic Pathology For Physicians, Hospitals, & Patients www.cellnetix.com (866) 236-8296

-4-