Overview
Anatomic Pathology laboratories, with their specialized equipment and required environmental controls, are generally expensive to maintain. Consolidation of services among facilities may create savings in supplies and labor, but Anatomic Pathology services in today’s healthcare systems are varied and cater to the needs of each facility. Therefore, Accumen’s approach to consolidations includes an in-depth survey of each laboratory to truly understand specific needs and solutions.
The Assessment Process
Assessments evaluate both technical and professional components of pathology workflows. Generally, an assessment consists of:
• Examination of physical layout and equipment
• Evaluation of services performed and referred
• Labor productivity analysis
• Cost of services analysis
• Community impact valuation
• Facility impact valuation
Findings from each, in conjunction with the goals of the facility, will determine if consolidation is a possibility.
“Analysis of data from the technical and professional components provides insight on the type, frequency, and volume of work being performed.”
–Kelly Parman
Accumen Consultant
“Pathology services are frequently needed in radiology and surgery; consolidation opportunities should be customized to the unique needs of each facility” says Parman.
Drivers of Decisions
How will consolidation affect patient care? How will it impact clinical, procedural, or essential community services? Are the changes sustainable?
In Accumen’s perspective, a pathology services consolidation is not just “closing shop” and moving work elsewhere. Most facilities performing surgical or cytological procedures have a need for some type of pathology service, e.g., cytologic, intraoperative, and frozen sectioning evaluations.
Consolidation Options
Full consolidations typically occur within large health systems with the space and capacity to manage the technical component– tissue processing, microtomy, and staining services– at one or two strategic locations for the entire system. These larger systems often have five or more locations performing pathology sample-generating services. Couriers are deployed to collect and deliver samples and materials at designated intervals. Grossing of samples may remain at one or more locations depending on goals and necessity.
Partial consolidation occurs when one or more required services are performed and managed at another facility. Typically, a facility has a need for a specific service, but insufficient volume to justify the equipment and staffing. Allowing a supporting facility to absorb, perform, and manage the low volume services makes sense. Service levels and turnaround time (TAT) must be maintained or improved. Financial implications include labor, equipment, and supply savings as primary drivers for this partnership. Examples of partial consolidations involve specialized applications such as immunohistochemistry, FISH or CISH, special stains, frozen sectioning services, and cytology preparations.
Consolidation May Not Be an Option
Occasionally, the outcome of an assessment indicates consolidation is prohibitive. This situation occurs when risk is high, outweighing savings. For example, logistics coordination may be limited in some areas, delaying mobility between sites, and extending the turnaround time of the final report. In a recent partnership, Accumen’s assessment identified positive outcomes through a consolidation of six facilities. However, while the proposed central site offered space and staffing capacity, it lacked key operational processes and technology. Improvements supporting automation, barcoding, electronic tracking, and high-throughput tissue processing were first implemented, and system-wide consolidation was then completed within two years.
The Technology Advantage
The use of digitized slides in pathology creates an environment enabling acquisition, management, delivery, review, and report creation from nearly any location with internet access. This technology encourages distribution of digitized slides instead of physical slides, creating realized savings in shipping and courier services. While this technology is slowly gaining popularity in the pathology marketplace, its place in multi-site consolidated systems offers advantages in case distribution, internal consultations, turnaround time, quality, and tumor board discussions, and more.
Facilities providing cytology, intraoperative, and frozen section services benefit from digital technology tools and resources as well. Microscopes outfitted with high-definition cameras may be accessed via live feeds in various ways to view prepared cytology and frozen sections remotely. Additionally, small, whole slide digital scanners are also available to digitize and deliver prepared slides for rapid evaluation and consult. This scaled form of technology enables smaller community and rural institutions to perform procedures which may have been previously unavailable due to limitations in pathology support.
About Accumen:
Accumen’s Anatomic Pathology assessments offer an in-depth analysis to identify which consolidation option, if any, offers practical solutions for the laboratory or system, while safeguarding the services provided. The addition of digital technology in pathology offers the opportunity for expanded access to pathologists and specialists.
