Unfortunately - a great deal of the pathology environment IS becoming a 
"factory."  Hospitals own the histology laboratories in many situations - 
requiring incredible feats to overcome bureaucratic resistance to adequate 
staffing - and on the outpatient side, many pathologists in the US are 
client billing (allowing the clinician to bill for pathology services) or 
forming "pod laboratories" where the clinician is "owner" of the histology 
laboratory - essentially providing kick-backs to the clinicians for sending 
the biopsy material to that outpatient pathology laboratory...

This translates to PATHOLOGIST DRIVEN decimation of reimbursement (tell me, 
folks - in whose mind could it possibly be SANE to negotiate for a lower 
reimbursement than what we struggle to get from the insurance companies - 
and call it "a businessman's dream"?).  Insurance or pathologist driven 
declines in reimbursement translate to substantial increases in volume daily 
for each histotechnologist and each pathologist.

The factory model has some advantages:  Histotechs who are more skilled at 
handling smaller biopsy specimens can "subspecialize" and cut prostates, 
breast cores, GIs and such... while other histotechs may be particularly 
skilled at cutting larger surgicals without wrinkles, chatter or holes.  
Pathologists in these "factory" settings may also subspecialize - but I'm 
not seeing as much of that as you'd expect.  The subspecialty becomes 
"general biopsy pathologist" - splitting a days work between prostate needle 
cores, breast biopsies, GI biopsies and skin.  The jack of all trades is 
never master of ONE... I think that this translates to risk to patient care.

As a practicing pathologist - I don't balk at reviewing 100+ slides/day - as 
long as they are in my area of "expertise" (GI/liver).  But hand me 100 pap 
smears and that will take me 10 hours.... 100 skins and maybe I could sign 
that out in a week.

Though there was a push to primary care and "generalist" medicine while I 
was in medical school in the 90s - I'm a firm believer and practicer of 
subspecialization for the sake of better patient care and, believe it or not 
- EFFICIENCY.

Until more pathologists are willing to say "No way" to client billing, "Not 
a chance" to pod laboratories and to be involved locally in resisting HMO 
capitated contracts that give exclusive contracts to Quest/LabCorp, etc. for 
100% of clinical and anatomic services - the factory model will increase and 
GET significantly worse.  The minimum number of CASES (not slides - remember 
that some cases require 3 slides - 2 levels and 1 special stain) - for a 
factory pathologist is 100.  That's the minimum.  And the compensation for 
those 100 cases:  Certainly not the $10,000. of income that that generates 
(average reimbursement for a 88305 [skin, GI, breast core] is $100).  
Between the client billing arrangements that many of the factories agree to 
($50 for the pathology group - $50 for the gastroenterologist who sends the 
biopsy), and the capitated contracts with HMOs, the income available to 
histotechs, PAs, grossing clerks, administrative support staff, couriers and 
pathologists is gouged by the CEO of factory laboratory - marketing, lawyers 
to defend against OIG investigations and lobbyists to paint a rosy picture 
to the government.

Someone in each laboratory (and hopefully it's a top down phenomenon) has to 
take interest in what is best for the patient - in each case - every day.

Isn't that what made medicine so appealing as a career in the first place?

JD



>From: "Marshall Terry Dr,Consultant Histopathologist" 
>
>To: "Bonner, Janet" , 
>,,
>Subject: RE: [Histonet] who reads what?
>Date: Wed, 6 Apr 2005 16:38:35 +0100
>MIME-Version: 1.0

>
>That's not a histology lab. - that's a factory.
>Good God - how do you cope?
>
>Dr Terry L Marshall, B.A.(Law), M.B.,Ch.B.,F.R.C.Path
>  Consultant Pathologist
>  Rotherham General Hospital
>  South Yorkshire
>  England
>         terry.marshall@rothgen.nhs.uk
>
>-----Original Message-----
>From: Bonner, Janet [mailto:Janet.Bonner@FLHOSP.ORG]
>Sent: 06 April 2005 16:25
>To: 'Michele_Marggi@ssmhc.com ';
>'histonet-bounces@lists.utsouthwestern.edu ';
>'histonet@lists.utsouthwestern.edu '
>Subject: RE: [Histonet] who reads what?
>
>
>  We used to distribute by 20-slide trays - taking into consideration the
>Histology slides only.  Then, because the Pathologists also had Cytology,
>Bone Marrows, FNAs, Flow Cytometry and Peripheral smears to read, we now
>distribute the night before by slide count, using Pathology/Cytology
>dictation, the Copath System, and verbal call-ins - taking into
>consideration ALL the slides the Pathologists have to read. I believe we're
>close to 1500 slides per day to distribute among 14 Pathologists.
>
>                           -Janet
>
>-----Original Message-----
>From: histonet-bounces@lists.utsouthwestern.edu
>To: histonet@lists.utsouthwestern.edu
>Sent: 4/6/2005 9:37 AM
>Subject: [Histonet] who reads what?
>
>Hello all:
>
>I am hoping that I can get some help.....
>
>I am wondering what system people are using  to divide up cases/slides
>to
>your pathologists.  We currently have a very "painful" process of
>dividing
>up cases to our pathologists.  Trying to make it fair in terms of
>numbers,
>types of cases, and even trying to accommodate personal interests or
>specialties.  All of this consideration means a lot of time added to the
>process.   I would really appreciate some response and ideas for a
>better
>and more efficient process.
>
>Thanks,
>
>Michele Marggi
>Surgical Pathology Supervisor
>St. Marys Hospital Medical Center
>707 S Mills Street
>Madison WI  53715
>Telephone: 608.258.6930
>Fax: 608.258.6268
>
>
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