Inside the Lab Industry: With Mobile Labs and Expanded EHRs, Pathology Practices Cater Directly to Patients

Call it the pathology of convenience. Two sizable providers have made changes to the way they deliver pathology services and results, with a focus on enhancing the speed and ease of delivery to patients. Doctors Pathology Services, the Delaware-based pathology group that made headlines a decade ago when it introduced the Mobile Intraoperative Consultation Service (MICS), a mobile pathology laboratory operated by its own clinicians, began earlier this year to sell and lease such labs to other medical practices. Doctors Pathology currently operates four of the labs, which serve providers in Delaware, Maryland, New Jersey, Pennsylvania, and the District of Columbia. They can provide basic pathology services such as sectioning, frozen sectioning, staining, grossing, and microscopic analysis. It’s not the only pathology practice delving into the possibilities of mobile care. Mid-Florida Pathology in Leesburg, Fla., recently began providing a mobile frozen sectioning service. It’s so new that the lab’s commercial director, Alexander Onushko, declined to comment for now. Meanwhile, the Cleveland Clinic has just announced plans to greatly expand the data available to patients in its MyChart electronic health record that is available to patients online. The expansion includes full pathology reports and their textual interpretations—making the renowned hospital among the first in the nation to provide such records to patients electronically, according to Kandice Kottke-Marchant, M.D., chair of the Cleveland Clinic’s Tomisch Pathology & Laboratory Medicine Institute. Cleveland Clinic and Online Pathology Reports Indeed, both Doctors Pathology and Cleveland Clinic officials say the reasons behind such decisions are to make both the health care decisionmaking and clinical processes easier for patients. “By enhancing the connection between our patients and their clinicians, we will create new opportunities to use information to more fully engage our patients as active partners in their health and the decisions they make related to the care they receive,” said C. Martin Harris, M.D., the Cleveland Clinic’s chief information officer. “The release of this type of information is important for patients. They often receive life-changing diagnoses,” Kottke-Marchant observed. Most want copies of their records in order to receive second opinions or to further research their conditions. The traditional process of obtaining such records is securing releases from the patient on paper, which may be particularly burdensome to them if their diagnosis is serious. The availability of such records is not instantaneous. After about two months of deliberation with a small team of colleagues that included anatomic pathologists, cytopathologists, and others, Kottke-Marchant and her colleagues decided that a 20-business-day delay before posting such records was appropriate. Such a policy is intended to be helpful to the patients. “We felt it would give them ample time to meet for the physician and allow for any ancillary studies, such as cytogenetics and molecular testing, to be performed,” she said. Physicians still have the option of manually releasing records earlier than that time frame, according to Kottke-Marchant. The result, she says, is that patients will not only be provided with more convenience by being able to access their results electronically, but such access should also encourage better dialogue with caregivers. “They will have a report they can discuss with their physician, which could [prompt them] to raise additional questions,” noted Kottke-Marchant. “It helps with engagement.” Reduced Costs and Greater Visibility Doctors Pathology created a new entity, MIX Management, to sell its MICS laboratories. It has already sold one of its mobile labs to a New York-area Mohs surgeon, according to V. Raman Sukumar, M.D., the practice’s medical director. A major New York teaching hospital upstate and another interested party are likely to purchase or lease vehicles later this year, Sukumar said. Despite a price tag that begins at $200,000 and can approach $300,000, it is actually significantly less expensive for a MICS to diagnose patients than the traditional physician-referral-to-hospital model, according to Sukumar. He noted that if a patient undergoes similar procedures in a hospital, they likely not only have to pony up copayments and deductibles for in-hospital providers such as a radiologist, but hospital facility fees as well. Such fees have been mushrooming in recent years and can now run well into the three-figures and can sometimes exceed $1,000. “Generally the hospital costs run 132 percent of Medicare. We run at 80 percent of Medicare,” Sukumar said. He added that a hospital visit can almost double the out-of-pocket expenses for a typical patient versus the mobile lab. Practice costs are also lower for clinicians. Sukumar noted that the first buyer of the mobile lab, the New York-area Mohs surgeon, plans to operate almost exclusively from the vehicle, avoiding the cost of running a traditional histology lab from the most expensive real estate in the United States. “The guy who bought it said ‘I am just going to go full-time with it and not doing anything else. I can take around and provide services to 10 different dermatology groups,’” Sukumar said. Utilizing a mobile lab can also be seen as a way to enhance patient engagement. Although Sukumar admits up front that selling the mobile lab is intended to make money for his pathology group, employing such a vehicle greatly enhances convenience for patients. They can undergo a biopsy at their primary care physician’s office—while the mobile lab is parked nearby—and receive the results as soon as that day and often within 48 hours. That compares to three weeks or more under the traditional care model. To Sukumar, that is eminently preferable to a patient being referred by their physician to the hospital and spending hours shuttled around undergoing a biopsy before finally having the samples sent to the pathologist. Given the push for accountable care organizations and other cost-efficient structures, a mobile laboratory is a great way for pathologists to remain cost competitive while creating greater patient satisfaction, according to Sukumar. “Part of pay-for-performance and performance-based review is the patient being happy,” he said. Moreover, by getting pathologists away from their notoriously reclusive way of practicing medicine, a mobile lab can help create a networking structure that will eventually lead to enhancing their revenue streams. “The mobile service is 10 percent of our revenues, but it’s the conduit to everything we do,” Sukumar said. The mobile labs operate from Mercedes Sprinter buses that retail for about $50,000. The vehicles are modified and outfitted by a firm that specializes in such work (Sukumar declined to identify the company). Along with the lab equipment, the buses contain an appropriate air conditioning and ventilation system for such work, as well as convenience items such as refrigerators and microwave ovens. Lab prices start at $200,000, but can reach $299,000 if the buses are equipped to provide fine needle aspiration ultrasound. However, a 60-month lease option is available through an arrangement with PNC Bank. Payments are in the neighborhood of $5,000 a month, according to Sukumar. “If you do one frozen section a day, and one fine needle aspiration a week, it pays for itself,” he said. “The rest is gravy.”