Pathology: how to avoid running a video store* 5 th National Pathology Conference 1.10pm 8 th September 2014 Len Moaven *Disclaimer: these are my own personal views • Funding • Outsourcing • Centralisation
Jan 17, 2015
Pathology: how to avoid running a video store*
5th National Pathology Conference 1.10pm 8th September 2014
Len Moaven
*Disclaimer: these are my own personal views
• Funding
• Outsourcing
• Centralisation
Video stores: the luddite’s parable
Blockbuster:
1985: Founded by David Cook, a computer programmer
1994: Sold to Viacom for $8 billion
2004: 9000 retail stores and 60 000 employees
2010: Bankruptcy
2014: Closed down
Customer expertise, clever inventory management & strong brand
On line rentals, kiosks, streaming, iTunes, Netflix
Stuck in an old paradigm
• Intellectually / emotionally
+ Pathology
• Medical baggage / etiquette / tradition
Funding: more for less
At the mercy of the crown
- Co-payment: poorly thought out
- Re-regulation of collection centres
- Coning….we will pay for diagnostic HbA1c….save MBS $5m pa
- Incentives eg state based for POC testing
- Processes are too slow: MSAC, MBS
- TGA…..does it represent value for money?
Funding: increasingly patient centric
Patients will pay for tests:
- Anti mullerian hormone (AMH) or the 'egg timer' test
- 100 000 AMH tests performed in Australia per annum.
- $60 for each test this reflects around $6m pa and no cone
- Useful test
- No one can be bothered to go through the tortuous MSAC path The federal process has saved us from bulk billing
- The price is right....people are willing to pay $60 for an informative assay.
- Patients have been educated from a variety of sources
- There are other useful analytes that could take the AMH path
Funding: increasingly patient centric II• Advertising to patients
- We all have www sites
- Everyone else directly advertises…..
IVF clinics (Virtus / Monash IVF / Genea)
= 5% diagnostic market share
• STI screening (public / private HSP & SHL)
- Paying or free anonymous testing
www.smarthealth.me
• Patient gets a copy of results (PCEHR)
• Apps to monitor health including pathology
- Diabetics HbA1c, urine microalbumin
Funding: non-pathology - outside NPAAC / NATA / RCPA
• General practice
- 5000 INR tests per day = 1.3m pa (30%)
- Funded through MBS consults ($25m pa)
- Total pathology outlays = $42m pa!
• HIV POC testing
- Pop up shops using non-NRL tests
MBS 1m HIV vs POC 0.1m HIV tests for $20m
• Specialists
-HbA1c testing
• Chemists, overseas…..?supermarkets…..
Why not pathology practices through ACCs?…..wrapped ourselves in legislation / convention
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
4,500,000
INR (65120) billed pa
⇩⇩POC
Outsourcing
• Wages
• IT
Outsourcing the pathology test request cycle I
• Data entry
• Billing
• Enquiries
Phone / email / www / live chat / forums
Instant / multitask / record of event
Outsourcing the pathology test request cycle II
All labs refer out tests
- Immunohistochemistry
- Hepatitis markers
- Reference labs - malaria films, Salmonella cultures, HIV serology
- Uncommon genetic tests
What else? Can we outsource parts of the test?
Send DNA / serum to China / India / Vietnam / Philipines
Analysis / Interpretation
IT: Will continue to drive efficiency
• Home visits – online appointments…..google maps
• Data entry from medical software
• Digitised high resolution whole slide images (www.ventana.com)
- Central point for cut up then distribute slides….intersate….overseas
• Automated microbiology lab
- Drives centralisation
I have ignored scientific advances
• PAPs: HPV testing
• HCV treatment: HCV genotyping / viral load will become redundant
Centralisation: volume I
We already have a hub and spoke model in the states in private and public pathology…..why not Australia based?:
- The mega lab: close to an Airport (Sydney / Melbourne / Brisbane)
e.g. Badgery’s creek – cheap land / access / no curfew
- Maybe the only solution for PAP smears
Centralisation: volume II
Genetic service
Two Australian sites using Hiseq X Ten platform @$10m each
- 40 000 genomes per year @ $1600 per genome
- Compare to charging $2000 for BRCA gene testing
- MBS group P7 in 2013/14 there were 250 000 services with $42m outlays
Summary: anyone remember Ilford?
• Identified the threat in early 1980s
• Were nonchalant by the 1990s
• Receivership in 2004……the end was relatively sudden
Our turn next?