I was wondering if anyone is using while slide imaging for sign out right now. We are considering using this option for a minority of cases .
Anyone using whole slide imaging for primary diagnosis
- Thread starter Noosh
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Yes the Phillips system is used at Stanford for Gyn (small cases) and Neuropath. It has merit!
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I have been pushing for this for years; for many reasons however I have encountered difficulty getting others onboard—-at multiple institutions now. Financially it requires some investment and the biggest problems have been getting the IT coordinated and onboard.
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WSI is an expensive and overly complicated solution in search of a problem, with limited practical use cases (e.g remote frozens, education/testing).
For every one institution that actually ends up using WSI, there are several where the machines are left to gather dust after a while.
For every one institution that actually ends up using WSI, there are several where the machines are left to gather dust after a while.
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It is a stupid investment. You can't bill any extra so it is not something we have even considered.
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We've looked at it, but can't really find a financially viable reason for doing so.
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Actually reimbursement is higher for a primary diagnosis on digital microscopy. I have looked Into some of the numbers and how this could offset the cost over time.
Additionally there is some element of increased efficiency in the histology lab, distribution, and filing/refiling.
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What codes pay higher? Have you ever billed yourself?
This used from distance, brings the issue of "place of service" as well.
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My understanding is that a CPT code is billed at the same level irrespective of your fixed costs. Adding digital pathology certainly adds to your fixed costs unless a participating institution shares some of the initial investment and IT infrastructure maintenance costs.
A major hospital system we contract with is finding this out. It sounds like a great idea to them to centralize all the histology and electronically distribute it instead of running a vast courier network. Then comes the conversation about money and it’s been stalled there for at least 6 months. I’m told their optimistically projected ROI breakeven date is somewhere in the 2040s
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Yes - my understanding is that sign out of cases needs to be in a CLIA-certified location (which my mom's basement is NOT). So the whole "signing-out on the beach" idea is not only repugnant from a protection of personal time aspect, but also is probably a no-go from a regulatory aspect.
I think that for the proper business use case, WSI for primary diagnosis could be compelling.
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A major hospital system we contract with is finding this out. It sounds like a great idea to them to centralize all the histology and electronically distribute it instead of running a vast courier network. Then comes the conversation about money and it’s been stalled there for at least 6 months. I’m told their optimistically projected ROI breakeven date is somewhere in the 2040s
I guess a compelling use case...but perhaps not convincing
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Can you post a source for this.
I was not aware of any modifier or separate bill for the TC or PC of any of our common codes performed digitally( I am not talking about computer assisted quantitative IHC, which does have a different billing code which is higher).
Another big issue is added turnaround time. You have to go through the whole process of creating a slide and then hold up distribution of that slide while it gets scanned at multiple magnifications. Technology should improve the scanning speed and parallel scanning capabilities over time, but it will always cost you money to add a nonzero amount of turnaround time. Widespread health networks with elaborate courier systems probably have a break point in cost and time, but I don't think there will be much use outside of niche applications in the near term until costs go down and efficiency goes up.
I'd love to go fully digital, but it doesn't seem feasible yet.
I'd love to go fully digital, but it doesn't seem feasible yet.
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Not to be too critical, but I do not like how the term "turn around time" has been adopted for surgical pathology. It is a wait time. Not a widget production with input - process - output.
Other specialists consultants do not use that term to describe how long it takes to see a patient/perform an intervention from referral.
That term has its roots in manufacturing. Corporate entities love that we've adopted that term as it does have a deprofessionalizing effect.
As we provide one-on-one diagnoses to patients (a part of a patient is still a patient), this term should be cast aside.
My understanding is that a CPT code is billed at the same level irrespective of your fixed costs. Adding digital pathology certainly adds to your fixed costs unless a participating institution shares some of the initial investment and IT infrastructure maintenance costs.
A major hospital system we contract with is finding this out. It sounds like a great idea to them to centralize all the histology and electronically distribute it instead of running a vast courier network. Then comes the conversation about money and it’s been stalled there for at least 6 months. I’m told their optimistically projected ROI breakeven date is somewhere in the 2040s
You hit the nail on head. Cost verses benefit. It is a giant IT investment. Set up is not plug and play.
There are a lot of hidden costs for everyday usage.
I see your point, although I don't think I've heard any other phrase used to describe the time from specimen receipt to report generation. In a sense we do follow a production model. Input = specimen, process = grossing/embedding/staining/evaluation, output = report. We serve the patient, but only indirectly. Our "customers" (and I've heard this used in exactly this way) are the physicians we provide a report to. And those physicians want their reports in a timely fashion, understanding that sometimes there are exceptions (extra ancillary studies, consultations, etc.) If they are dissatisfied they will complain and may bring down administrative scrutiny in an academic or employed model or take their specimens to a rival lab in a private practice model.
There's certainly an argument to be made about how we view ourselves and how we are viewed by others, but it doesn't change the reality that "turnaround time" or whatever you want to call it, is an important factor in the life of a pathologist, even to ourselves. In my experience, there is a lot of frustration if cases aren't ready when the pathologist comes in that morning. With digital pathology in it's current form you're putting that at risk unless you adjust a lot of other moving parts (additional scanners, additional lab staff or adjusting staff schedules, etc.), all of which come with their own costs.
