Telepathology and POD labs and Do Retail Clinics Threaten Primary Care Physicians?

As a follow up to my previous post on ASCP’s companion meeting at USCAP last Sunday night addressing sleaze, graft and corruption in pathology practice.  I neglected to realize this was an "update" from last year’s USCAP meeting.  As expected, the room used was packed but I gathered not much was new from last year’s excellent presentations with the exception of ASCP‘s successful campaign on the anti-markup rule which I previously discussed here. Those familiar with the issues concerning, condo/POD labs, in-house labs, etc… know the issues – declining reimbursements in medicine, labs being seen as a commodity, failure of anatomic pathology "to sell its value", loss of relationships, financial motive on the part of clinicians to benefit from TC/PC arrangments, etc…

In the latter post I asked the question "How likely are these "practices" going to be about adopting digital pathology?"

Actually, come to think of it, why not?  Perhaps very likely.  Stark Law  does not have provisions for telepathology and telehealth.  This would enable laboratories that have "in-house" pathologists actually perform their duties remotely, perhaps covering several labs, whether they are "on-site" or not.  Tissue may be processed in "same building" but read and signed out "out of building".  Imagine several urologists, gastroenterologists, dermatologists with tissue processors essentially "outsourcing" their work with digital pathology by either dynamic telepathology or whole slide imaging to a pathologist for review. 

This could create a couple of scenarios – maximizing their "in-house" pathologist throughput from several locations or create a market for tradtional community, hospital or university pathologists to "access" these cases again.  Furthermore, worked could essentially be outsourced overseas all together so U.S. pathologists lose all the way around. 

I don’t think it could ever come to this otherwise the large commercial reference and referral labs would have started doing it by now.  In some ways it happens already in anatomic pathology — laboratories that provide immunohistochemical staining for groups that do not have it, collect TC while digitizing slides for review (and PC) by referring pathologist.  It is a model enjoyed by both the laboratories and pathologists who use them to provide a desired service. 

Of course, we have seen this before with the "pap mills" of the 1980’s resulting in part to CLIA ’88 which madates that review of specimens be done in a "professional environment" which may not include Starbucks, or airport terminals before you get the idea that a pathologist can sign out "in-house" cases in "their house".  Having House MD, Bones, American Idol or ESPN on in the other room "of the same building" may not qualify as a "professional environment".