Thoughts on Pathology Visions 2014

Attended Pathology Visions 2014 a few weeks ago in San Francisco, CA.

Having missed the meeting the past couple of years and perhaps not being able to speak first hand about the quality of the content of those meetings (2012 was upended by a super storm), the content at this meeting was the best I have seen in recent years. The program committee did an excellent job of balancing concurrent tracks of clinical and research/education relate sessions intermixed with highly informative workshops. A number of sponsors also help support the meeting and are listed here.

Currently available technologies from both industry and investigators ranged from image analysis, a key topic of the meeting, image search, multispectral and in-vivo imaging. The workshop sessions focused on key issues to implementation, in-sourcing and the laboratory of the future and more image analysis applications.

One session I found most interesting in both design and scope was a session dedicated to in-sourcing. Drs. Tom Bauer, Anil Parwani and Toby Cornish presented their respective institutions (Clevland Clinic, UPMC, Johns Hopkins) experience with in-sourcing, that is providing professional pathology services to pathologists and patients in China.

As with many industries, China has the potential to be a multi-billion-dollar market for medical services, particularly given 1 billion people, fewer pathologists than there are in the United States and the need for these services.

The basic model scratches an itch. There is a solution to the problem. It is helped by the fact there are real issues concerning slides and tissue leaving the country given its geopolitical climate. Digital pathology breaks down these barriers.

While revenues and fee-for-services continue to shrink in the domestic space for pathology consultations and more bundled payment services, China remains a great hope for utilizing our pathology services that we can export to them.

While consumer goods are imported by the cargo ship after cargo ship from China for large retailers, pathology services can be an export product of this country overseas.

The irony is that one of the many disbeliefs of digital pathology for probably the better part of a decade or more was that the technology would encourage off-shore pathology services. We would be outsourced, or our jobs would be, like many other industries over the past several decades. Has not happened.

Rather, small and large organizations are looking to other markets to offset losses from CMS cuts to pathology services. Many are looking for additional revenue streams, particularly large organizations as a potential for additional patients seeking destination medicine services from national centers of excellence for their definitive care.

While the promise remains high and the technology provides for solutions that work for clients and providers alike, doing business abroad and selling consult services is a lot different than selling small formalin-filled specimen containers to local providers, the mainstay of many outreach programs.

Much like local outreach services, there is no contracted minimum number of specimens or expectations the client has to meet for contracted pathology services from abroad.

While all strive for high quality and fast turnaround times via digital pathology to help patients around the world, the world is not completely outsourcing its pathology either. Or even a fraction perhaps. Without knowing the exact denominator perhaps only a few percent of all necessary consults are now being done so electronically with U.S. pathologists.

Still, Western medicine is still of value in parts abroad and is no longer a technical question but a professional one in terms of breaking down a pathology read to a lab test. The relationships to capture that business will require confidence, trust, mutual respect, fair market value pricing and client service with unique cultural challenges to address.