len moaven - laverty pathology - pathology: how to avoid running a video store
DESCRIPTION
Len Moaven delivered the presentation at 2014 National Pathology Forum. The National Pathology Forum 2014 featured case studies on innovative testing methods in the fields of genetics, biobanking and PoCT. The highly interactive nature of the National Pathology Forum allowed delegates to network with each other and converse with the speakers asking questions as part of debates, industry roundtables, short workshops and panel discussions. For more information about the event, please visit: http://bit.ly/pathology14TRANSCRIPT
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?