editor.jpg (9296 bytes)After two days in New Orleans at the Dark Report’s Executive War College on Lab and Pathology Management, my head and notebook are crammed with the problems, solutions, agendas, politics and technology that make the clinical diagnostics industry among the most dynamic and fascinating to watch.

Robert Michel, editor of the monthly Dark Report, which bills itself as “reliable business intelligence, exclusively for medical lab CEOs, COOs, CFOs and pathologists,” is a charming stirrer of the diagnostics industry pot. His favorite activity is cattle-prodding the industry toward what he sees as its expanded and glorious role in the future of healthcare. He’s happiest when presiding over controversy, such as the War College’s “Great Debate — Centralized Core Laboratories versus Decentralized Laboratories.”

Michel kicked off the meeting with his take on, “Why new technologies and the Internet will fuel rapid changes to the lab marketplace.” He predicts laboratories with significant testing volume will be offering Web-based ordering and reporting within 18 months. His crystal ball also revealed that the lab’s analytical strength and capability to transform raw data into useful information will be its “Nike” strategy for the future. Michel notes that Nike makes sneakers for $5 and sells them for $125. That means the market places a $120 value on Nike’s engineering, design, marketing and sales talents. The real value is not in making the shoes or processing the lab tests, it’s in how you market the shoe to adolescents or how you present clinically-helpful information, not just data, to clinicians.

One of my favorite seminars, “Clinical pathology professional services for which managed care companies will reimburse,” was delivered by the fast-talking and entertaining Michael Laposata, M.D., Ph.D., director of clinical laboratories for Massachusetts General Hospital in Boston. Laposata and his pathologist colleagues are providing their primary care physicians with valuable clinical interpretations on esoteric hematology tests. And, they are being reimbursed for it by managed care companies! Of course, this took some doing, but Laposata, an evangelist for his model, hopes to see it duplicated at other sites. It’s a fascinating story.

In brief, the number and complexity of lab tests has grown so that it’s impossible for the average primary care physician to keep up. A survey of physicians at Laposata’s hospital found that 75 percent don’t fully understand which labs tests to order and don’t understand what the results of those tests mean. (Just think, these are Harvard docs! Imagine what it must be like for physicians who didn’t get wicked-high MCAT scores!) Laposata’s consultations, which have been transformed into a series of diagnostic test selection algorithms, are helping physicians order the correct test the first time. It also helps the doc understand the results.

To drive home his point about the importance of clinical pathology consultations, Laposata tells the story of an infant brought to the hospital and diagnosed with shaken-baby syndrome. The father, who said he dozed off while feeding the baby and she fell off his lap, was convicted and sent to the state penitentiary. The child ended up in foster care. Among the grounds for his conviction were lab test results that pointed to the shaken-baby diagnosis. However, recent lab tests found that the child suffered from a blood disorder that presented symptoms similar to shaken-baby syndrome. The lab tests that would have determined that she had this disorder were not performed at the time. The father is still in prison, according to Laposata.

In this case, the laboratorian-physician consultation that did not occur added up to a very high price for one man and for one child. Ever have one of those days when you think what you do doesn’t make a difference? Remember that story.

Coleen Curran