In a recent post (see: Reinventing the Autopsy: CT Imaging as a Routine Part of the Procedure), I suggested that this may be the right time to begin to reinvent the autopsy. In particular, I believe that a whole-body CT scan should be a mandatory first step in all such procedures. At the beginning of this note, I cited Dr. Jared Schwartz as the individual who had stimulated my interest in integrating imaging techniques such as the CT scan into the standard autopsy. He has posted a comment to this note which I copy below with boldface emphasis mine:
Bruce you are correct I have been preaching to pathologists, pathology educators and hospital leaders of the potential value of reinvigorating the autopsy using modern technologic tools. Imaging combined with fine needle aspiration and the promise of molecular diagnostics could result in a minimally invasive autopsy or no autopsy in the traditional sense in some cases. Lets not forget other tools such as laparoscopy. High resolution CT imaging for autopsy is occurring at a few research/military facilities in a few countries. Unfortunately i have not been able yet to convince our health system to be an alpha site for this procedure. We need to continue to try and educate healthcare leaders that a modern autopsy using all the tools available would without doubt renew the autopsy as an important part of improving the quality of health care. BUT unless a financial model can be developed to show the savings through improved outcomes few hospitals will invest in the research needed to demonstrate whether our belief of imaging improving the autopsy and autopsy rates is correct. I am an optimist and thus convinced that soon a few brave institutions will step forward.
Jared is absolutely correct that a new financial model is required if the catopsy, the reinvented autopsy that will include medical imaging, has any chance of being widely adopted. Let me put forward a couple of thoughts with regard to the development of this new financial model:
- I stated in my original note that tissues harvested at the time of catopsy would be submitted, whenever possible, to tissue biorepositories and that the revenue from these biorepositories would be used to offset some of the costs of the catopsy service. I do not know whether this financial model is feasible or how much additional revenue would be raised by pursuing this option.
- I believe that majority of catopsies would require little additional work beyond the initial performance of the CT scan and its rapid interpretation. Given that such a scan would cost what I would estimate to be one-quarter of the cost of a standard autopsy today, I believe that converting an autopsy to a catopsy service would actually result in a cost savings. However, catopsies may be in such demand that their numbers would increase. This increased workload would obviously increase the total cost of the proposed catopsy service.
Finally, I want to speak to Jared's last point which relates to the need to demonstrate to hospital executives that the conversion to a catopsy service (or even the current autopsy service, for that matter) will improve health outcomes in hospitals. My working hypothesis is that a catopsy will yield more useful feedback for physicians about their care of patients than the current autopsy. I further hypothesize that these physicians, in turn, will improve their modes of practice (i.e., improve health outcomes) on the basis of the reports that they receive following the procedure. In order to acquire data documenting any improved outcomes as a result of the conversion to a catopsy service, I would suggest adoption of the following procedure:
After receiving the catopsy report, the responsible physician will be asked, as part of the hospital QC program, to comment whether he/she will modify future treatment of patients in any way on the basis of information contained in the report. If the catopsy report documents findings that differ significantly from those recorded in the ante-mortem medical record, such a response will be considered mandatory.
Because these responses from physicians will be viewed as an important component of the total hospital QC program, they will be treated in a confidential and protected manner. They will thus be identical to other queries that are used to improve the quality of care and identify possible judgmental or procedural errors by physicians or nurses.
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