More on Integrated Diagnostic Centers; Trend or Lukewarm Idea?

In a recent note (see: Repurposing Outpatient Clinics and Medical Procedure Units as Integrated Diagnostic Centers), I continued my ongoing dialogue about Integrated Diagnostic Centers (IDCs). A reader, Mark Terry, posted a comment to this note, taking issue with my use of the term trend for IDCs, suggesting that the level of interest he has observed for this idea does not rise to this level. I am elevating his comment to the level of a note to enable additional discussion:

The conversion [to Integrated Diagnostic Centers] is an interesting thought. I'm wrapping up a large report on integrated diagnostics and have recently been interviewing and profiling hospitals that have (or say they have) some level of integration in diagnostics, ie., pathology and imaging. Very few, if any, think this is actually a trend. They think it's a good idea, more or less, but not many are willing to call it a trend. And I think when you look at the 8000+ hospital laboratories in existence in the U.S. and then try to figure out exactly how many of those have anything even remotely resembling "integrated diagnostics," those who are doing it probably can't even be called leading edge so much as experimenters. Only time will tell, perhaps.

I won't quibble with Mark's claim that integrated diagnostics and IDCs are more of a germ of an idea at this time than a full-fledged trend. However, I would also suggest that hospital laboratories may not be an ideal location for sniffing out new trends. In support of this statement I would cite the rapid development of in-office histopathology labs and the tepid reaction of organized pathology to this major economic threat (see: Corrected Definition for a Pod Lab and a Look at In-Office Labs).

An increasing share of the ambulatory surgical pathology small-biopsy work is now being re-directed from hospital pathology groups to in-office histopathology labs owned by clinical practices. Smaller urology and gastroenterology physician groups are rapidly merging to create economies-of-scale. One of them is greater access to the development capital and managerial talent necessary to establish in-office histology labs. This results in higher income for the group partners with no obvious loss of pathology reporting quality. These labs tend to be staffed by well-trained pathologists, often with sub-specialty training. I would like to see evidence of an organized effort on the part of pathology groups or professional organizations to effectively counter this movement which places pathologists as contract employees for these mega-clinical groups.

Having said this, I would then suggest that the place to look for any IDC trend is not within pathology groups but rather in large clinical group practices. Put another way, a urology or gastroenterology group practice with an in-office histology lab is already functioning, to a large extent, as what I have defined as an IDC. By decreasing the time to process tissue specimens and the use of telepathology or an on-site pathologist, a final surgical pathology report for a patient could potentially be generated in a small number of hours. Similarly, histopathology labs could also be "integrated" into ambulatory surgery centers (ASCs) and these latter facilities could also then function as IDCs. I am told by a lab consultant colleague that histopathology labs are not currently permitted with direct access to ASCs. However, such facilities can be built contiguous to the ASC but with a separate entrance to the street.