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Barry Portugal

Hi Bruce,
I agree that laws 1 and 2 probably won't have a major impact on pathology, but I have a different perspective about law 3.

While there may be some referrals from small pathology groups to pathology groups with greater sub-specialization, I believe another market dynamic will be more prevalent. I believe that there will be a significant number of pathology group mergers over the next few years.

According to industry information, the majority of pathologists working in hospitals practice in groups of five or less. Smaller pathology groups are unable to negotiate effectively with managed care plans, and are often excluded from performing outreach work from plans offered by large insurance companies. Larger pathology groups with substantive sub-specialization and with more geographical diversity will be able to leverage multiple hospital contracts to be included in those networks and compete with national reference laboratories. Additionally, larger pathology groups can compete more strategically relative to the outsourcing of outpatient histology and pathology services to office-based practices.

Mark Pool

Excellent post, Bruce. One other way in which the future pathologist would be valuable is to use image analysis tools to provide more actionable information regarding tumor microenvironment, intratumoral heterogeneity, host immune response, etc (at least for cancer and defined inflammatory biopsy specimens). Linking this to genomic and epigenomic information might also be useful.

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