Lab leaders on hires, wages, scanners, and storage

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Autumn, it seems you would like to know whether anyone is using international candidates, and if they are, whether they’re doing so through an agency or doing the paperwork themselves for their visas. Does anyone have experience with this?
Julie Hess, VP, laboratory services, AdventHealth, Orlando, Fla.: We have hired about 50 international candidates in the past year and a half. We have a recruiting service managing H-1B applications.

Joe Baker (Baylor Scott & White): We do our own paperwork. Our legal department contracts a lawyer to work with us for H-1B visas and others. We’ve done about 10 to 12 over the past year, and it takes a long time. The agencies we’ve looked at are expensive. Reports are that it costs around $130,000 per individual.

What countries are you working with?
Joe Baker (Baylor Scott & White): We were working with the Philippines, but that has become tougher recently, and some countries in Africa.

Wages in laboratories have gone up 10 to 20 percent over the past three years. What are you seeing in your market and what are you doing around laboratory compensation?
Autumn Farmer (Bon Secours): We took wages up on average about 15 percent. Even though we knew we had to do it and communicated we were doing it, it’s still causing a budget variance. The other pressure is to eliminate use of agency employees.

Mike Eller (Northwell): One issue with the wage increase is a snowball effect to management compression, with technologist salaries starting to approach those of supervisors and managers. From a budgetary perspective, it has to be phased in, because it’s a big hit when you do it all at once in a large health system.

The public health emergency will end May 11 in the United States. What do you think might happen with laboratory testing and reimbursement after that?
Dr. Martinez-Torres (NorDx): We’ve received guidance from payers about what CPT codes they will use and what the reimbursement rates will be. It won’t be $100 a test for COVID, like we had seen before; it’s about half of that. We’ve received clear guidance that those will continue to be covered as long as we bill them appropriately.

I’ve spoken to my clinical colleagues at MaineHealth, and I anticipate that anyone presenting with respiratory symptoms will still be tested for COVID after May 11. It’s ingrained into the order pattern, just like they will order influenza and RSV and tests for other potential pathogens, depending on the prevalence at that time.

Autumn Farmer (Bon Secours): We’ve modeled the reimbursement reduction from Medicare at about $95,000 a month. I don’t think it will change our pattern of testing. On a good note, when we looked at the model for how much it was going to cost us on Medicare for COVID, we also looked at the allowable rate under Medicare for venipuncture, and it went up from $3 to almost $9. That offset the reimbursement reduction for us.
Some of the boutique labs that popped up to do COVID testing will get out of the business, which may drive up our nonacute business.

I’d like to open the discussion to anything you want to comment on about the laboratory and pathology.
Dr. Martinez-Torres (NorDx): I’d like to take the pulse of the Compass Group members in regard to where they are in their journey of digitizing pathology workflows—at the beginning, middle, or end? Are you mature or are you still thinking about it?

Sam Terese (Alverno): We’ve been digital for the past four or five years and have transitioned most of our workload to digital. We have a few sites left to convert, but that will occur as we transition the remaining histology processing to the central laboratory. We’re scanning 1.2 to 1.3 million slides a year—H&E, specials, IHC, the whole gamut. Most of our pathologists read off computer screens.

The return on investment is not the most exciting I’ve seen. But for a large integrated health system, at least from the laboratory perspective, going digital makes a lot of sense versus moving glass across the geography, and it has positioned us for the adoption of AI.

Joe Baker (Baylor Scott & White): Half of our system has been using Philips for a couple of years. One of our informatic pathologists led this for the system, so all of our employed pathologist-supporting hospitals are on Philips. We have seen a nice decrease in slide movement throughout our central Texas region. We have a pathologist outside of Texas reading for us.

Dr. Sossaman

Gregory Sossaman, MD, system chairman and service line leader, pathology and laboratory medicine, Ochsner Health, New Orleans: We’ve had Philips scanners up and running for a couple of years. Our plan to go fully digital was delayed during COVID. We’ve basically restarted our validation for primary diagnosis and it’s now close to complete. We’ve used it for teaching and IHC. It’s quite an investment, and I’m a little worried, as capital has become harder to acquire recently with the focus on expense reduction, that it might become even harder. And as Sam said, the ROI is not great. We may have to make modifications in what we were planning to do and acquire additional scanners and maybe modify what we were thinking about as far as slide storage, because it gets expensive if you store a lot of slides digitally. We’re planning a go-live for primary diagnosis in the third quarter.

Dr. Bridges (Bon Secours): We have been looking at it and haven’t gotten far. Questions have come up regarding the optimal number of scanners to get and which scanners. The question I have is, How do you calculate your total digital pathology need with regard to scanners and storage requirements? How many scanners do you need per number of slides, and what does that storage requirement look like? As we dug into it, it appeared that the storage requirement of approximately 250,000 slides per year at a gigabyte per slide was going to be extremely expensive.

Dr. Sossaman (Ochsner): If you’re going to go primary diagnosis and your entire workflow is dependent on those scanners, you will need more than the volume itself would suggest because they have issues, they go down, they’re sensitive to vibrations and all kinds of things. It takes experience with them to truly understand that. If you’re using it just for IHC and education, you could probably get away with a couple of them, depending on your volume. But if your entire workflow is built on that and you get rid of the couriers moving things around the system, you will need more than you realize.

Storage gets complicated quickly. There’s no requirement now to store all these images, but if you’re going to use them for AI you need to retain the images. All storage is not the same cost; it depends on the type of storage. There are so many variables that you have to map out your workflow and use case for figuring out what those expenses will be.

Dr. Anthony (Allina): We’re not using digital for primary diagnosis at this point. We have a scanner for specific IHC analysis, and we use nonconnected iPhones with specific adapters for consultation, if someone’s at a site doing an adequacy assessment for cytology or a frozen section. Everybody’s interested in it, but there are barriers.

Sam Terese (Alverno): To calculate number of scanners, we looked at our target turnaround times and figured out what a throughput of a given scanner could be in a continuous-load model. Digital storage is terribly expensive, so we’ve chosen not to do that as a permanent record at this time. We keep glasses that are permanent and hold the images for about a month. There is a process to tag a slide for longer-term storage.