CEO SUMMARY: During the 1990s, pathologists at Palm Beach Pathology recognized that more and more procedures were being done in ambulatory surgery centers and physicians’ offices. To maintain access to these patients, Palm Beach Pathology developed a strategic marketing plan with a unique feature: a mobile laboratory that could process specimens at the clients’ site and provide referring doctors with a fast diagnosis. Although the mobile lab is not a profit center by itself, it has helped Palm Beach Pathology build market share and develop new accounts with key providers in its service area.
IN SOUTH FLORIDA’S HIGHLY-COMPETITIVE market for anatomic pathology services, Palm Beach Pathology has taken customer service to a higher level by offering mobile, “come to your site” histology and pathology services.
To set itself apart from other pathology groups, Palm Beach pathology operates a mobile histology van. “For about ten years, we’ve used this mobile van to offer clients on-site pathology services,” stated Michael J. Imber, M.D., Ph.D. “We’ve found this service to be particularly popular with ambulatory surgery centers (ASC) and dermatologists.”
Palm Beach Pathology is located in the coastal community of West Palm Beach, Florida, about 70 miles north of Miami. It is a 16-pathologist practice, of which two, including Dr. Imber, are dermatopathologists. The anatomic pathology (AP) group serves numerous hospitals, health systems, physician practices, and surgery centers in Palm Beach and Martin County.
“South Florida has always been a competitive market for anatomic pathology services,” observed Dr. Imber. “In this region, several pathology groups have aggressively marketed their services. We decided to develop mobile pathology services about ten years ago as a way to expand our business and gain market share. We considered AP services, delivered closer to the point of care, would be a competitive advantage with certain types of clients.
Mobile Pathology Services
“At that time, we could identify two mobile pathology services, operated by a pathology group in Orlando and one in Greater Miami,” he recalled. “The goal was to provide similar, but better, service to burn centers, hospitals, dermatologists,
and plastic surgeons in our service area. By bringing our pathologists closer to the physician during patient procedures, we would develop bonds that would strengthen both our clinical and business relationships with client physicians.
“Because we already had a strong presence in this market, we also believed it would not take an expensive marketing campaign to introduce mobile pathology services,” stated Dr. Imber. “In fact, that’s how it worked out. We used a low-key marketing approach and that kept our start-up costs relatively low.”
“The next step was to design the actual mobile laboratory,” explained Dr. Imber. “One of our pathology group’s marketing team was good at design work, so he took the lead role in developing the mobile pathology van.
“We wanted a safe, efficient and comfortable work environment for two people,” he added. “There would be a pathologist and a histotechnologist, along with all the necessary equipment. Of course, the mobile laboratory had to meet federal and state regulatory guidelines.
“We purchased a GMC van. The roof was modified to allow us to stand up inside,” he said. “The van was equipped with a cryostat, microtome, genera- tor, sink, hood, air conditioner, microscope, and dictation unit. It is roomy enough that two people can work inside at the same time.
Adequate Working Space
“The mobile lab’s design allows us to gross, microtome, stain, cover slip, and read the slides. The aisle space only allows room for one to pass by at a time, but the total space compares favorably to the amount of space some facilities dedicate to frozen specimens,” commented Dr. Imber.
Noxious fumes are not an issue, since the only chemicals used in the staining process, including xylene and alcohol, are contained in the staining equipment. In fact, Palm Beach Pathology was able to completely equip the mobile laboratory with off-the-shelf items. This further minimized the cost of building the lab.
“Designing and equipping the van was relatively easy compared to operating the mobile lab,” Dr. Imber observed. “We’ve learned that it takes the right kind of histotechnologist to make the concept of the mobile pathology lab work successfully. For example, a histotech needs to be willing to drive the van to the client’s site and work in this unique, somewhat restricted, environment. Also, the histotech will have more direct contact with our customers, which is not always the case in the lab.”
Mobile Histology Lab Has Adequate Room
Whenever the mobile laboratory service offered by Palm Beach Pathology takes to the field, it usually is scheduled for about 50% of a working day. What’s it like to do laboratory work in the constricted area of a mobile van?
Michael J. Imber, M.D., Ph.D. and a dermatopathologist at Palm Beach Pathology, is more than six feet tall. He likes the environment. “Working in a GMC van is not as challenging as some may think. For example, the van’s roof was modified to allow us to stand up and work. The layout of the van actually makes it a comfortable work environment.
“During client visits, two of us work in the mobile lab at the same time,” he continued. “Because of the van’s design and layout, we don’t get in each other’s way. The histotech can efficiently gross, stain, and cover slip while I read slides and do dictation. It’s organized to allow us to both be productive while we are on site.”
Dr. Imber explains that pathologists typically drive their own car to the client site. “This minimizes our downtime, since the histotech can arrive early, prepare the lab, and start processing the specimen in advance of the pathologists’ arrival,” he explained.
“In regard to regulatory issues, there were no special requirements for our mobile laboratory,” recalled Dr. Imber. “It proved to be no different than the standard clinical laboratory. We have the same monitoring and follow-up as if the lab van were in a building. But there are some extra things for which you must be aware.
“For example, when not in use, the mobile van must be parked where it can be hooked up to a continual power supply,” he said. “This keeps the cryostat cold, otherwise it won’t be ready to go. Also, experience has taught us lessons which we’ve incorporated into a check- list so we don’t overlook anything.”
Carries a Full Caseload
A typical day in the life of Palm Beach mobile pathology starts with the organization of the daily surgical work- load. A staff member coordinates surgical cases for the “mobile pathologist” of the day. “each mobile pathologist carries his or her normal caseload for the day,” commented Dr. Imber. “It’s just done at a different location. While waiting for a frozen section in the mobile lab, I can read slides from the previous day’s outpatient surgicals. This minimizes downtime and the daily workload is maintained at a surprisingly optimal pace. Reports are easy. We give the referring physician a verbal report and send the hard copy the next day after routine processing.
There is an unexpected reward from this outside pathology service. Dr. Imber declares that “it puts you in touch with the outside world. Often you go into the physician’s office and meet the nursing staff and the patients. This is very unlike the outpatient laboratory.
“In fact, most physicians enjoy introducing their patients to a pathologist; it makes the patients feel special to think that their specimen will be read during the time they are under the knife,” noted Dr. Imber. “Because of this positive effect on patients, there’s no shortage of plastic surgeons or dermatologists that want to schedule us to take the van to their offices and read their frozen sections.
“However, to maximize the productivity of our pathologists, we carefully monitor the number of cases we handle with the mobile lab,” he added. “Currently we schedule the van about three times a week and usually have 3- 4 cases for the morning. This gives us about 50 cases per month.
Pathologists In Rotation
“There are three pathologists who usually operate this service,” continued Dr. Imber. “Two are dermatopathologists and one is a non-skin pathologist. This way we always have a backup and can share the workload. Personally, I enjoy this aspect of my work because it gets me out of the laboratory for half a day, plus the van provides a peaceful and quiet working environment.”
What about the financial performance of the mobile histology service? Does it make money? According to Dr. Imber, the mobile lab was never designed to be a stand-alone profit center. “Our original goal in offering on-site pathology to selected clients was less about generating direct profits from the service, but rather to anchor important account relationships.
“For a smaller pathology practice, I’m not sure if it would be profitable enough for them to use this type of approach,” he offered. “Our mobile lab is one of a full menu of services offered by Palm Beach Pathology. At budget time, we look at the expense of this service as part of a bigger strategic marketing strategy. We don’t expect it to be financially self-sustaining.”
Although not run as a stand-alone profit center, the mobile laboratory does reasonably well on its own and billing arrangements are straight forward. “Revenue from this service is billed exactly like the outpatient laboratory,” observed Dr. Imber.
Mobile Lab Backs Up Clients
The ability to perform on-site pathology leads to some interesting service scenarios. “We also service physicians with offices in close proximity to the surgery centers,” Dr. Imber added. “If one of those physicians conducts minor surgery in their office during the time we are scheduled to be at the nearby surgery center, then one of their staff members brings the specimen to the van and we provide the results almost immediately. Our clients appreciate this type of service. We are a backup for them that’s not available anywhere else.”
As Dr. Imber notes, Palm Beach Pathology’s mobile laboratory provides a variety of added-value benefits to physicians who use its services. But intense competition in South Florida for pathology specimens makes it necessary to continue to innovate. Palm Beach Pathology is preparing to introduce telepathology services as a way to protect and increase its market share.
“In central Florida and the Everglades, there are several areas underserved by pathology services,” observed Dr. Imber. “As an example, there are small hospitals that do not have full time pathologists. These hospitals are excellent candidates for telepathology.”
To serve this market, Dr. Imber is developing a mobile telepathology concept. “This is a way to allow a pathologist to remain at the central lab,” he said. “The histotech drives to the client, prepares the tissue, places the slide on the microscope, and the pathologist can read the slide using a wireless Web connection.
“As a foundation for this service, we’ve already introduced digital and video images for some reports from the main lab,” Dr. Imber noted. “A consultant is helping us develop the telepathology capability.”
THE DARK REPORT believes that Palm Beach Pathology’s mobile laboratory is a valid response to an ever-growing trend. During the past ten years, there has been a significant shift away from inpatient procedures. The number of outpatient surgery and other procedures has grown significantly. That is reflected in the larger number of ambulatory surgery centers, as well as the growing numbers of physicians performing minor surgical procedures in their offices.
Mobile pathology is a rational way for local pathology groups like Palm Beach Pathology to support outpatient procedures and maintain access to patients which formerly would have been served by the hospital. It is consistent with the need to lower the cost of care while improving the overall quality of care.
THE DARK REPORT notes the experience of Palm Beach Pathology also demonstrates that both physicians and patients respond favorably when given direct access to the pathologist. This is the marketplace speaking to the pathology profession. It is one sign that pathology groups willing to be more visible within the healthcare community will probably gain a competitive advantage over pathology groups who chose to maintain a lower profile.
Appropriate For Some Areas
Of course, a mobile pathology lab is not a practical business strategy in many areas of the United States. But it may be appropriate in densely-populated markets where there is increased competition for patients. examples of such areas are Los Angeles, Houston, Atlanta, and Chicago.
What Palm Beach Pathology has done with its mobile lab is provide an expert, local, and instantaneous pathology result to its most valuable clients. It is using this added-value service to leverage its business relationship and expand its share of the office-based physicians’ market.
Because it was willing to invest in this mobile lab as part of an overall marketing strategy to gain share and build specimen volume, Palm Beach Pathology has managed to protect its turf from the inroads of other pathology competitors in the area. That is a significant accomplishment, given the intense competition for specimen referrals from office-based physicians in the South Florida market.
Willing To Invest Capital
The marketing strategy used by Palm Beach Pathology involved more than offering mobile pathology services. The mobile lab was part of an integrated business plan that required the pathologists to invest capital and management resources to expand the volume of specimens and revenues flowing into their group practice.