1. Departments of Pathology & Translational Molecular Pathology
Productivity and Efficiency of an Anatomic Pathologist-Challenges & Opportunities
Dipen Maru, MD
Professor
Departments of Pathology & Translational Molecular Pathology

2. Productivity-Definition
Labor productivity: Measure of economic performance that compares the amount of goods and services produced (output) with the number of hours worked to produce (input)
Multifactor productivity: Measure of economic performance that compares the amount of goods and services produced (output) to the amount of combined inputs used to produce those goods and services*
*United States Department of Labor
*Unites States Department of Labor

3. Productivity-Definition
Pathology administrative leaders need to differentiate between labor vs. multifactor productivity when establishing benchmarks for productivity and incentive programs for faculty and classified staff

4. Productivity in Anatomic Pathology-Inherent Challenges
Aligning productivity measures with wRVU
Few data points available to collect healthcare outcome information for pathologists
Limited scope of expansion or modifications of clinical practice
Measures applicable to clinicians are difficult to apply for pathologists

5. Existing Models
wRVU
Days of service, number of cases, number of slides, TAT or combination of all or some of these
Automatable Activity Based Approach to Complexity Unit Scoring (AABACUS)
Royal College of Pathologists Guidelines on Staffing and Workload
Calculated weighted value based on complexity (L4E)

6. RVU
Relative value of work for a subspecialty based on certain factors*
Work required by a physician: a. Time b. Mental effort and diagnostic acumen c. Physical effort or technical skills d. Psychological stress by magnitude estimation
Cost of maintaining practice
Liability expenses
?? Cost of acquiring skills/education
1 to 3 x geographical adjustment x conversion factor=RVU in $$
*Hsiao et al. NEJM, 1988

8. How does RVU relates to effort and time spent on providing clinical service

9. Associations of Pathology Chairs Survey*
Annonymized data from 629 pathologists from 51 pathology departments
Median cFTE: 0.7 (range ), Median Days on service 148 (5-365), median (range) wRVU 4644 ( )
Four practice models a. General, b. Hybrid, c. single subspecialty, d. Multiple subspecialties
Compare data with MGMA and FPSC benchmarks
*Ducatman B. Academy Pathology, August 2016

10. APC survey General (n=170) Hybrid (n=193) Single Subspecialty (n=176)
Multiple subspecialties (n=90) p
Part A effort (FTE)>0
0.11
0.19
0.15 NS
Part B effort (cFTE)
0.7
0.55
0.67
<0.003
Days on service
130
152
150
171
<0.02
wRVU
5215
4479
2662
5426
<0.001
Education effort>0
0.12
0.1
Research effort>0
0.05
<0.004
Median Salary
$221216
$234171
$241500
$235000

11. Effort vs. wRVUs (APC survey)

12. Days on service vs. RVU

13. AABACUS*
Automatable Activity-Based Approach to Complexity Unit Scoring
*Cheung C. Modern Pathology, 2015 (28)

14. AABACUS Automatable Activity-Based Approach to Complexity Unit Scoring
Calculation of Pathologic
Clinical Units in AABACUS
Clinical workload unit
by AABACUS
Information in LIS

15. AABACUS
Capture from LIS: “Raw Parameters” generating by the Department using LIS
Export: As excel files to AABACUS
Identify:
Workload Parameter: # blocks/slides/stains
Workload Activity: Specimen acquisition, Handling, Analysis, reporting and QA activities

16. AABACUS Count: Number of activities by the Pathologist
Score: Number of activities x complexity factors

18. UTMDACC Survey
Surgical Pathologists with committed clinical effort 60-70%
Subspecialties where we got responses from more than 1 pathologist
Effort of activity as % of clinical commitment

19. Effort required for clinical activity
Mean (%)
Range SD
Frozen section diagnosis 10
1-16 5
Gross examination 13
10-21
H&E review with and without review of non-pathology modalities 41
35-55 2
Dictation/sign out 11
5-18 8
Ancillary studies 9
3-20 7
Biomarker related work 3
1-5
Consultant 6
2-12
Tumor board or planning clinic 4
0-10
Committee meetings related to direct patient care 1

20. Non RVU Generating Activities
Mean
Range
Standard Deviation
Grossing Supervision 6
1.7
Specimen harvest for clinical research 2 1
Tumor Board/Planning clinic 4
0-10 3
Consultation with clinicians and other pathologists
2-12
Department and institutional committee meetings 5
1-7
1.5
Development and establishing a new test, protocol, overseeing daily operations * NA

21. UTMDACC survey 23% of clinical effort to activities without wRVU
Activities related to QA/QC
Better documentation is necessary for activities which targeted to improve quality of clinical care for billing purposes
Need for efficiency: Not only for financial incentive

22. Processes Needing Efficiency Improvement
Service Schedule
Number of services in your section
Distribution of service days across week or month
Mix of activities in one service
Specimen/Slides related issues
Grossing delays
Grossing mistakes
Processing and staining delays (for HE only)
Ancillary testing delays
Ancillary testing mistakes
Unpredictable work flow of ancillary and biomarker testing
Transcription issues
IT issues

23. Processes Needing Efficiency Improvement
Tumor Board/Planning clinic
Number of meetings
Time take to prepare
Issue related to availability of material for review and present
Number and types of cases in each meeting
Activities other than those not related to providing direct pathology services for patient care
Coordination of workflow with fellows
Meetings and non academic commitments

24. Measures not directly related to Billable units
TAT
Number of Amendments
Communications related to Patients
Utilization of best practices
Department/Subspecialty Specific QA/QC activities
Grossing supervision
Specimen Harvest for research
Tumor board
Committee meetings
Clinical
Measures not directly related to Billable units
Number of days on service
Number of cases/Slides
wRVU
Establishing a test for the department
Quality Matrix 2
3 or 4 1
3 or 4
Measures directly related to billable units

25. Thank You