Hi, my name is Dr. Jeff Myers, and I'm here to welcome you to today's webinar, Pathology Clinics, What They Are, Why You Want Them, and How to Start. I want to remind you that by participating, you are agreeing that ASCP may use the recording of your image and statements on ASCP's website and YouTube channels, a few housekeeping reminders there will be polling throughout, the answers will be anonymous. Please in posing questions or putting information into the chat, do not share any protected health information or personally identifiable information about patients. CME and CMLE credit is available for this event. Instructions for claiming credit will be shared at the end of the presentation and will also be sent to the email address you provided at the time of registration. A reminder that faculty have no relevant financial relationships with commercial interests to disclose. The story of patient and pathology clinics, I think really begins with work done by the Institute of Medicine in reframing how we think about safety and quality in the work that we do. With their first release of a report in November 1999 to AIR as Human, they put us on notice that safety was not what it needed to be in healthcare, and in March of 2001, they released the second volume of a series of reports, and this made it clear that it was more than just safety, that the expectations for a new healthcare system for the 21st century was that it be safe, that it be effective, that it be patient-centered, that it be timely, that it be efficient, and that it be equitable. Most institutions and practitioners breathed a sigh of relief when they read that it was patient-centered, assuming that that already characterized their work, and as we've learned more about what it means to be patient-centered, I think we've learned that we still have a ways to go. The final in the trilogy of reports regarding the safety of our healthcare system was released in 2015, this one called Improving Diagnosis in Healthcare, and while the first two may not seem like they were speaking directly to pathology and laboratory medicine, although I would argue they were, this one clearly hits us where we live. The committee said that in reviewing the elements, they had to conclude that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences, and in thinking about how to fix that, they wanted to make sure that we were all operating with the same dictionary when it comes to what diagnostic errors are, and they defined them as failures to establish a timely and accurate explanation of the patient's health problem or problems, or failure to communicate that explanation to the patient. We're here today to talk about pathology clinics as one of the tactical responses to how we might more effectively communicate that information to patients in ways that are timely and effective. It is my pleasure to introduce, before we get started, to one of our ASCP patient champions, Tanya Cochran-Stalker. Tanya, as she'll tell you, is a lung cancer survivor, and hearing the stories of our patients reminds us of why we're here and why we do this work. Tanya. Thank you for that introduction. Pleased to be with you all today, and equally pleased to be alive and part of the ASCP Patient Champion Program. I'm a lung cancer survivor, and we'll spend a few moments just how pathology and how pathologists really impacted my diagnosis. First, if I may, I just want to emphasize the value of self-advocacy. As I was told, I had asthma and bronchitis based on my condition at the time, and at that time, that made sense. I didn't have a family history of lung cancer. I was an active, otherwise healthy adult, so lung cancer, I could see not completely jumping to the forefront as a possibility. But it was after I insisted on more testing that pathologists determined that I, in fact, had lung cancer. And why did I insist on more testing? At the time, I was a writer at the University of Chicago Medical Center, and I was interviewing a grateful patient for a magazine that I produced. And that grateful patient just happened to be a lung cancer survivor himself. And one of the questions that I had asked him was, tell me about your symptoms. And as I was sitting there taking notes, it was one of those moments where I stopped and paused because I realized everything that he was describing were the same symptoms that I was experiencing. So that was why I then insisted on more testing and then, of course, learned that my diagnosis was not, in fact, bronchitis and asthma, but, in fact, lung cancer. So although it was my main doctor that I met with throughout this process, because of my knowledge of my past job as a writer, I'm aware that pathologists, very skilled pathologists, are behind the scenes reviewing lab tests and thus determined my accurate diagnosis of lung cancer. And I've said it before, I will say it again, that if it were not for the efforts of these skilled experts, I may not be here with you all today. So my gratitude runs deep for those of you in this line of work. I think a lot of people don't know that there are experts behind the scenes doing these diagnoses, but I think there's a lot of benefits to that, especially for those who need more detailed information, maybe just a bit more clarity on their diagnosis. One of the things I'm often asked as a lung cancer survivor is how has it impacted my life. It's greatly impacted my life, particularly to be a survivor. However, I do know that those who know me know that I lived a pretty active and really very blessed life before cancer. So that hasn't changed. My outlook has always been very positive. I've always seen the glass is half full, but I'm just a bit more sunnier now that I have a cancer-free diagnosis. I don't take this gift lightly. I don't wait, for example, to travel. Actually, this weekend I leave for Costa Rica. So I am definitely moving things full speed ahead and taking advantage of this second opportunity, this life that I've been given. I guess the best way in a sense to describe life or my status post-cancer is I'm in a perpetual state of gratitude. I wake up thankful. I'm an avid hiker. The only real setback, the only really thing that I noticed with having a missing lung, I had a lobectomy, is when I'm climbing mountains, which is one of my passions. So once I start to ascend a mountain, my body quickly tells me, what are you doing to me? And so I have to regroup, take a breath, and just get back into things. So I do recognize my limits, but honestly, a limit of only having to go slow. I'm still able to embrace the things I enjoy. I run. I don't do marathons like I used to, but I'm still able to run. I'm just slower. And honestly, I'm older as well, so I probably would be slower regardless. So in no way, shape, or form has my lung cancer limited me from continuing to enjoy life. I think, if anything, the biggest takeaway for me is greater appreciation of what I've been given as a gift. So thank you for your time, and thank you for allowing me. Thank you, Tanya. I really appreciate that and appreciate your helping us understand what your diagnosis has meant to you, and I loved hearing your gratitude for the work that happens behind the scenes. So why are we asking for an hour of your time to talk about pathology clinics? It's stories like Tanya's. And our overall purpose is really to help laboratory members start or improve pathology clinics at your institutions in order to improve patient experience, the experience of pathologists and laboratory professionals and non-laboratory providers, everybody on the healthcare team, to impact patient outcomes, to improve the visibility of the laboratory, and thereby improve recruitment into the laboratory field. And at the end of the day, to do all of that, to improve communications, patient safety, and the quality of the care that we provide. To do that, we've tapped four speakers. I am one of them. The other three will introduce themselves. First, Catherine Lapidus will talk about the importance of health communications and pathology clinics' role in that landscape. Dr. David Lee will talk to us about patient impacts from a provider perspective. Dr. Ligia Joseph will talk about the impacts on pathologists and treating clinicians. And I'm going to clean up work by talking about how you start this conversation with institutional leaders. So with that, next slide, please. Dr. Lapidus. Hi. Good afternoon, everyone. I'm Dr. Catherine Lapidus. I'm a pathologist and researcher at University of Michigan. And I'm going to talk about the importance of health communications and the role that pathology clinics can play in pathology communications, both at the individual level and also the health system level. So the pathology report, it's just one component in the patient's overall experience with their care. But I strongly believe that it's our duty as pathologists and laboratory professionals to make the pathology report a useful and empowering component for both patients and their treating clinicians. So let's take a little look more in depth at why health communication matters. So at an individual level, a provider's ability to communicate can be linked to a myriad of factors, including whether patients are even able to access care, improve patient knowledge, a therapeutic alliance, which is like the trust that a person has in the medical system, emotional well-being, empowerment and agency. And all of these things can be linked to higher quality decisions and treatment adherence. So they really connect into, you know, downstage patient outcomes. Health communications also impact the ability of a health system to work together. So communication breakdowns have been repeatedly identified as a major source of adverse events and medical error. Effective communication is associated with improved patient safety, improved quality of care, job satisfaction and quality of relationships. So knowing the importance of health communications, I wondered how do we as pathologists do with communications on both an individual and a systemic level? So there's limited research on this topic, but some early research shows that our pathology reports alone are not particularly good at communicating information to their intended audience. A recent study published in JAMA Dermatology showed that only 12 percent of patients were able to even pick out their diagnosis in the report when they were initially shown it, and 92 percent were worried about the report even when the diagnosis was benign. More research is definitely needed in this area, but the initial data suggests that our reports don't really do a great job of communicating health data to our patients. Some people might say, well, patients aren't really our target audience for the pathology report. It's treating clinicians. I think there's two problems with that. Number one, since the Cures Act now prevents information blocking, pathologists are directly sending the report to the patient. So I really think we should think of patients as our target audience. And the second thing is that the small amount of research completed on how well our reports communicate to the clinicians, such as the study from Yale by Pausner et al., shows that there's a 30 percent discordance rate between how the clinician interprets the report and how the pathologist intended the report to be interpreted. And a 30 percent rate of diagnostic communication is scary because it can lead to serious medical errors and patient safety concerns. So this literature supports that there's a communication gap in the pathology report between both pathologists and the patients that we serve, so this arm here, and pathologists and treating clinicians. And a pathology clinic really has two components, one where the patient and the pathologist they review the slides, they discuss the diagnosis, they discuss the medical laboratory results, depending on what type it is, and then they also send a note or do a phone call to the treating clinician based on how complex everything is. So this is really a two-part intervention that can address these communication gaps. So the first question our research group aimed to ask was a simple one. How many patients would be interested in attending a pathology clinic? I had my own hypothesis, but I'm interested in what everybody else thinks. All right, as soon as we have a critical number, we'll put that up there. Okay, so it looks like the median group, most people, 55 percent, say 25 to 75 percent of people would be interested. So I thought it was going to be like 5 to 10 percent of patients. I really didn't think very many people would be interested. In our study of 100 cancer patients at University of Michigan, 86 percent of cancer patients surveyed were either definitely interested or interested in meeting with their pathologist to see a glass side of their tissue. We also did qualitative analysis, so we got to learn about the reasons why. So what are some of the reasons that you think patients might want to attend a pathology clinic? We'll just take a second to wait for the group to fly. All right, so it looks like we're kind of spread across the board. Really, these are all reasons that people cited, so 90 percent say improve the understanding of diagnosis, which was a top thing that patients mentioned and one of the primary outcomes that I'm really interested in studying. So that's great. All right, next slide, please. So our qualitative analysis from the study showed that the patients perceived a pathology clinic to be a potentially empowering interaction, which would demystify the patient's diagnosis and enhance their overall understanding of disease. And this led to the development of a conceptual model. This is an original conceptual model from Street et al. They're experts in health communications that we've modified to be related to the path clinic. So our group, our qualitative analysis showed that the communication functions of a patient pathologist consultation are not limited to but are likely most in the information exchange, like improving understanding, getting more information, managing uncertainty, you actually know what your pathology report says, and enabling self-management. When people understand what's in their pathology report, they're better able to advocate for themselves and talk about it. And these are linked to an indirect path of outcomes as well as a direct path of outcomes. You've got proximal and intermediate as well as overall health outcomes for sort of, this is how I conceptualized studying this area. So we did a pilot in men with prostate cancer, localized prostate cancer, and we gave them a pathology explanation clinic right after they had their diagnosis and then followed them over six months. And we showed, indeed, that this conceptual model really does pan out. So our participants showed that they had increased understanding, more trust, the patient felt really involved in their care and was very satisfied. Many others, including Dr. Joseph, has showed the high level of patient satisfaction people have with these path clinics. We also had the intermediate outcomes of a quality medical decision, trust in the system, and emotional management. And then our overall health outcomes really landed most in emotional well-being as well as overall less suffering. These men had an easier time making their treatment decision, so they had less conflict, and they felt more sort of okay with their decision, regardless of what it was, after they had it. They didn't have very much treatment regret. So we also had system-level impacts. So we saw that in adding this arm with the pathology explanation clinic, pathology clinic here, and the note here, we really tightened also not only the patient-pathologist connection, but the pathologist-treating-clinician connection. And we had some major patient safety things that resulted from that. One was that 33% of the cases that wouldn't have been re-reviewed were re-reviewed because the pathologist was involved and talking with the treating clinicians. And several of those cases were downgraded and that led these men to be able to choose active surveillance. So we really changed their course of care. Additionally, the pathologist who was meeting with the patient was really instrumental in communicating changes in diagnosis. There was one misdiagnosis that needed to be communicated and as well as a minor diagnosis. And this work that there's, you know, these patient safety and quality impacts has been shown by others such as Chakar et al. in PATH Clinics in Tel Aviv, where they had a 5% change in treatment plan following the PATH Clinic. And 20% of patients were referred for a second opinion and 20% had a revision of their analysis. So really when we introduced the pathologist here, we're doing a lot of work in the quality and patient safety area. And with that, I'm honored to pass the stage to Dr. Lee, who will be highlighting some of the individual level impacts of PATH Clinics through patient stories. Thank you so much. Thank you, Dr. Lapidus. My name is David Lee. I'm a practicing hematopathologist at Mayo Clinic here in Florida. So as we know, pathology clinic is taking place all over the country, and there's no better way to talk about impact on patient than to describe them through actual patient stories. So the first patient that we have here is a 30 year old woman who presented with multiple symptoms and just general discomfort for a few months. Routine laboratory workup shows some abnormal, possibly suspicious results for hematologic malignancy, and a bone marrow biopsy was performed. Although the bone marrow biopsy was normal, the patient, along with her mother, was interested in learning more about the result and her bone marrow report and proceeded to set up an appointment with the pathologist to do so. After the appointment, in a post appointment survey, the patient stated that she went in not knowing what to expect. I was blown away by the attention to detail and explanation in which I could understand. As an individual who comes from a non-science background, I truly feel more knowledgeable of my report. I did not feel rushed at all, and I always felt any question I had was not missed. I would highly recommend any patient to do this. So for this particular patient, knowledge was important to her, to understand about what is happening to her and what are some components in her bone marrow. A second patient, this is a 77-year-old retired surgeon who is familiar with the medical system, presented with some abnormal labs from routine exam that was suspicious for multiple myeloma. He proceeded to have a bone marrow biopsy that showed multiple myeloma. The patient and his wife, through the pathology report, requested an in-person meeting to further discuss the diagnostic process and had some questions regarding the laboratory results. In the post-appointment survey, he noted, doctor was excellent. He was thorough, unhurried, answered my questions. He made me feel like I was in the appropriate place to treat this disease. I like to think of him as part of my team, part of my support team. I can call on him for further reviews. For the surgeon, it was important to him to feel that he can trust the hospital he was at, his support team, his physician, and his pathologist. And pathology clinic was able to provide that for him. This next patient is a 50-year-old Hispanic woman who was diagnosed with breast cancer. In her area, the pathologist had made a TV interview about the pathology clinic. And the patient reached out to the pathologist to review her biopsy results. In particular, the patient was very excited after seeing her estrogen receptor immunohistochemical stain result. She told the pathologist, I had some barriers to taking a medication, specifically related to trust. If only I had seen these slides and someone explained to me why I should continue taking these medications, I would have never discontinued the anti-estrogen medicine after two years. The side effects were not agreeable to me, so I just decided to stop taking it. I never explored why this would have been important or why they were asking me to continue the medicines. So this story illustrates the importance and the role pathology clinic can play in terms of treatment, in terms of patient adhering to treatment, and ultimately outcome. So overall, pathology clinic can help improve patient understanding, knowledge of their disease, of the report, which in turn improves personalized care and monitoring of the disease, and ultimately, hopefully leads to better outcomes for the patient. And with that, I will turn it over to Dr. Joseph. Thank you, Dr. Lee. I'm Dr. Lidja Joseph. I'm the chief of pathology at Lowell General Hospital. We've had a pathology clinic in place since 2017, and we've seen over 200 patients in our clinic. So my perspectives that I'm sharing is from personal experience. So one of the questions that many of you who are pathologists or laboratory professionals are considering right now is, how is this going to impact my life? Why should I care? Why should I start to do something different? And again, just based on my experience, I can tell you that the pros definitely outweigh the cons. Meeting the patient is one of the most meaningful experiences in my professional career. I went to medical school imagining that I will meet patients, and engaging in direct patient care brings you a certain level of professional fulfillment that any level of being a doctor's doctor cannot fill. Just listening to Tanya, I was just reinforced about how this has definitely reduced my own personal burnout during the pandemic, as well as through the pandemic and after the pandemic. There's definitely many reasons for me to just shut down shop and go sit at home and say, this is not for me. But meeting patients like Tanya, hearing the level of gratitude that she brings to you and helping you to understand the value of what we do every single day definitely has impacted my personal burnout. The cons. On Catherine's paper that she did, 80 or 85% of pathologists expressed interest in doing pathology clinic and meeting with patients, and there are 15% who will not be interested. When I presented my data in Europe, they said there is a certain percentage of pathologists who said, I became a pathologist so that I don't have to meet a patient. And that is valid, and that is definitely acceptable. There are some concerns about communication skills that everybody has. I didn't go to residency, meaning to meet with the patient. Nobody trained me. My program director did not model that for me. But I can tell you that definitely at Duke and several, at Michigan, at Mayo Clinic, there are pathologists doing this. A recent CAP survey stated that I think close to 19 to 20% of pathologists across the country are actually offering this. You definitely have to have skills for workplace safety with all the things we hear in the news about the risk of being a physician or a healthcare worker is real. There is also anxiety about lawsuits, and if you are behind the paraffin curtain and you don't have to meet a patient, maybe they won't identify you as one of their members of their care team, and if things go wrong, maybe you're hidden, you're behind the scenes, and they may never name you, and that's not true. That also is from personal experience. The other concern, honestly, is how to get your colleagues under your tent, and that is actually more challenging. The pros of it is, again, Catherine's study showed that when the urologist, after having had the patients meet with Catherine's team, doing their prostate cancer diagnosis explanation, when they met with the urologist, they were spending more time on actual treatment planning, rather than discussing why this diagnosis, why this diagnosis is not working. Why not? Why not benign? So it really improves the time, the quality of the time that they spend with patient, and that will improve patient safety. The patient can ask more intelligent questions because they have come with a knowledge that is direct from their pathologist, their biopsy, not from Dr. Google. So that makes an engaged patient, and that definitely improves care. What are the challenges? It is a new care model. It is not something they are familiar with, so they have to trust the pathologist, so it's even more important to develop that trust, even after five years. Here at Lowell General, there are a handful of doctors who regularly refer the patients to the pathology clinic, and there are many others that don't care, and they don't think they see the value of it, even after multiple papers that we've published about how important this is. Every single patient basically says knowledge is power. I really don't have to go to Google. My pathology report.ca in Canada, which provides pathology terminology explanations in 25 different languages, saw a 60% increase in the traffic after the Cures Act went into effect. So patients, if you don't explain it to them, they will go to places where they can find the answers. So why not be that person for your patient? Definitely for the clinical team, there is concerns about scope creep and reimbursement, or if this diagnosis has a certain dollar amount for DRG, and if that is the reimbursement amount, if I allow a pathologist to enter the room, would that decrease my payment? That is definitely another concern that the clinical team may have. So we have a couple of polling questions. So the first one is, if a pathology clinic is set up in your organization, how confident would you feel in your abilities to meet with the patients to address their concerns? We all went to residency and we all met with patients. We all were medical students. So many of the pathologists here probably perform fine needle aspirates as well. So you are meeting patients. Here's the answer. See, 48% are confident, 27% very confident. It's only 2% that's not at all confident. So I'm really grateful that you validated our hypothesis that this can happen. And for this question, you can choose up to three answers. What are your concerns that will prevent you from starting a pathology clinic? And the answers are coming in. So we'll just give it a few more seconds, and then we'll come up with the final. Time constraints is the 78% felt time constraints. The next highest is reimbursement issues, and then lack of support by leadership. And I've heard these questions. Of course, this is a self-selected group, so there is nobody who's not interested. That is reassuring. I definitely want to at least mitigate one concern about reimbursement. We have been successfully billing and getting reimbursed both from commercial as well as government insurances at Lowell General. So there are ways to make it happen. Lack of support by leadership, that is something that I really feel sorry about because this is ultimately about the patient and about patient safety. So hopefully we can get strategies in place to overcome that barrier. And with that, I think I hand off back to Dr. Myers. Thank you, Ligia. And we're going to close by addressing that issue of engaging institutional leadership. As Ligia says, this is hard to do without it, and so how do you get it? I'm a practicing surgical pathologist at the University of Michigan in Ann Arbor, where I also serve as vice chair for clinical affairs and quality, and I co-chair our patient and families advisory council with one of our patient and family advisors, Michelle Mitchell. I think it's important to understand the language of leadership when you're seeking endorsement of this or any other proposal. And the credibility of your message really begins with your track record of quality in the laboratory and the pathology services that you provide. If we don't have that as a foundation, it's hard for anything else to happen. I think conveying that message in partnership with a non-pathologist patient facing peer champion is an important part of a strategy for endorsement, meaning partnering with one of your clinical colleagues who can speak to the value of the laboratory work that you provide. And I think the proposals for pathology clinics have to speak to the interests of the C-suite or your executive leadership in language that they understand, rather than in the language that we may use with one another. Who they are depends on where you are. And when you think, well, who are we talking about when we talk about institutional leadership? Maybe it's your board of directors or board of trustees. That's unlikely to be your first stop, but it may be your ultimate destination. And the question is, who has to get you to that final stop? It may be one of your executive leaders in the, I call it the C-suite for lack of a better term. Maybe it's your CEO. Maybe it's your chief operating officer. Maybe it's your chief financial officer. Maybe it's your chief innovation officer. I don't know who it is in your organization. But knowing who that is is an important piece of information to make this work. If you're in an organization that has a chief patient experience officer or an office of patient experience, I think that's a really good place to start. And that's what we've done here at the University of Michigan. Next slide, please. And I think the message has to start first with why. Why should anyone be interested in a pathology clinic and expressed in language that they understand? And by why, I'll use the words of Simon Sinek, who talks about understanding your why is the thing that distinguishes you from other peer organizations that do the same stuff. And what you do and how you do it is likely the same from one place to the next. What distinguishes great from good is why you do it. Meaning, what's your purpose? What's your cause? What's your belief? And why does your organization, your department, your laboratory exist? And why should anyone care that it thrives? And to kind of convey that message in language that will be well received, you have to step into their shoes. And I think we sometimes feel like talking about margin is somehow out of line with our commitment to the interests of patients. And I would argue that if you can't speak to the margin in ways that are compelling, you're really talking about something that's unlikely to be sustainable. And when you think about the key strategic goals that frame the way executive leaders think about margin, they're pretty much the same from one place to the next. It's the language of patient satisfaction, or safety and quality, or access, or employee engagement, or innovation. I think patient satisfaction and safety and quality are key things on which to focus in engaging executive leaders in a conversation about implementing pathology clinics wherever it is that you are. What we do know from several publications, many of them by my co-faculty in this program, is that high levels of satisfaction accrue to those patients enrolled in pathology clinics, and it elevates their willingness to recommend the institution as well as pathology clinics themselves. If we take some of the narrative comments in some of these publications, patients who've had the experience say things like, this has been the most helpful meeting I've had since my diagnosis. This program is an excellent program for every hospital. Those are messages that matter to executive leaders. Next slide, please. And as Dr. Lapidus referenced in her talk, some evidence from a study from Israel pointed out that in their experience in oncology, there was a significant change in diagnosis or interpretation of biomarker studies for 5% of the patients enrolled in their clinics. Next slide, please. There's also reason to believe that pathology clinics can improve access and information shared by a pathologist engaged in a program in the Chicago area. By implementing pathology clinics, it will reduce appointment times for non-pathologists by half, meaning hour-long follow-up appointments will go to 30 minutes. Employee engagement is improved. We've seen some of the information and data that those who participate in pathology clinics feel like a return to purpose in ways that address engagement and burnout. And every C-suite occupant wants to brag about how innovative their organization is. And pathology clinics remain innovative today, although our hope is that someday they are standard practice. Next slide, please. So I think that the take-home messages are executives of healthcare organizations are moved less by passionate appeals based on personal conviction, which is often where we start, and more by data-driven decisions that articulate value and the language of the priorities that matter to them. And we believe that pathology clinics can address all of those things. I would say that any plan likely to gain their support in durable ways will require accountability for delivering on their expectations. And so I think you have to reflect on what will you measure to demonstrate to the organization the value of the work that you do in general, but in pathology clinics in particular. If I think about a five-minute or maybe a three-minute elevator pitch, should you find yourself in the company of the decision-makers in your organization, the message goes something like this. I want to talk to you about pathology clinics as a way to improve the patient experience and patient safety. And they do that by addressing communication gaps while improving the experience of providers inside and outside the organization. And you'll be interested to know that pathology clinics complement the reporting requirements of the 21st Century Cures Act. It's an innovative line of billable laboratory services with the potential to be a driver of patient choice. And we strongly suspect, what we're willing to measure and be held accountable, that it will improve access for non-pathology patient-facing providers. So that brings us to the conclusion of the planned portion of our program. We wanted to reserve time for questions, which can be typed in to the Q&A function that is being monitored by ASCP staff. We also received questions during the registration period for this course. And we can start with some of those to get your inquisitive juices flowing. The first that I think is a common one is, how does this apply to clinical pathology? Most of the information that has been generated about pathology clinics has tended to focus on surgical pathology or cytopathology or hematopathology and the sorts of information for which pathologists play a key role. But there are other models, including models looking at transplant populations, that have shown this can apply equally to clinical pathology. And I think the key first step is to identify the right patient audience, those likely to benefit from having the opportunity. And I would pause for a moment to ask if any of our other faculty have a response they would like to add to the question of how this applies to clinical pathology. Jeff, I can answer that. We've had at least three or four patients who have actually come to review their laboratory test results. So many of them have come with three-ring binders with their test results clipped in with dates and various other things. So this was my white blood cell count on this date, and then it went to this number. And the clinical laboratory and pathology laboratory, the distinction is quite blurry, especially when you think about hematology, which is my specialty. And they do ask a lot of questions trying to understand why a particular molecular test was done in a certain way. I must say that many of these patients have a particular personality. They're not coming to cry on your shoulders. They're really trying to understand what's going on in their body. They want a partner in their health care and wellness journey. Most cancer patients are now, cancer is considered a chronic condition. One in three people will have cancer at some point in their lifetime. So we are just being partners just like every other health care worker who are visible partners. We are now going to emerge from behind that. The machines and the paraffin and be visible partners in their journey to wellness. Thank you, Ligia. That's so helpful. I want to get to another question that was posed by a number of folks who entered questions during their registration process. And David, I think let's start with you in responding to this. The question was, some pathologists may have concerns, understandably, regarding speaking to patients directly and discussing bad news. Can you share some of your own thoughts and your personal experience in speaking with patients? Sure, absolutely. First of all, I'm no expert on this area, but I will say that it has been a humbling experience, number one. During training, during residency, we were taught that every case, every glass slide, there's a patient behind that. And that's how our approach should be when we look at a case. But I think it puts things in more perspective when you actually meet that person behind the glass slide. And I've certainly been humbled when I started doing this, because this is not something we encounter or even think about how to process. And so I think this is an experience that every pathologist should have. I think it helps to take that experience to daily work, because you're not going to meet every single patient that you diagnose, but the ones that you do will leave an impression on you as you look at your next case or the ones after that. So for me, if you just remain humble and really put yourself in their shoes, I think it really helps. It makes things easier. And also in terms of bad news, because of the Cures Act, patients have already seen their result. They already know. And most of them have time to process that. They're not looking for you to provide anything more than just some sometimes clarity about the report. But it just solidify in their mind that that is their diagnosis, and you're sure of it, and you're confident. And then they can accept that and move on to the next stage, which is treatment and management. So thank you, David. That's really helpful. And I think also speaks to the impact on pathologists as well as patients. Catherine, do you have anything to add based on your experience with prostate cancer patients? Yeah, I would say for me, I agree and echo what David says about it just being very humbling. You know, you get nervous going in talking about, you know, talking with this patient, you know, going through all their cancer with them. But I've also found that it has made me a really strong advocate for system change. So in our pilot, we had one patient who was misdiagnosed. The outside was a misdiagnosis, and it was misdiagnosis bilateral disease instead of unilateral disease. And because he was misdiagnosed as bilateral disease, it was because a slide was missing. There was some like, it was like a typo, like it was a very obvious misdiagnosis. He was sent down to U of M to look at, to have a re-review of his path. And on the re-review, it was known that he had this misdiagnosis. And it was noted, but it wasn't really like clearly communicated. The clinician wasn't called. The patient, it was kind of obscure, just that, you know, slide G is missing. And when I met with this patient, I went over slide by slide. This is why I'm confident that you only have disease in your right side quadrant. I've called your outside pathologist. They've issued a re-report. I've talked to your treating clinician. They are aware. Your treatment option is now, you're good to go on choosing active surveillance. And for me, like seeing that patient, I think about him, you know, very frequently and just has really pushed me to advocate for, you know, these things need to be well-communicated. We need to pick up the phone and call people. And I submitted a patient safety report for that. So for me, I guess it's sort of lit a fire inside me, as I feel like Dr. Joseph has said before, to really be a strong advocate for quality improvement and patient safety, as well as being a very humbling experience in meeting with the patient and really keeping me focused on why this work is important. Thank you, Dr. Lapidus. I really appreciate that. And Leija, one more that I'm going to direct to you, and then let's see what we've gotten from the online audience. But I think this is a question that commonly comes up and you mentioned it in your comments. Can you talk a little bit about billing for these services? Yes. So there is a way to bill for it. It is CPT code 99203. It is evaluation and management metric. It is based on time spent with the patient. And there is a very specific requirement of how you need to write a note in the patient's chart. It cannot be an addendum to the pathology report. It has to be a note in the patient's chart. And once you have all the required elements, which you can easily generate in a templated format, and as long as you tie it in with a patient's clinical diagnosis, we have consistently been able to get reimbursement from insurance companies. I'm also very transparent in view of the no surprises bill. I am very transparent with the patient. I say that I'm here to help you. I'm here to explain your diagnosis. And if there is any concerns about billing, I disclose what their out-of-pocket costs should be and how the whole reimbursement process works. So I spent two minutes with every patient and every single one of them said this is definitely the value that I get from this encounter is so much more than that amount. And I'm really appreciative of having an option to meet with the pathologist. So it's never been a reimbursement has not been an issue. That's not the primary goal anyway, but I've been pleasantly surprised that now that we've identified the correct CPT code, it's not been a concern. Thank you. That is really useful. I'm confident we will not get to all the questions that have been posed by the online audience. I want to assure you that we will respond to your questions after the close of the webinar and send responses via email. I'll leave the logistics of that to the ASCP staff, but we maybe have time to get to one or two before we close our webinar. Loti, what would you like us to respond to? Yes, I can combine two questions. One is, is ASCP considering putting a startup toolkit together for pathologists and lab administrators to help get this type of program implemented in our hospitals? And then the second part would be, and is this something that is only feasible in academic settings or can pathologists in the community incorporate this into their practice as well? Yeah, great questions. With reference to the first one, as a project launched by our patient champions program, we have a project team that is putting together a toolkit for exactly that purpose, to provide the information, the evidence that is helpful in not only conveying messaging to leaders, but knowing how to set up a clinic and it will include some of the operational details. So that is in the works. It is not yet completed, but it's ongoing. With reference to the second, this is absolutely not unique to academic medical centers. And in fact, there are models in community settings that are very successful. So this is not unique to academic centers. Would any of the other faculty like to weigh in on either of those questions? It's definitely possible. I am in a community hospital and we championed it. So I just want to put a plug in for diversity, equity and inclusion. Often the patients, please don't assume that only well-educated, super smart people will come. I've had, I work in a low income neighborhood and I've had so many patients, some of whom never speak, did not speak one word of English who came. And it definitely is an opportunity to advocate for patients who may not have all of the access or the tools to advocate for themselves. So please consider starting a program like this. I have many stories to tell. I don't have the time, but I do want to request you, especially from a patient safety perspective, if you as a pathologist can advocate for your patient, that will definitely be something that will help you sleep well at night. Thank you, Ligia. And as you've read in the chat, we are at time, but we will respond to your questions via email. There's also information in the chat about claiming your CMA and CMLE. Thank you for attending. Please stay on to complete a 30 second survey that will appear as the webinar ends. Your input will inform future educational initiatives like this one. Thank you so much for your time and attention.

pathology clinics

patient outcomes

healthcare system

ASCP

CME credits

health communication

patient safety

community hospital

Q&A segment