Laboratory administration / management of pathology practices
Patient related
Patient centered pathology (PCP)


Topic Completed: 25 March 2019

Revised: 25 March 2019

Copyright: 2018-2019, PathologyOutlines.com, Inc.

PubMed Search: Patient centered pathology[TI]

Rachel Jug, M.B.B.Ch.
Adam L. Booth, M.D.
Page views in 2018: 73
Page views in 2019 to date: 170
Cite this page: Jug R, Booth AL, Cummings TJ, Gardner JM, Joseph L. Patient centered pathology (PCP). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/managementlabpcp.html. Accessed August 21st, 2019.
Essential features
  • Consultation service in which pathologist meets with patient to explain diagnosis and pathology report
  • Does not include discussions regarding therapeutic treatment options or decisions
Relevance
  • Up to 30% of surgeons misunderstand their patients' pathology reports (Arch Pathol Lab Med 2000;124:1040)
  • Patients invited to view their doctors' visit notes through fully transparent electronic medical records reported improved understanding of health information, enhanced relationships with health care providers and improved self care (therapy compliance and empowerment) (BMJ Open 2016;6:e010034)
  • Personalized, focused clinical encounters with radiologists improve patient satisfaction with the health care system (ACR: Virtually Connected [Accessed 10 January 2019])
  • Pathologist led consultations could enhance accurate communication of pathology reports and results to patients while offloading this task from clinical colleagues
  • Anecdotal evidence suggests patient centered pathology consultations have the potential to increase treatment adherence (Arch Pathol Lab Med 2018 Nov 6 [Epub ahead of print])
  • Looking at tumor cells or diseased tissue can enable patients wishing to employ guided imagery in their treatment strategy
    • Randomized controlled trials in cohorts of breast and prostate cancer patients revealed beneficial immunomodulatory effects can arise from relaxation training and guided imagery, including upregulation of natural killer cells and lymphokine activated killer cells (Breast 2009;18:17, Psychosom Med 2011;73:218)
  • Many patients do not understand the vital role pathologists play in their health care
Logistics
  • Establishment and patient recruitment
    • Interest and feasibility for a patient pathology consult program needs to be evaluated by hospital administration, risk management, marketing and practice managers
      • Gaining support from pathologists and clinical colleagues is critical for long term success
      • Current consultation services have distributed flyers promoting their program institutionally in the clinic, hospital and cancer center
      • Posting information about the program on the institution website has also been well received
      • In addition, the program can be promoted at venues, such as tumor board, cancer committee and medical executive committee meetings
    • The patient, oncologist or surgeon can initiate the consultation process by contacting the pathology department, via an invitation inserted by a pathologist in their pathology report or through text messages in the electronic medical record, allowing an appointment to be made like any other doctor's visit
      • Example of text message into electronic medical record from Thomas J. Cummings, M.D., at Duke University Medical Center: "Pathologists are physicians who are part of your health care team and who specialize in diagnosing disease by examining your cells and / or tissues under a microscope. If you would like to see your pathology under the microscope, please send me a message in Duke MyChart and I will arrange this with you."

  • Preconsultation
    • Staff uses a standard script to schedule the patient's appointment, with a preference given to times closest to existing appointments
      • Preparation time is ~15 minutes, which includes gathering slides, reports and consent forms
      • Additional care is taken to coordinate a HIPPA compliant space for the consult to take place (i.e. pathologist's office or conference room) that contains a computer or multiheaded microscope
      • Pathologist spends ~10 minutes for slide and chart review prior to the appointment
    • When the patient arrives, routine clinic check in procedures are followed, including confirmation of the patient's identity and consent form signatures
      • Importantly, the slides and pathology report are considered the patient's medical record
      • If the patient is accompanied by a family member, they are required to provide identification and the patient is required to provide consent for the family member to be in the room

  • During consultation
    • Agenda for the appointment is set by inquiring if the patient has any specific questions and establishing the patient's level of understanding of the disease
    • Pathologist then shows the patient their name on the slide and briefly describes the tissue processing procedure, including slide preparation
    • Patient is shown normal tissue to identify significant structures using basic terminology, with care to avoid unnecessary medical jargon; for example, "The nucleus is the brain and the cytoplasm is the body of the cell"
      • Once a foundation of normal is established, the patient is shown diseased tissue, which often leads to additional questions
      • Pathologist defers specific questions regarding treatment to the referring physician
    • Appointment lasts ~30 minutes
      • Patient is free to take notes; however, no audio or video recording is permitted
      • At the conclusion, the patient is offered a copy of their pathology report and asked if they have any further questions
      • Following this, the patient is escorted to the hospital exit
      • Signed consent forms are filed in accordance with hospital protocol
    • Pathologist may give the patient a business card and hospital administration contact information, should the patient choose to write a letter regarding the experience

  • Postconsultation
    • Issue addendum to pathology report or clinical note documenting the visit stating that slides were reviewed with the patient, including date / time / duration and an email is sent to the referring clinician
    • Patient pathologist consultation service meets the criteria for time based evaluation and management (E / M) services when counseling dominates the encounter
    • Evaluation and management CPT codes such as 99203 (~$105 per Medicare 2019 billing) may be applied pending institutional approval (Clin Colon Rectal Surg 2005;18:279)
    • Counseling in this setting would be discussion of diagnostic results with patient and patient / family education
Specific program examples
Board review question #1
When considering whether to implement patient centered pathology in your practice, useful tools for surveying customer (patient, clinician and hospital) needs when marketing your laboratory / department's services include

  1. Contacting competitors to see what they are doing
  2. Contacting personnel of competitors to see how they are doing it
  3. Reading laboratory marketing textbooks and journal articles
  4. Reviewing market research documents that are commercially available
  5. Sending a questionnaire to active or potential customers (patients, clinicians and hospital administrative staff)
Board review answer #1
E. Sending a questionnaire to active or potential customers (patients, clinicians and hospital administrative staff)

Comment Here
Board review question #2
Your colleagues are concerned they will not be reimbursed for time spent with patients. What do you tell them?

  1. CPT coding for consultation does not apply to pathologists
  2. Evaluation and management code exists and pathologists can be reimbursed through a time based qualifier
  3. Evaluation and management code exists but requires consultants to counsel on therapeutic options
  4. They are correct and cannot be reimbursed
Board review answer #2
B. Evaluation and management code exists and pathologists can be reimbursed through a time based qualifier

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