Wednesday, December 20, 2023

CAP TODAY: Continues Rising Coverage of Digital Pathology

CAP TODAY, which is open access, has published a series of detailed articles on digital pathology and AI and lab medicine in 2024.  They're closing out the year with an interview panel on Digital Pathology.

See a Linked In entry point by Katie Maloney here, and the CAP TODAY article here.  (Note that CAP TODAY splits the article in 2 parts, both of which are accessed by the "create pdf" button.)

 The interview is led by publisher Bob McGonnagle, talking with Katie Gillette of Decibio, M.E. de Baca (VP, Sysmex), Michael Quick (Dig Pathol Assoc, DPA), Lisa-Jean Clifford (Gestalt Dx)and Eric Glassy (Affil Pathol Med Group).   

AI Corner

I asked ChatGPT4 what it saw as ten top takeaways from the article.

ChatGPT: "The document, "2023 CAP TODAY 1201 Decibio Gillette Dig Pathology," contains a series of expert interviews discussing the interplay of digital pathology and AI in healthcare. The key takeaways from these interviews are:

  1. Digital Pathology Adoption: Adoption varies widely across institutions, from minimal use to fully digitized workflows.
  2. Role of Academic Centers: Leading centers are keen on adopting state-of-the-art digital pathology tools and contributing to their development.
  3. Perceptions of Digital Pathology: There's a disparity in how digital pathology is perceived across different pathology meetings and associations.
  4. Drivers of Adoption: Early drivers included needs for tumor board, education, and research. Now, pathologist shortages and remote sign-out capabilities are key factors.
  5. Pathologist's Job Security: Concerns about job loss due to digital pathology and AI are diminishing as the field recognizes AI's role in augmenting, not replacing, pathologists.
  6. Impact on Workforce: Similar to the evolution in cytology, digital pathology and AI are expected to transform, not diminish, the roles of pathologists and cytotechnologists.
  7. Budgeting and Financial Constraints: Budgeting remains a challenge, especially in determining the financial equation for adopting digital pathology.
  8. Regulatory and Reimbursement Landscape: The environment is evolving, with new CPT codes and an increasing focus on data interoperability and patient safety.
  9. Patient Involvement and AI: The role of patients in driving technology adoption and the necessity of pathologist involvement in AI development are highlighted.
  10. Future Trends and Concerns: Anticipating future needs and challenges, such as regulatory approvals and the impact of AI on clinical practice, is crucial.


What are the five main points made about Reimbursement and Dig Path?

ChatGPT: The five main points made about the reimbursement topic in the "2023 CAP TODAY 1201 Decibio Gillette Dig Pathology" interviews are:

  1. Implementation of Category Three CPT Codes: The CAP and American Medical Association have added over 30 category three CPT codes for digital pathology, and they are now working on AI codes. These codes are essential for CMS (Centers for Medicare & Medicaid Services) to gather data to inform the need for reimbursement for new services​​.
  2. Challenges in Budgeting: Laboratories struggle with budgeting for digital pathology due to the complexity of financial equations. Large labs can leverage economies of scale, while smaller hospitals find value in remote consultations and addressing pathologist shortages. Academic centers focus more on research opportunities than the direct financial implications, as direct reimbursement is not yet fully established​​.
  3. Need for Effective Use of Current Billing Codes: There's an emphasis on the importance of properly utilizing existing Category Three codes for digital pathology. This ensures that their intended purpose for tracking and reimbursement is realized. Without effective use, these efforts might not be fully recognized or compensated​​.
  4. Shift in Attitude Towards Technology Adoption: Initially, proposals for lab automation and digital pathology were rejected due to cost concerns and lack of direct reimbursement. However, as the demand and workload increased, the same institutions that initially rejected these technologies sought to implement them, recognizing their value in improving efficiency and managing increasing volumes​​.
  5. Reimbursement as a Key Factor for Patient Involvement: For patients to be involved in digital pathology, three conditions need to be met: physician access to information, availability of technology in the lab, and insurance or payer reimbursement. The success of direct-to-consumer approaches in areas where these conditions are met indicates the significance of reimbursement in advancing digital pathology​​.

These points highlight the complexity and importance of the reimbursement landscape in the adoption and implementation of digital pathology.


BQ: There are a couple problems with the Category III codes.  (1) They are structured as add-on (+) codes, so they must be on the same claim same day as the original surg path (or staining) codes.  (2) A huge proportion of relevant specimens originate in hospital outpatient (or inpatient) environments, where CMS has made the codes nonpayable (bundled or packaged).


BQ: See also a 2023 article, open access, by Lennerz et al, on diagnostic quality and a framework for adding AI-ML to it.  


click to enlarge


BQ: On a humorous note, I recently asked ChatGPT to write a health policy news article about a digital pathology conference that will occur in the future, in March 2024 - here.