Background
Precision oncology has made nextgeneration sequencing a part of daily practice. With indications for comprehensive genomic profiling expanding, there will be further attendant increases in pathology workload. The pathology workforce shortage is one of the greatest barriers to precision oncology and an understanding of pathology workload associated with POMTs is necessary to address this barrier and plan for the future.
Methods
In this presentation we aim to provide, or at least contribute to, such an understanding through a review of the process at our site and measurement of associated time for each step. We began by conceptualizing the process in order to develop a process map. We then measured the average time for each step. We reviewed our anatomic pathology records for 2021 to determine the number of POMTs then calculated cumulative time investment on POMTs. A theoretical number of relative value units (RVUs) for POMTs was calculated using the new pathology clinical consultation CPT codes (80503-80506), and this was compared to the total anatomic pathology RVUs actually generated in 2021.
Results
Of the 7007 anatomic pathology cases, there were 706 cancers and 446 that required POMTs. At our institution, it was determined that on average 1.5 hours – about 50 minutes of pathologist time and 40 minutes of technician time – was needed to complete the tasks necessary to fulfillment of requests for POMTs. For all of 2021, 669 hours of pathology staff time were dedicated to POMTs. With the ability to bill for this time, we would have generated 13.2% (1142/8640) more anatomic pathology RVUs.
Conculsions
In light of this, we have implemented measures to bill for these formerly uncaptured activities such that our documented productivity more accurately reflects our workload. This will hopefully result in more appropriate resource allocation such that the barrier created by pathology understaffing is recast as a buttress in support of precision oncology practice.
