What Is the Best Indicator to Determine Anatomic Pathology Workload?

Maung, Raymond

doi:10.1309/23nygnb2hfnnw4v8

Cited by 22 publications

(13 citation statements)

References 15 publications

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“…The L4E method is based on data collected from two independent surveys of Canadian pathology departments 10. Using existing complexity level scoring systems for surgical pathology, it was proposed that one unit of work be termed a “level 4 equivalent” (L4E), and other surgical pathology complexity levels and activities (eg, autopsies, cytology, intra-operative consultations) be weighted in comparison to level 4, which was assigned a complexity score of 1.00 units.…”

Section: Discussionmentioning

confidence: 99%

“…All 2891 pathology reports were then retrospectively reviewed and assigned workload scores using the 2005 RCPath dermatopathology matrix8 for each case (table 1), and using level 4 equivalents (L4E), as described by Maung10 for each specimen (table 2). …”

Section: Methodsmentioning

confidence: 99%

“…subspecialisation, ancillary testing, requirement for minimum data sets and synoptic reporting), measurement of case and/or specimen numbers alone may not accurately reflect pathologist workload 4 5. Therefore, more recent approaches to workload measurement typically employ a complexity-weighted scoring system 6 – 10…”

mentioning

confidence: 99%

“…In this study, we assessed the workload of three subspecialty dermatopathologists using a time–motion study and then applied both 2005 RCPath workload scores8 and complexity levels10 to each case/specimen reported. We compared the achieved hourly workload to RCPath recommendations, and tested the hypothesis that RCPath histopathology workload guidelines underestimate the workload achievable by an experienced, subspecialty dermatopathologist.…”

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confidence: 99%

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Workload measurement in subspecialty dermatopathology

et al. 2008

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The RCPath histopathology workload guidelines underestimate the workload achievable by an experienced dermatopathologist, and thus are not directly applicable to subspecialty dermatopathology practice. Hourly work rates 3-4 times that recommended by the RCPath workload matrix are routinely achievable, but extrapolation to yearly workload estimates requires detailed knowledge of practice pattern and time required for non-clinical duties such as teaching, research and administration.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Workload measurement in subspecialty dermatopathology

et al. 2008

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“…2,3 In Canada, a system called L4E (level 4 equivalent) has been described. 4 In this system, there are six activity levels, with level 4 representing "small specimens for diagnosis, including all endoscopic biopsy specimens and small organs removed for benign conditions." 4 These specimens are weighted as having a 1.0 value; levels 1 to 3 are weighted lower and levels 5 and 6 are weighted higher.…”

Section: Alternativesmentioning

confidence: 99%

Physician Productivity

Storfa

Wilson

2015

American Journal of Clinical Pathology

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In the not-too-distant past, most physicians were paid by one of two ways: a fixed salary or by collecting fee-forservice charges. The former payment system was typical for physicians employed at academic health centers, larger integrated health care systems, commercial laboratories, and public hospitals, and for many hospital-based physicians. The latter payment system was typical of private practice groups, independent laboratories, and some hospital-based physicians. As the structure of health care reimbursement changed from 1980 to 2000, many physicians began changing to systems characterized by a guaranteed base salary with one or more variable salary components such as incentive, supplement, or bonus payments. Because the variable salary components were often used as incentives to modify physician behavior (eg, utilization of health care resources) or to increase productivity, there arose a need for the development and implementation of systems to track and analyze behaviors and productivity.Because of the structure of reimbursement systems at that time, this approach was primarily aligned with billable charges. The most widely used of these productivity measurements was the relative value unit (RVU) system, which attempted to assign units of productivity based on "relative values" of specific activities. Early on, this system made intuitive sense: most reimbursement during that era was based on fee-for-service systems, so increased productivity was directly related to increased charges and payments. Not surprisingly, important flaws in these systems quickly became evident: the incentive was to do as many procedures and perform as many tests as possible to maximize reimbursement, increasing utilization was a constant risk (even for unnecessary procedures and tests), and development of standardized approaches to account for nonbillable activities lagged behind. Moreover, because there was no incentive for physicians to do things that did not generate charges, not surprisingly these activities received less emphasis.As time passed, a number of changes in health care delivery occurred, all of which have the net outcome of driving utilization of tests and services downward. These included the emergence of managed care programs, growing awareness that keeping populations healthy through preventive measures resulted in decreased costs, adoption of best models of health care delivery around the world, and the growing use of evidence-based medicine. Through time, as these factors have matured and become widely adopted throughout health care, it has become apparent that the traditional approach of assessing productivity linked to billable services is fundamentally at variance with the concept of decreased utilization as part of contemporary health care.For pathology, as in many other medical specialties, the recent past has been characterized by important changes in practice. In many academic medical centers, large private practices, and reference laboratories, services increasingly are aligned with the need for sub...

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One procedure—one report: the Re-Imagine Cytopathology Task Force position paper on small tissue biopsy triage in anatomic pathology

Balassanian

Alperstein

et al. 2023

Journal of the American Society of Cytopathology

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What Is the Best Indicator to Determine Anatomic Pathology Workload?

Cited by 22 publications

References 15 publications

Workload measurement in subspecialty dermatopathology

Workload measurement in subspecialty dermatopathology

Physician Productivity

One procedure—one report: the Re-Imagine Cytopathology Task Force position paper on small tissue biopsy triage in anatomic pathology

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