OUTREACH by UNM Pathology

---and--- TriCore Reference

LabsPresented By:

Brian Hjelle, MD, FCAP

Medical Director, Genetics and Cytometry Laboratory

TriCore Reference Laboratories

Int. Chairman, UNM Pathology

OUTREACH

•Residents/Fellows

•TriCore

•Hemepath

•OMI

OUTREACHPathology Clinical Fellowships

Hematopathology

Forensic Pathology

Cytopath

Molecular Genetic Pathology

Surgpath

Transfusion Medicine

Research Fellows

Usually about 6

Grad Students

Usually 10-12

OUTREACH –resident alumni

UNM Department of Pathology

•58 faculty members, including

27 MDs

21 PhDs

5 MD-PhDs

5 Others

•An MLS (med lab sciences) program

Braggin’ Rights•NCI: Comprehensive Cancer Center

•Roadmap Initiative/Flow Cytometry

•SEER site

•33rd highest NIH-funding for Path Depts

•T32 Training grant

•Office of Medical Investigator

•Top-tier residency w/broad training

•HTR, microscopy, FISH

•TriCore

History of TriCore

• Created in 1998

• University of New Mexico Hospital Health Sciences Center

• Presbyterian Healthcare Services

• The Reference Laboratory (TRL)

• St. Vincent’s Medical Center (Santa Fe)

University of New Mexico Hospital Health Sciences Center

• Affiliated with only medical school in New Mexico• Pathologists university employed and faculty at

UNM SOM• Diagnostic services• Research • Teaching – medical students and residents;

medical technicians• Cancer Center• Level I Trauma Center • Transplant Center

TriCore Structure

• Independent not-for-profit entity• Sponsors (Presbyterian, University

Hospital) comprise Board of Directors• Lab staff to be employed by TriCore• Non-urgent testing consolidated at

Core lab• Histology and cytology consolidated at

Core lab• Two pathologist groups to be

contracted for medical directorship, technical oversight and anatomic path

• TriCore-hired CEO and CMO

New Building

• Consolidated Core lab opened January 2004

• 1,000 TriCore employees at Core lab, in sponsor hospital labs, branch labs, patient draw sites

• Service in New Mexico, El Paso, and southern Colorado

• National consult service in hemepath, flow cytometry, cytogenetics

HISTORY

TriCore ($MM) % YOY Grwth

1998 $29,659,294

1999 $42,984,363

2000 $45,481,206 5.8%

2001 $52,914,181 16.3%

2002 $58,980,552 11.5%

2003 $66,144,265 12.1%

2004 $71,598,294 8.2%

2005 $77,182,389 7.8%

2006 $87,270,831 13.1%

2007* $95,009,747 8.9%

* Jan - Jul Annualized

* Jan - Jul Annualized

NET REVENUE 1998 - 2007

TriCore ($MM)

$0

$50,000,000

$100,000,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007*

TriCore ($MM)

Hemepath and Related Services

HISTORY

TOTAL

1998 3,339,192

1999 3,298,736

2000 3,257,094

2001 3,618,912

2002 3,970,069

2003 4,692,155

2004 5,238,953

2005 5,681,886

2006 5,999,368

2007* 6,385,776

*Jan-Jul Annualized

TEST VOLUME 1998 - 2007

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007*

Flow Cytometry Case Volume 2003-2006

0

1000

2000

3000

4000

5000

6000

7000

8000

2003 2004 2005 2006

# o

f fl

ow

ca

se

s

0

500

1000

1500

2000

2500

3000

3500

4000

# o

f C

ases

200520042003200220012000 2006 2007*

Consult Case Volume 2000-2007 (projected)

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

2000 2001 2002 2003 2004 2005 2006 2007*

# o

f cy

tog

enet

ics

test

s

Total Cytogenetics Tests 2000-2007 (projected)

The Players• M Kathy Foucar, MD

– Director of HemePath and Vice Chair for Clinical Affairs

• John Hozier, PhD– Pioneering cytogenetics/FISH clinical investigator

• Kaari Reichard, MD– Helped initiate FISH service

• Mohammad Vasef, MD– Seasoned Molecular Onc, started MolPath fellowship

• Carla Wilson, MD, PhD– Established leukemia “template” system for efficiency

• Qian Zhang, MD, PhD• Kristin Hunt, MD

Office of the Medical Investigator (OMI)

New Mexico Office of the Medical Investigator

• Centralized, statewide, university-based

• 8 forensic pathologists

• 10 central and 130 field investigators

• Administers University Hospital autopsy service

• Trains fellows & pathology residents

New MexicoOffice of the Medical

Investigator

• Authorized by legislated state statute• Investigates violent, sudden, suspicious,

unexplained & unnatural deaths• Determines: condition of body

cause/manner of death• Investigates ~5100 of 14000 deaths/year• Performs ~2100 autopsies/year (>95% of NM

autopsies)

New MexicoOffice of the Medical

Investigator

• Comprehensive autopsy report & computerized database

• Retrospective analyses/prospective coding for epidemiology & research

• Organization: statewide population-based surveillance

• UNM tie: consultation/collaboration, enhanced diagnostic accuracy, research

Participation in National Surveillance Systems

• National Violent Death Reporting System– Conjunction with crime lab, vital records, state

health dept., & police agencies– Surveillance & granular epidemiology for all

homicides, suicides & unintentional firearm fatalities– CDC funded

• Drug Abuse Warning Network– Tracks all substance abuse (licit and illicit) deaths– SAMHSA funded

Anthrax

Med-X Surveillance Model for Bioterrorism & ID Mortality

• Developed model for Medical Examiner ID surveillance with CDC funding

• Uses antemortem symptoms to capture potential cases

• Pathology-based syndromic reporting standards• Organism & toxin specific diagnoses

– SLD NM Dept of Health– CDC - ID Pathology Activity -

enhanced diagnostic capacity

• Now implemented: NH, OR, MN, GANolte KB, et al: Hum Pathol, 38:718-725, 2007

Some Summary Comments• We have pioneered in regional laboratory

models• We have a model ME office• We have strong leadership in forensic path,

hemepath, cancer biology• We have steady growth in hemepath, surgpath,

molecular, cytogenetics, FISH, many other areas

• Good old fashioned leadership and outreach..