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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..