John O'Sullivan, Managing Director, Biomnis Ireland 'Public -private partnerships in diagnostic pathology'

1. Biomnis
National Healthcare Conference
22nd March 2012
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Réunion mensuelle DSC - BIOMNIS

2. Biomnis HQ Lyon
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www.biomnis.ie

3. What is Diagnostic Pathology (Laboratory Medicine)?
Allergy Human Genetics
Antenatal diagnostics Immunochemistry
Autoimmunity Infectious serology
Clinical trials Microbiology
Cytogenetics Oncology
Endocrinology Reproductive Biology
Serological Markers
Genetic Fingerprinting (Trisomy 21)
Haematology Specialised Biochemistry
Haemostasis Toxicology - Drug Levels
Histopathology Virology
Biomnis Test Menu > 2,500 parameters
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4. Trends in Global Diagnostic Pathology services
ü.
More than 70% of diagnostic
decisions based on a lab test
ü.
Lab test results are the major
contributor to patient records
ü.
65 year olds account for x6-9
more lab tests per head
ü.
It is estimated that pathology
testing in US will increase
c.90% by 2017
In countries with ageing populations, there will be considerable
pressure on Diagnostic Lab services due to ageing populations
and increasing reliance on lab diagnostics
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5. Global Drivers of Change in Laboratory Medicine
•.
TECHNOLOGY
•.
Consolidation of IVD industry
•.
More complex tests : Molecular Diagnostics/ POCT /”Lab on a chip”/Microchip
sensor implants
•.
Personalised medicine
•.
ICT :UHI
•.
DEMOGRAPHICS - Ageing populations and lab testing
•.
STANDARDISATION & REGULATION - ISO 15189
•.
CHRONIC DISEASE STATES - Diabetes /Obesity
•.
GLOBAL SKILL SHORTAGES - Pathologists and Medical Scientists
•.
OUTSOURCING - JV’S, MSC’s, PPP’s
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6. Outsourcing on the Agenda?
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7. Independent Pathology Providers (% Total Market)
U.S
Germany
France
Canada
30%-60 % or more
Australia Independent
New Zealand
Spain Lab Sector involvement in
Brazil Public sector contracts
Ireland & UK = < 5%
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8. International Cost Comparison
Table 1.: International Clinical Pathology Costs per Capita and Per Test.
COUNTRY POPULATION TESTS/YEAR PATHOLOGY TOTAL COST/TEST
(m) (m) SPEND PER ANNUAL (€)
CAPITA (€) PATHOLOGY
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SPEND (€)
Ireland 4.4 77 107 469m 6.09
USA 300 4,500 80 24,000m 5.33
England 51 700 67 3,400m 4.86
Australia 23 N/A 39 900m < €3*
NZ €2.60
1.4 N/A 27 N/A
(Auckland)
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9. International Cost Comparison
COUNTRY HEALTH SPEND PER PATHOLOGY SPEND % (PATH/HEALTH)
CAPITA (€)6 PER CAPITA (€)
Ireland 2,536 107 4.2
France 3,038 92 3.0
England 2,216 67 3.0
Germany 2,566 67 2.6
Australia 2,486 39 1.6
USA 5,400 80 1.5
New Zealand 1,817 27 1.5
(from World Health Statistics 2009 :W.H.O.)
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10. Pathology Services in French Healthcare Market
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Long history of outsourced provision of healthcare services in France
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Private market c.€4.4bn , Public c. €2.8bn (2009)
•.
Reimbursement paid for by Government
• Cost borne by the social security system for biomedical analyses depends essentially on
the rate which the State decides to pay for each analysis, that rate being the same for all
laboratories, irrespective of the actual cost of providing that service
•.
Current transformation process of French diagnostic market
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3,500 “Laboratoire de Ville” consolidating via acquisition
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Mandatory ISO 15189 accreditation for biomedical laboratories by 31st October
2016
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Recent ECJ ruling (Commission v France)
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11. Diagnostic Pathology in UK NHS
•.
There have been significant developments in pathology in the UK in the last 36
months. OJEU tenders have been issued for private sector support to a number of
NHS Trusts and other public sector bodies .
Major Public/Private Partnerships
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Serco /Guys and St. Thomas = GSTS
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GSTS /Kings College Hospital
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Labco /Sodexo = IPP
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Biomnis /Assura –Stockton
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The UK is clearly now seeking to increase the role of independent providers in
pathology to reduce the burden on public sector services. Tables 1 and 2 suggest
that per capita pathology costs are lower in countries that have a significant
independent sector involvement in pathology service provision.
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12. Current Status in Ireland
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Provision of laboratory medicine mainly via public system
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Irish population of 4.4 million. 77 million clinical pathology tests are performed
annually at a cost of €469 million. (2008)
•.
Biomnis Ireland c. 2m tests per year (2011)
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HSE Service plan 2012
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€750m in cuts
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No explicit mention of laboratory medicine
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Regional (x4) service plans - 3-8 % cuts in current spending
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Lab medicine services under continuous pressure to deliver cost savings
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Dept. of Public Expenditure & Reform - Radical thinking on outsourcing
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Laboratory modernisation /Teamwork report (2007)
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Internal reconfiguration preferred after public and private market soundings exercise
carried out in late 2010 12
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13. Diagnostic Pathology in Ireland - Modernisation
The HSE’s Clinical Strategy & Programmes
Directorate (DSCP) has established a
National Clinical Programme in Pathology
with the initial objective of implementing a
National Pathology Network.
10 Principles
q.
Accreditation & Quality
q.
Clinical input
q.
Networking
q.
Demand Management
q.
ICT Connectivity
q.
Work Practice Reform
q.
Core Lab Automation
q.
Better Phlebotomy and Sample Transport
q.
Improved Cost/Workload Model
q.
Regulated POCT
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14. Diagnostic Pathology in Ireland - Modernisation
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The NPN will re-organise lab services at regional level into Clinically responsive
Co-operative Hubs doing hospital and GP work
•.
Hubs will receive Cold Work from a Regional Network of Spokes with Hot Labs or
POCT as required
•.
Adoption of the Hub-and-Spoke model also brings more tests in scope1 with higher
savings potential.
•.
Changes in staffing levels, skill mix and work practices will also apply throughout
the whole system
•.
Regional Network Governance will be drawn from participating Hubs and Spokes,
and will be under central direction of the national network
•.
Clinical cover, good logistics, and accreditation will be easier in this model
•.
Clinical, Quality, and Efficiency Targets will have to be met
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15. Outsourcing Germany - Wisplinghoff, Koln
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Serves a population of 9 million in the Köln area, in competition with 5
other private labs.
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GP work (Private insurance) and the hospital pathology for about 23
hospitals in the area. Mostly public and voluntary hospitals.
•.
The hospitals have no labs, only POCT. All work is sent to LK, including blood
bank.
•.
Contracts generally for 5 years or more.
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Change in model to central outsourced lab 5-6 years ago-Hospitals
running out of money & decision to outsource non-frontline services e.g.
cleaning, catering and eventually pathology .
•.
A lot of resistance from hospital consultants initially.
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Early retirement incentive scheme for technical staff to avail of and also TUPE in
certain instances.
•.
Reckoned that the centralisation of laboratory services yielded saving of over
60%
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16. Outsourcing Germany – Wisplinghoff, Koln
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Payments from insurers (private work) and public hospitals (fees paid on
case basis-negotiated directly with hospital)
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24 hour working day, 7 days a week. Shift system.
•.
There are two core labs: one which runs the GP work and one which runs
the hospital work
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Processes 16/17 million clinical chemistry (chem and endo) tests per year.
•.
TAT (guaranteed in SLAs): < 1 hour for STAT, <2 hour for routine (TAT
from arrival of sample in lab reception).
Germany does not have a Unique Patient Identifier
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17. Outsourcing New Zealand
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New Zealand has a population of 4.4 million, with 1.4 million (32%) living
in the Auckland Region. This region consists of urban, suburban and semi-
rural communities, and covers an area of 600 km2.
•.
All GP work outsourcing to independent sector has been in operation in
New Zealand for over 40 years
•.
Labtests was awarded the procurement contract for provision of all
primary care pathology services to the Auckland Region in 2006. This
contract was fixed at NZ$560 million (€310 million) over 8 years i.e. €38
million p.a. for 1.4 million people.
•.
Labtests manages the entire pre-analytical, analytical, referral and post-
analytical processes for all primary care samples (all tests) from the
Auckland region.
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18. Outsourcing Auckland New Zealand
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There is one central laboratory in Auckland : fully automated, 10, 000
patient samples per day ( c. 14,000,000 tests per annum).
•.
56 sample collection centres in the Auckland region . Home visits are also
arranged for sample collection from patients too ill to travel.
•.
Labtests has its own dedicated courier service, with real time GPS
tracking, operating on a hub-and-spoke model.
•.
Laboratory monitors key performance indicators and issues monthly
reports (http://www.labtests.co.nz/News-and-Updates/KPI-Results.aspx).
•.
The cost per test is about €2.60. This cost includes sample collection,
transport and all logistics and result delivery systems.
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19. Conclusion
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Global model of diagnostic pathology delivery is very much a mix of public
/private models
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Managed Service contracts
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PPP /JV
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Full outsource
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Ireland and UK historically out of kilter
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UK has undergone radical change in procurement of pathology services in last
3 years
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Ireland currently moving toward an internal reconfiguration /modernisation
of pathology services but ,
•.
Ageing population
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Increase in chronic disease states
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Rationalisation of lab services /labour & skill shortages
Will mean that public/private outsourcing initiatives need to be considered
………………….. “going forward…………”
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20. …..not going backwards!”
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21. Go raibh mile maith agaibh!
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