OUTREACH by
UNM Pathology
---and--TriCore Reference
Labs
Presented By:
Brian Hjelle, MD, FCAP
Medical Director, Genetics and
Cytometry Laboratory
TriCore Reference Laboratories
Int. Chairman, UNM Pathology
OUTREACH
•Residents/Fellows
•TriCore
•Hemepath
•OMI
OUTREACH
Pathology 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
NET REVENUE 1998 - 2007
$100,000,000TriCore ($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
$50,000,000
2005
$77,182,389
8.2%
TriCore ($MM)
7.8%
2006
$87,270,831
13.1%
2007*
$95,009,747
8.9%
* Jan - Jul Annualized
$0
1998
1999
2000
2001
2002
2003
TriCore ($MM)
* Jan - Jul Annualized
2004
2005
2006
2007*
Hemepath and Related
Services
HISTORY
TEST VOLUME 1998 - 2007
7,000,000
1998
TOTAL
3,339,192
1999
6,000,000
2000
3,298,736
2001
5,000,000
2002
3,618,912
2003
4,000,000
2004
4,692,155
2005
3,000,000
2006
2007*
2,000,000
5,681,886
3,257,094
3,970,069
5,238,953
5,999,368
6,385,776
1,000,000
0
1998
*Jan-Jul Annualized
1999
2000
2001
2002
2003
2004
2005
2006
2007*
Flow Cytometry Case Volume 2003-2006
8000
7000
# of flow cases
6000
5000
4000
3000
2000
1000
0
2003
2004
2005
2006
Consult Case Volume 2000-2007 (projected)
4000
3500
3000
# of Cases
2500
2000
1500
1000
500
0
2000
2001
2002
2003
2004
2005
2006
2007*
Total Cytogenetics Tests 2000-2007 (projected)
5000
4500
4000
# of cytogenetics tests
3500
3000
2500
2000
1500
1000
500
0
2000
2001
2002
2003
2004
2005
2006
2007*
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 Mexico
Office 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 Mexico
Office of the Medical Investigator
• Comprehensive autopsy report &
computerized database
• Retrospective analyses/prospective
coding for epidemiology & research
• Organization: statewide populationbased 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
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, GA
Nolte KB, et al: Hum Pathol, 38:718-725, 2007
Anthrax
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..