NEW YORK (360Dx) – Last year, Aurora Diagnostics, acquired five independent pathology practices, and the company has similar acquisition plans for 2018.
"We will continue to acquire, and we have more in our pipeline as we speak," said Bruce Walton, Aurora Diagnostics executive vice president and chief operating officer. Walton said the company plans to continue to acquire labs "fairly aggressively" in 2018, which he acknowledged could be at a pace similar to last year.
In 2017, Aurora Diagnostics acquired University Pathologists in Warwick, Rhode Island; Pathology Associates of Princeton in Plainsboro Township, New Jersey; Cleveland Skin Pathology in Cleveland; CytoPath in Alabaster, Alabama and CBM Pathology in Gaithersburg, Maryland, bringing to 31 the number of local independent pathology practices that have been acquired by Aurora Diagnostics. According to the company, it is now the largest independent integrated anatomic pathology and oncology diagnostics practice in the US.
Independent lab acquisitions are only one part of the Palm Beach Gardens, Florida-based company's business and growth strategy. Aurora Diagnostics provides hospital lab management services ranging from test utilization support to medical directorship services to more than 170 community hospitals and surgical centers around the country. The two-pronged strategy, while expanding the network of hospital labs it supports, has been key to Aurora Diagnostics' growth strategy since the company's inception.
For the independent labs it acquires, Aurora Diagnostics provides a range of administrative services including contracting, billing, collection, benefits packages, and malpractice insurance to enable pathologists to focus more on the technical and medical aspects of running their practices, according to Michael Walsh, chief medical officer of Aurora Diagnostics, who joined the company when his own pathology lab practice, Consultants in Laboratory Medicine of Greater Toledo in Ohio, was acquired by Aurora Diagnostics in October 2015.
Key challenges that independent pathology labs face in maintaining their independence is the rate of consolidation in the hospital industry, and contracting, according to Walsh.
"You might have a hospital contract, and that hospital might get acquired, so the idea of combining forces and getting larger is important," he said. "The second issue is very much the contracting, because you have to be large enough, or affiliated with the appropriate health system, to be able to be maintained in payor networks."
Aurora Diagnostics' acquisition strategy involves identifying pathology practices that are well-respected in the areas that it focuses on, which are mainly surgical or anatomic pathology and dermatopathology, according to Walton. The company also does clinical pathology in the oncology area, using molecular diagnostics and sequencing-based liquid biopsy analysis.
"We look for density in given markets, and what we describe as pedestal-based or well-recognized, foundation-based practices that have been in the market or community for a significant number of years," Walton said.
For pathologists at acquired labs, Aurora Diagnostics provides a network to facilitate communication, including meetings in which pathologists specializing in certain areas, such as gastrointestinal pathology or breast pathology, present best practices, according to Walsh.
"We allow an opportunity to engage in internal consultation, in other words, to discuss interesting cases among the 200 pathologists that we have, which elevates overall quality and allows us to feel more comfortable in making diagnoses that might be difficult," he said.
The company is also working to institute a cloud-based digital pathology system, through which pathology images could be more easily shared electronically with other pathologists within Aurora Diagnostics with particular areas of expertise, he said.
Meanwhile, for hospital labs, many of the management services that Aurora Diagnostics provides center around helping hospital labs control cost. The company's test utilization management services, for example, involve reviewing test ordering to ensure physicians are ordering the most appropriate tests and interpreting them correctly.
"We have internal programs that are designed to look at patterns of test ordering and we work directly with the ordering physicians, in other words, internists or pediatricians, to make sure that the tests they are ordering are compatible with the diseases they are trying to diagnose," Walsh said.
Other management services Aurora Diagnostics offers to community hospitals or surgery centers include a program designed to review the speed and accuracy of diagnoses in biopsies and surgical recessions, and subspecialty pathology services, through which pathologists trained in particular disease areas provide surgeons with specialized feedback. Aurora Diagnostics also has a transfusion medicine management service for evaluating transfusion practices. Transfusions can be costly for hospitals due to the high cost of blood and the risk of complications and extended lengths of stay, Walsh noted.
In addition to services targeting specialized and individualized care, Aurora Diagnostics also offers hospitals population health services, involving reviewing trends in large segments of the population, with the goal of establishing protocols that could improve care, according to Walsh.
"The big issue with population health is collecting the data," he said. "Let's say, for example, we have a 600-bed hospital. Most hospitals have a large population of diabetic patients. You would collect data on measuring hemoglobin A1C, which is the best nugget for determining glucose value for patients over a period of time."
Successful population health strategies have included introducing protocols that involve early intervention for patients who do not yet have acute kidney injury, but whose lab tests indicate they might be headed in that direction. When patients have creatinine levels that are still within the normal range, but are rising, early intervention has been shown to reduce morbidity and decrease costs, Walsh noted.
To help hospital laboratories meet Clinical Laboratory Improvement Act rules that require labs to have a scientific medical director who is directly responsible for laboratory's technical performance, Aurora Diagnostics also offers a medical directorship service, providing hospitals with a pathologist who has been trained on regulatory requirements to serve as medical director. The company's medical directors have also received training on working with hospital administrations to maintain the highest standards of lab quality. "We do not own the labs, but we provide the physician who serves as the technical head of the laboratory, and therefore is responsible for the quality of the results that the lab generates," Walsh said. "Under most of the guidelines, that is a fairly significant responsibility," he said.
Opened three years ago, the Aurora Research Institute is the company's newest division. ARI leverages the size of the network of hospitals that Aurora Diagnostics serves to support research, discovery, and validation of biomarkers through pharmaceutical clinical trials. The company works with its hospital clients to establish processes for obtaining patient permission for participation in trials.
"A lot of community hospitals very much want to be involved. There is some revenue generation and it is a very large area for development in the cancer field," Walsh said. "Because of our breath and scope of hospital coverage, we see a lot of resections of tumors."