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A clinical pathologist at a hub laboratory examines a sample using a microscope.
Network sharing among labs may provide more evidence to support new digital pathology CPT codes, which are currently under review by the Centers for Medicare and Medicaid Services.
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New Digital Pathology Network Aims to Benefit Smaller Clinical Labs

Nuance and Paige say their new consultation network will also generate revenue for larger laboratories

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Scott Wallask, BA
Photo portrait of Scott Wallask

Scott Wallask, BA, is senior editorial manager for Today’s Clinical Lab and G2 Intelligence. He has spent more than 25 years covering the healthcare and high-tech industries. A former newspaper reporter, he graduated from Northeastern University with a degree in journalism.

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Published:Dec 28, 2023
|4 min read
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The companies behind two established healthcare technologies have partnered to create a digital pathology consultation network that should allow smaller clinical laboratories to ease into whole-slide imaging without fully committing to the large expense. 

In an announcement on November 27, digital pathology provider Paige and artificial intelligence company Nuance predicted that their partnership would facilitate greater collaboration among pathologists via the new network. Nuance is a Microsoft company.

Photo portrait of  Peter Durlach
Peter Durlach, corporate VP and CSO, health and life sciences, Microsoft.

“With digital pathology, one of the challenges is people think they have to digitize their entire slide library to get it,” says Peter Durlach, corporate vice president and chief strategy officer for health and life sciences at Microsoft, in an interview with Today's Clinical Lab. However, the new network potentially offers “a way to get a lot of folks up and running in the [digital pathology] space without having to go all in.”

The new approach combines Nuance’s PowerShare image-sharing network with Paige’s digital pathology software and viewer to connect more than 14,000 sites. 

The partnership considers two use cases:

  • For smaller community laboratories, the opportunity to send consults digitally to a specialist for review, which results in faster turnaround times
  • For large medical centers that deal with a lot of external pathology consults, the ability to receive digital slides versus transporting and accessioning glass slides
Photo portrait of Andy Moye
Andy Moye, PhD, CEO at Paige.

“The concept is to provide better patient care and be able to create a formal digital pathology network for consults,” says Andy Moye, PhD, CEO at Paige. Patient outcomes may also improve from quicker turnaround times on complex pathology reads.

Digital pathology network follows a hub-and-spoke model

The network is set up with large medical center laboratories as “hubs,” with “spokes” going out to community-based labs. Nuance and Paige have contracted with a handful of large hub labs in a pilot phase of the network.

“At the spoke site, there’s a digital scanner of some type […] and the actual scanning is enabled by the Paige platform,” says Durlach. “The routing from the spoke to the hub is all done through PowerShare, which many sites already have on both sides of the network.”

At the hub location, Paige’s software enables pathologists to open a case, review it, and send a diagnosis back to a spoke lab.

“Imagine a smaller lab has a patient with a tumor in the leg that looks like a sarcoma,” says Durlach. “That lab might not be able to get to that review because the lab doesn’t have enough pathologists,” but larger hub labs do. 

Illustration of the hub and spoke laboratory model for Nuance and Paige's digital pathology network.
Today's Clinical Lab

Economics of the new digital pathology network

For smaller medical labs that might not be ready to evaluate a full digital pathology rollout, the new network from Paige and Nuance provides them a chance to try out the technology on a smaller scale. 

The model will also benefit large hub labs, as “[hub sites] are in the business of monetizing clinical expertise throughout the larger community,” he adds. Hub labs that receive the slides can receive reimbursement from this work.

“Based on looking at Medicare numbers, one to two percent of all [pathology] cases get sent for some sort of formal consult in the US,” says Moye. The consulting sites get paid for that through Medicare and private payer reimbursement.

“With Nuance, we’re helping facilitate more of this market so that two things happen,” he says. “First, experts qualified to do the read can monetize their expertise more than they do today. And second, larger labs can take advantage of the increased pathology workloads.”

Labs may also realize savings from digitally sending slides as opposed to shipping them via transport companies. “We talked to a couple of large academic medical centers […] and [the cost] to ship glass slides and blocks back to the originating hospital is mind blowing,” says Moye. “It’s hundreds of thousands of dollars [annually] in some cases.”

Additionally, this type of network sharing among labs may provide more evidence to support new digital pathology CPT codes, which are currently under review by the Centers for Medicare and Medicaid Services.

Hub labs will pay for the new digital pathology network

As with any technology, client laboratories will pay vendors for their services. The financial model for the digital pathology network from Nuance and Paige leans into large hub labs.

“Looking at it from the economics, the hub site pays for the consult service through the existing contract they have with Nuance for PowerShare,” says Peter Durlach of Microsoft, the parent company of Nuance. “Spokes that are sending consult cases will not be charged for this service. It's just part of the referral process that they already do anyway, but now the referral in digitized through the network.” 

Nuance established a similar network with radiologists. Based on that experience, it’s likely some spoke labs will eventually become paying hubs.

“What happens is some spokes start to see value [from the network], and they convert to hubs,” adds Durlach. “So those spokes become paying hubs after a certain point.” In some cases, labs may also become both hubs and spokes, receiving external consults and but also sending out digital slides for review by organizations with subspecialty pathologists qualified to do complex reads.