Pathology Opinions about Autopsy Cost, Referral, and Centralization
JE Hooper. Oregon Health and Science University, Portland, OR
Background: One of the reasons cited for the decline in hospital autopsy rates is the disinterest of pathologists themselves in performing a difficult and non-remunerative procedure. Autopsies desired by families outside of the hospital system can be a particular problem, especially for small pathology practices. Regionalized large autopsy centers have been proposed as a potential solution. Advantages would include the use of experienced providers, potentially education of trainees, and standardization of autopsy procedures.
Design: A one page ten question survey was distributed by electronic mail to all members of the state Pathologists Association including academic pathologists, pathologists in private practice small groups (5 or less) larger groups (greater than 5), and pathologists in private hospitals. Questions included demographic information, queries regarding attitudes about autopsy in general, cost versus benefit of autopsy, whether there is a clear system for referral for private autopsies and interest in a regional autopsy center.
Results: 42 (21%) of physicians responded to the survey. 50% of respondents perform less than 25 autopsies per year in their practices. In spite of reportedly low numbers, 71% strongly agree or agree that autopsy can provide findings relevant to clinical practice and 52% disagreed that modern diagnosis is so accurate that autopsy is not necessary. However, 52% report that autopsy creates more cost than benefit to their practices with 24% neutral on this question. Pathologists in private hospitals and small practice groups responded proportionately more frequently in the “strongly agree” category for this question. A clear overall majority (74%) disagree that there is a clear system for referrals of private autopsies, and 47% of respondents agree that they are interested in referring autopsies to a regional center, with private hospital and small practice group pathologists agreeing proportionately more frequently.
Conclusions: The pathologists surveyed appear to value the autopsy as a tool in clinical medicine; however, the performance of autopsy outside of a hospital setting is considered a burden in many practice environments. Currently, family requested autopsies in our state are referred to individual independent providers through the state Pathologists Association, though the survey results show that this fact may not be widely known. Implementation of a centralized referral center or system must include details such as cost and payment, but interest does seem sufficient for exploration of such a system in our state.
Monday, March 22, 2010 2:30 PM
Platform Session: Section G, Monday Afternoon