A laboratory in Boise is expected to close in the spring, after St. Luke’s Health System decided to end its half of an ownership agreement with Saint Alphonsus Health System.
St. Luke’s plans to move its testing to a larger, out-of-state laboratory.
The Idaho Cytogenetics Diagnostic Laboratory has been co-owned by St. Luke’s and Saint Alphonsus for about 15 years. Its small staff of 11, including a lab director, work seven days a week on samples from both health systems. But the bulk of the business comes from St. Luke’s — the larger of the two systems, with a busy cancer institute and children’s hospital.
The lab is highly specialized — performing tests that help diagnose cancers, confirm prenatal genetic screenings and even helping doctors figure out the best way to treat a patient’s illness.
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And it is profitable, according to its director, Julie Biggerstaff.
“That’s why we’ve been very confused about this decision,” she said. “They’ve been supportive of genomic medicine in the past, but now, all of a sudden, they’re not. It doesn’t make sense, because this is the direction that laboratory medicine is heading.”
But the decision to outsource was a long time coming for St. Luke’s, according to Bart Hill, the health system’s vice president and chief quality officer.
With how fast genetic technology is advancing, the health systems have had to decide on a regular basis whether to invest in new equipment, training and getting lab workers certified in new areas, Hill said.
“We’re faced with that kind of opportunity again, and this is about developing the next-generation gene sequencing diagnostic capabilities,” he said. “We took a pause and said, ‘Is adding this type of service in a smaller lab going to be the best [choice]?’ ... If we can consolidate as much as possible, it helps with logistics, information transported back and forth, and development of relationships.”
Biggerstaff said the “ballpark” cost she gave to the health systems was $300,000 to $400,000 to adopt the new technology. The sequencers themselves cost about $250,000, she said.
Hill said St. Luke’s foresaw an investment approaching $1 million. In addition to the up-front costs of adopting the technology, the lab would need to rent additional space or move into a new facility, and it would need to hire a bioinformatics specialist. The lab’s information system is due for an upgrade as well, costing $135,000 to $250,000, he said.
“And as rapidly the technology is changing, what’s your next investment?” he said.
Hill said St. Luke’s will spend about six to nine months choosing its new laboratory.
“With the changing science behind it, it’s going to require significant technology and new skills that don’t exist in Boise,” he said. “We’re truly committed to providing the highest quality care.”
What’s in the future?
St. Luke’s gave notice to Saint Alphonsus earlier this month that it was withdrawing from the partnership. Saint Alphonsus can buy out St. Luke’s shares and take over the lab, but it would lose a large amount of its business when St. Luke’s takes its testing elsewhere.
“We’re still exploring options as to the continued operation of ICDL, but at this time, don’t have finalized plans,” said Saint Alphonsus spokesman Joshua Schlaich.
If the lab closes, its employees will have to relocate or change careers; there are no equivalent jobs in the area.
One of the lab’s senior technologists said the job losses aren’t the only concern. She worries that Treasure Valley patients will have to wait days for tests that could have been done in hours.
“There are times when we receive STAT samples where a result needs to be given ASAP or a patient can die,” Keri Banner said.
For example, she said, the lab can turn results in the same day for acute promyelocytic leukemia.
“If it is positive ... a physician needs results ASAP in order to prevent the patient from [a life-threatening hemorrhage] that can cost them their life and is typically very curable with the current treatment regimen,” Banner said. “These samples being sent out of state will only add time to the testing, something some patients may not have. Really, we treat all samples as STAT, but some just take higher priority than others due to the immediate impact of the result.”
Hill said those time-sensitive tests come up occasionally, three or five times a year. St. Luke’s is looking at labs that would be able to turn around tests quickly, “not a significant impact of multiple days,” he said. “That kind of test, it wouldn’t make sense to send to the East Coast.”
He said the health system already uses a laboratory in Salt Lake City for some of its lab work.
Biggerstaff said the community will be losing a piece of its health care infrastructure.
“This cannot be limited to large megalaboratories like Quest [Diagnostics] and LabCorp,” Biggerstaff said. “Health care is local. It’s a local endeavor.”