ASH Directions
ASH Report Highlights New
“Systems-Based” Hematologist Role
Models Represent New Way to Provide
Hematology Expertise
In response to today’s rapidly changing U.S. health-care
system, hematologists – particularly those specializing
in non-malignant blood diseases – are exploring an
innovative, sustainable new role: the “systems-based
hematologist.”
A report from the Society recently published in
Blood outlines several models for this new systemsbased hematologist, a centralized position within
hospitals and health-care systems specializing in nonmalignant blood disorders.
In the report, “The Role of Hematologists in a Changing
United States Health-Care System,” senior author and 2013
ASH President Janis L. Abkowitz, MD, and colleagues
note that, while demand for hematology expertise remains
high nationwide, ASH and its members are concerned that
changes to academic training will hinder both the recruitment of new talent and the retention of seasoned experts.
To address this issue, ASH partnered with health-care
consulting firm The Lewin Group to identify emerging
career opportunities for hospital- and health system–based
hematologists and to provide guidance on pursuing those
initiatives. At the core of this concept is the need for easily
accessible hematology expertise and leadership.
Despite rapidly advancing research in the area of nonmalignant blood disorders, Dr. Abkowitz and co-authors
write, today’s hematology trainees are unlikely to receive
the same non-malignant training as many “classic” hematologists trained in prior decades. Training shortfalls are
further compounded by the fact that primary care physicians do not have the expertise to manage common blood
disorders – increasing referrals to hematologists.
This combination of factors results in higher demand
for a smaller pool of hematologists entering the field with
adequate training to effectively and efficiently manage
non-malignant disorders.
“Given the rapid evolution and complexity of the field,
the time is appropriate to identify career pathways that
attract and enable physicians to practice non-malignant
hematology in a sustainable manner,” said Dr. Abkowitz, chief of the hematology division at the University of
Washington in Seattle.
Defining a New Role
In response to these challenges, U.S. hematologists are
defining new paths and assuming more centralized positions in large and small health-care systems. These positions involve specialty-trained physicians, employed by a
hospital, medical center, or health system, that optimize
individual patient care as well as the overall system of
health-care delivery for patients with blood disorders.
For example, a systems-based hematologist could
work closely with surgeons to minimize perioperative
bleeding and could manage care pathways for patients
with chronic blood diseases.
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ASH Clinical News
Based on interviews with 14 early adopters of the
systems-based approach to hematology, the report offers
four examples where the involvement of a systems-based
hematologist would le ad to cost-effective decision-making:
• Heparin-induced thrombocytopenia (HIT): A systems-based hematologist implements care pathways
that focus on HIT by working to reduce unnecessary
heparin exposure, optimize laboratory testing for
suspected HIT, and reduce unnecessary procedures
in patients.
• Thrombotic thrombocytopenic purpura (TTP): A
systems-based hematologist optimizes testing for TTP,
which may reduce system-wide plasma utilization.
• Medical director for hemostasis and thrombosis: A
systems-based hematologist fosters appropriate and
safe practices, including implementation and adherence to preventive care for blood clots and optimal
use of novel anticoagulant medications.
• Non-malignant hematology consultation in an
Accountable Care Organization (ACO) environment: While the formation of ACOs has enabled
more patients to be served by a health system, there
are fewer incentives for physicians to manage common hematology-related issues. A funded systemsbased hematologist in a health system ensures that
patients have more timely access to hematology
consultations.
Sharing Hematology Expertise
“A systems-based hematologist position presents a unique
opportunity for hematologists to design new models for
care delivery and demonstrate their ability to improve
clinical outcomes while maintaining or reducing costs,”
said Dr. Abkowitz. “Just as blood must flow throughout
the body, the expertise of hematology must flow throughout the health-care system.”
As a next step, the Society is building a collection of
case studies to guide creation of institutionally supported
positions focusing on non-malignant hematology.
ASH is inviting its members to share practice models
they have developed and examples of how they have
collaborated with others to improve health-care outcomes, reduce complications, and eliminate unnecessary
spending. In addition to the systems-based hematologist
project, ASH is committed to supporting recruitment and
retention in hematology through robust education, training, and award programs.
To learn more about these and other efforts by ASH,
visit www.hematology.org/Clinicians/Practice-Policy. ●
Related Resources
“The Role of Hematologists in a Changing
United States HealthCare System”
A Blood Forum article outlining several
models for a “systems-based clinical
hematologist” position within hospitals
and health-care systems specializing in
non-malignant blood disorders. (Wallace
P, Connell NT, Abkowitz JL. Blood. 2015
March 6. [Epub ahead of print])
Business Case Portfolio for Systems-Based
Hematologist
The Lewin Group’s
report on the role
of systems-based
hematologists in reducing spending and
improving quality.
The ASH Practice
Partnership
The ASH Practice
Partnership (APP) is
a collaborative group
that helps to inform
and guide ASH’s work on practice, including new initiatives in practice.
The ASH Practice
Update
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news for practitioners by subscribing to the ASH Practice
Update. This bi-monthly e-newsletter
includes updates on legislative and regulatory issues, news about meetings and
advocacy efforts, and new resources of
interest to practicing hematologists.
March 2015