Bobbi Pritt, M.D. (00:34):

Hello, I'm Dr. Bobbi Pritt, a clinical microbiologist and laboratory leader at Mayo Clinic, and your host for today's episode. Dr. Bill Morice is back to discuss some trending topics. Then, I'll welcome Angie Reese-Davis for an inside look at what it takes to get tests delivered and processed efficiently. Bill, welcome back.

William Morice II, M.D., Ph.D. (00:53):

Yeah, it's always good to be back.

Bobbi Pritt, M.D. (00:55):

It’s always great to have you. So, there's a few things going on, and I thought, let's start by visiting what's new and noteworthy with you. And I think the big thing on everyone's mind, or a lot of us at least, is PAMA and the RESULTS update. In late 2025, you had shared that the PAMA implementation was delayed until January 30. Now, we're recording this a few days before that deadline. So could you speak to what you anticipate will happen by the time that people listen to this episode?

William Morice II, M.D., Ph.D. (01:26):

Yeah, happy to. So just to kind of remind people, and myself included I guess as a person, is that what's happening is that as the government is facing shutdowns, due to lack of funding, there are continuing resolutions which are passed, which allow the government to be funded. And what we've seen is that there are healthcare provisions that need to get funded to continue for patients of beneficiaries in the U.S. to have access. As part of that, we've been fortunate to have delays to the cuts in the clinical lab fee schedule that will be part of PAMA, the law that was passed back in 2016, I believe. We've had delays in those, and the most recent was the continuing resolution, which ends on January 30. We had another delay of PAMA cuts until that January 30 deadline.

So, what we've seen in between now and then is that, as of this recording, a funding bill has passed in the House of Representatives, which includes a PAMA delay until the end of the year, so until December 31, 2026, and also some changes in the data reporting. So, we would be able to report current data, not have to go back to 2019, which is also part of that law. That's where things stand.

We can't be definitive yet though on whether or not we'll see those delays, because that bill will have to pass the Senate as well. And it's a little complicated at this juncture where we're talking, because if changes are made by the Senate on that bill, then it has to go back to the House to get repassed. So, there's still a few back-and-forths, and the Houses is on recess right now. There's all these sorts of idiosyncrasies of the federal government, which we don't want to go into in too much detail. But that's where things stand. If things for some reason don't pass, either the continuing resolution or somehow in this back-and-forth those delays are somehow not included in the final bill that's passed, then we will be facing cuts in the clinical lab fee schedule on January 30.

I don't think that's gonna happen, because the other great piece of news out of all of this is that there's continued bipartisan interest in passing the RESULTS Act, which is of course the permanent fix to PAMA so we can get out of these one-year delays and these continuous cycles that we've been on. There was a congressional hearing, and Susan Van Meter, the president of the American Clinical Lab Association, which we've discussed many times in this podcast, gave a quite a bit of testimony. But, it's not just her. There's many lab groups and patient groups that have stepped forward with the RESULTS Act. So that's what we're really hoping for. But as we record this, we're still in a kind of a little bit of a haze of uncertainty.

Bobbi Pritt, M.D. (03:49):

Thanks, Bill. We're going to have to wait and see what happens. As we’ve encouraged in the past, too, we recommend that our listeners stay engaged and really pay attention to this important issue.

William Morice II, M.D., Ph.D. (03:59):

Yeah, absolutely, rigth? No matter what is the outcome. Because the most likely outcome, I think, is a delay. And hopefully that's what people as they're listening to this is what they've heard. That doesn't mean we could take our foot off the gas though, in terms of really keeping up the pressure, and the good news is that we actually, as laboratories, have the attention of Congress on this issue. So the other good news, I guess, is that it's given us something to talk about over the last several years outside of COVID. But I know there's other things that we should talk about, too. And you have some news of longevity of sort and the public domain that I think listeners would be interested if you shared.

Bobbi Pritt, M.D. (04:33):

Well, I do have some big news in that just last night I posted my 800th parasite case of the week. I've been doing this since 2007, when I started my blog called “Creepy Dreadful Wonderful Parasites.” And I try to post a case every week, and I've been pretty loyal about it, so, it's been an amazing journey that I'm now up to my 800th case.

William Morice II, M.D., Ph.D. (04:57):

Living up to the moniker Parasite Gal. Number one, your superhero name. But also, how many of those are repeats? Is there really that much of a diversity in parasites that you can have 800 different cases?

Bobbi Pritt, M.D. (05:11):

Well, yes and no. I mean, yes, we definitely have our repeat guests like the pinworm, the head louse, the things that are more common, but they're all different in their own subtle ways. So actually, for those who want to check it out, we really have some stunning images for this week's case. And they were taken by my technical specialist, Heather Morris, who is amazing with photomicroscopy. So take a look and see if you can guess what it is.

William Morice II, M.D., Ph.D. (05:38):

Well, yeah, maybe even I'll give it a shot. I guess the other thing, and you and I have talked about this, because it really speaks to the importance of our profession, and that is that even if you have the same pathogen, I would imagine just like a lot of diseases, they can have different manifestations. And especially for some parasites, I would bet that would make the diagnosis not obvious to the clinician. And really important that we as laboratorians are, you know, helping to deal with these kind of unknown cases and keep these things in mind. So is that the case where you can have 800 cases because they can have really very protean or different manifestations clinically?

Bobbi Pritt, M.D. (06:11):

Yeah, absolutely. And sometimes they're atypical manifestations of something that's common. Sometimes it's an uncommon worm, but they're always different, even if it's something common. And sometimes I ask myself, “Oh, should I post a real stumper this week?” You know, something that people are going to find challenging?” And I'll have a few people write in. But honestly, people like the so-called bread-and-butter of parasitology. They want to see the things that they could look at and say, “Oh wow, cool. I know what that is.” So, I try to give a good mix. And so, there are the repeats, but like I said, each one's different. And then sometimes I'll compile them and I'll say, “Hey, let's take a trip down memory lane. How would you like to look at 20 different cases of pinworm, for example?” And then you can go back and look at all of them.

William Morice II, M.D., Ph.D. (06:59):

Yeah. First of all, it's wonderful that you do that. You're such a great educator. I know when I was the chair of the Department of Lab Medicine and Pathology, you were our vice chair of education and did a fantastic job with that. And it's a real joy of working at an academic medical center, getting to share what you've learned with others. So I just had the privilege of giving Grand Rounds at Yale, where I was talking about my job now, which is kind of this intersection of business and medicine and health, and diagnostics is such a big part of that. So you're such a wonderful ambassador for our profession, so it’s great. And 800 cases is a real milestone, so congratulations.

Bobbi Pritt, M.D. (07:32):

Hopefully there'll be another 200 at least, you know, I'll hit a thousand and then we'll have to think of, you know, have a big parasite-themed party.

William Morice II, M.D., Ph.D. (07:39):

Yeah, that would be great. Hopefully with my extensive travel, I will not actually be one of the cases of the week. That's one of my goals, but yeah, let's hit a thousand for sure.

Bobbi Pritt, M.D. (07:49):

Let's aim for that. It's a plan. Well, thanks again, Bill, for the great discussion.

William Morice II, M.D., Ph.D. (07:54):

Yep. As always, it was a lot of fun. And we'll keep each other posted on what's happening in the world of parasites and the world of regulation and policy and everything in between.

Bobbi Pritt, M.D. (08:02):

Yeah, PAMA and parasites, there we go.

Welcome to today's deep dive. We're going to go beyond the headlines with Angie Reese-Davis. Angie is the director of logistics and specimen services at Mayo Clinic Laboratories, and she's going to give us a behind-th-scenes look on how we get samples from all around the world to our laboratories. Angie, thank you so much for being with us today.

Angie Reese-Davis (08:30):

Yeah, thank you for having me.

Bobbi Pritt, M.D. (08:32):

So to start, can you share what your group is responsible for and the role it plays in the testing process?

Angie Reese-Davis (08:39):

Yes, absolutely. Our team gets the samples to the appropriate laboratory in Rochester, Minnesota. It ensures that the results are quickly shared back with clients. We have approximately 55 countries that are the population of our clients, and we gather samples from those clients, which includes managing more than 1,500 courier route stops domestically, and an average of nearly a hundred international shipments per day. 87,000 samples arrive in Rochester each day, and many of them are for Mayo Clinic's practice, but close to 40,000 of them come from other clinics and hospitals sent to us in Rochester, Minnesota. Nearly all of those samples arrive on time, and the global logistics team ensures that we deliver a result in the ordering practice in the expected time frame in most cases.

Bobbi Pritt, M.D. (09:35):

Angie, that is so impressive. So we're getting specimens in from 55 countries, and we're getting 1,500 courier stops domestically and nearly a hundred international shipments a day. That just blows my mind. So these metrics are really impressive, especially given the unexpected challenges that your team must face, like weather disruptions, custom delays, geopolitical issues. How do you stay on top of all of these hurdles?

Angie Reese-Davis (10:03):

Yeah, the team does a great job. They operate 24/7. We monitor flight arrivals, courier impacts, and line hauls, which is our trucking, and then potential disruptions to identify and mitigate any risks. So, the team's working really hard every day to watch all of those things to ensure a specimen arrives on time. Each day, the global logistics team tracks approximately 800 inbound shipments and about 480 outbound shipments. And we try to be as proactive as possible when we identify a potential issue. An example of how the global logistics team goes above and beyond: so every single day they’re watching any type of disruption in any service, whether that's international and domestic. The team will look at the weather per day, they'll predict any type of mitigation that needs to happen later in the week or even the following week. And so an example of that would be, if we have disruption at some of our major, I would say our flight hubs, we will go ahead and be proactive and create a contingency plan to ensure that we divert work to different areas of the United States to ensure that our specimens arrive in Rochester on time.

There's a lot of planning and a lot of just really hands in, everybody working any time of the day, whether that's night or daytime, to ensure that the specimens arrive. So the team comes together really nicely to do those things.

Bobbi Pritt, M.D. (11:31):

Yeah, that's really impressive, Angie. And I can imagine we have U.S. holidays, but there are many international holidays, and they don't always line up perfectly. So that sounds like a lot of details to keep track of. So how do you build resilience to keep operations running smoothly in these moments?

Angie Reese-Davis (11:48):

Yeah, it's really being proactive. We don't wait until there's an issue impacting a certain number of specimens to engage in that. We care about every single specimen. So it really comes down to a commitment to our patients and teamwork. It's central to everything the team does. We focus a lot on our primary value, the needs of the patient come first. It's never lost on our staff how important the samples we're tracking are to our patients that are sending their specimens to us. Secondly, teamwork and collaboration are so ingrained in Mayo Clinic's culture and that really contributes to the resilience of our team. And everyone knows when something happens, they're not alone. So we pull together as a group and work on those situations together to get the best outcome. And this applies to how we innovate and look to improve. We actively promote staff at levels to submit ideas and feedback. So, we're always looking for ways that we can perform better and do better in any given situation.

Bobbi Pritt, M.D. (12:49):

That's great. What other innovative strategies or technologies help you maintain that level of performance?

Angie Reese-Davis (12:56):

We are always looking for process improvements. It's not a one-time initiative for us. It's ongoing every single day. Our people will always be our foundation, and it's important for us to invest in them. For example, we recently added staff and transitioned to a more regional approach for our work. We found that having teams focused on specific regions has given our staff more detailed support structure and focused view of our work. It's important to have good vendor relationships as we continue to grow. We also want to make sure our staff have the tools and technology to be as effective as possible. We have several technological upgrades happening at Mayo Clinic Laboratories and continue to explore AI and automation tools that can help make jobs easier for our staff.

Bobbi Pritt, M.D. (13:46):

Well thank you, Angie, for sharing all of this great information and again for joining us today on our podcast.

Angie Reese-Davis (13:52):

My pleasure. Thank you.

Bobbi Pritt, M.D. (13:58):

Let's wrap up with the top takeaways and how to learn even more on the topics we discussed. Dr. Morice and I talked about the latest developments related to PAMA reform and as we mentioned, we encourage you to connect with your professional organizations for the latest on this work. We then briefly chatted about my 800th case of the week, and you can find all 800 cases of my “Creepy Dreadful Wonderful Parasites” blog at the link in the show notes.

We then moved on to the deep dive summary. Angie joined us for a deep dive into logistics and if you enjoy conversations on operational topics, I'd highly recommend checking out our outreach podcast, called “Leveraging the Laboratory.” You'll find the link for that in the show notes as well.

Thank you for joining us today. If you haven’t already, make sure to subscribe so you never miss an episode. In our next episode, I’m excited to welcome Bill back for a deep dive into Mayo Clinic Laboratories’ platform business models. We’ll explore how this approach is enabling a more comprehensive view of clinical diagnostics and helping bring innovative new tests to market. I hope you’ll join us.