Summary
The 2005 Base Realignment and Closure (BRAC) provision required the Department of Defense (DOD) to close the Armed Forces Institute of Pathology (AFIP). GAO was asked to address the status and potential impact of implementing this BRAC provision. This report discusses (1) key services AFIP provides to the military and civilian communities; (2) DOD's plans to terminate, relocate, or outsource services currently provided by AFIP; and (3) the potential impacts of disestablishing AFIP on military and civilian communities. New legislation requires DOD to consider this GAO report as it develops its plan for the reorganization of AFIP. GAO reviewed DOD's plans, analysis, and other relevant information, and interviewed officials from the public and private sectors.
AFIP pathologists perform three key services--diagnostic consultations, education, and research--primarily for physicians from DOD, the Department of Veterans Affairs (VA), and civilian institutions. AFIP provides consultations when physicians cannot make a diagnosis or are unsure of their initial diagnosis. About half of its 40,000 consultations in 2006 were for DOD physicians, and the rest were nearly equally divided between VA and civilian physicians. AFIP's educational services train physicians in diagnosing the most difficult-to-diagnose diseases. Civilian physicians use these services more extensively than military physicians. In addition, AFIP pathologists collaborate with others on research applicable to military operations and general medicine, often using material from AFIP's repository of tissue specimens to gain a better understanding of disease diagnosis and treatment. To implement the 2005 BRAC provision, DOD plans to terminate most services currently provided by AFIP and is developing plans to relocate or outsource others. DOD plans to outsource some diagnostic consultations to the private sector through a newly established office and use its pathologists for consultations when possible. With the exception of two courses, DOD does not plan to retain AFIP's educational program. DOD also plans to halt AFIP's research and realign the repository, which is AFIP's primary research resource. The BRAC provision allows DOD flexibility to retain services that were not specifically addressed in the provision. As a result, DOD will retain four additional AFIP services and is considering whether to retain six others. DOD had planned to begin implementation of the BRAC provision related to AFIP in July 2007 and complete action by September 2011, but statutory requirements prevent DOD from reorganizing or relocating AFIP functions until after DOD submits a detailed plan and timetable for the proposed implementation of these changes to congressional committees no later than December 31, 2007. Once the plan has been submitted, DOD can resume reorganizing and relocating AFIP. Discontinuing, relocating, or outsourcing AFIP services may have minimal impact on DOD, VA, and civilian communities because pathology services are available from alternate sources, but a smooth transition depends on DOD's actions to address the challenges in developing new approaches to obtaining pathology expertise and managing the repository. For consultations, these challenges are to determine how to use existing pathology resources, obtain outside expertise, and ensure coordination and funding of services to avoid disincentives to quality care. While DOD has begun to identify the challenges, it has not developed strategies to address them. Similarly, whether the repository will continue to be a rich resource for military and civilian research depends on how DOD populates, maintains, and provides access to it in the future, but DOD has not developed strategies to address these issues. DOD contracted for a study, due to be completed in October 2008, of the usefulness of the material in the repository. DOD plans to use this study to help make decisions about managing the repository.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director:
Team:
Phone:
Randall B. Williamson
Government Accountability Office: Health Care
(206) 287-4860
Recommendations for Executive Action
Recommendation: As part of DOD's initiative to develop a plan for disestablishing AFIP, the Secretary of Defense should include in the December 2007 plan to Congress implementation strategies for how DOD will use existing in-house pathology expertise available within military treatment facilities, identify and obtain needed consultation services from subspecialty pathologists with appropriate expertise through the Program Management Office in a timely manner, and solidify the source and organization of funds to be used for outsourced consultation services.
Agency Affected: Department of Defense
Status: Open
Comments: In its comments on this report, DOD concurred with this recommendation. On August 2008, DOD sent Congress a report to meet the requirements of section 722 of the National Defense Authorization Act for FY 2008, to disestablish the Armed Forces Institute of Pathology and establish a Joint Pathology Center (JPC) that will ensure that DOD's diagnostic pathology needs are met. DOD's Assistant Secretary of Defense-Health Affairs (ASD-HA)chartered a Work Group to develop options, and eventually selected the option to locate the JPC at the new Walter Reed National Military Medical Center. On February 2009, the Commander Joint Task Force Capital Medical Region developed a strategic plan to ensure that DOD's diagnostic pathology services are met. The plan was reviewed by the JPC Work Group and the Defense Health Board. The Joint Task Force Capital Medical Region plans to develop a detailed implementation plan, and once it is reviewed, the plan will be presented to the ASD-HA in the summer of 2009. The goal is to meet the timelines for the JPC with the opening of the new Walter Reed National Military Medical Center. DOD is staffing a memorandum requesting Presidential authority to establish the JPC in DOD.
Recommendation: As part of DOD's initiative to develop a plan for disestablishing AFIP, the Secretary of Defense should, within 6 months of completion of DOD's study regarding the usefulness of the pathology material in the repository that is to be finished in October 2008, require Uniformed Services University of Health Sciences (USUHS) to provide Congress with information on the status of the repository's assets and their potential for research use.
Agency Affected: Department of Defense
Status: Open
Comments: In its comments on this report, DOD concurred with this recommendation. On August 2008, DOD reported that the Uniformed Services University of Health Sciences (USUHS) had commissioned a study to evaluate the assets of the Armed Forces Institute of Pathology (AFIP) Tissue Repository and that the contract period was through Sept. 31, 2008. On February 2009, DOD reported that it had received the contractor's final report on December 31, 2008, and USUHS was reviewing the results of the study and planned to submit a report to Congress by the summer of 2009 that would provide an evaluation of the status of the Tissue Repository's clinical data and pathologic specimens. In accordance with the National Defense Authorization Act for FY 2008, DOD planned to include information and details about the maintenance and modernization of the Tissue Repository in the Joint Pathology Center implementation plan.
Recommendation: As part of DOD's initiative to develop a plan for disestablishing AFIP, prior to USUHS assuming responsibility for the repository, the Secretary of Defense should provide a report to Congress on its implementation strategies for how it will populate, manage, and use the repository in the future. The implementation strategies should include information on how USUHS intends to use pathology expertise to manage the material, obtain pathology material from a wide variety of individuals, maximize availability of the repository for research through cooperative ventures with other academic institutions, and assist interested groups--if any--in supporting the continuation of educational services, such as the Radiologic-Pathologic Correlation course.
Agency Affected: Department of Defense
Status: Open
Comments: In its comments on this report, DOD concurred with this recommendation. On August 2008, DOD noted that the strategic plan for the Joint Pathology Center (JPC) was under development, and that in accordance with statutory guidance, the JPC would provide for the maintenance and modernization of the Tissue repository. DOD also noted that until DOD's military medical leadership approves the strategic plan and implementation plan, the potential recommendation would remain undetermined. On February 2009, DOD noted that a detailed implementation plan for JPC was in development. Similar with statements noted on Aug. 2008, DOD noted that in accordance with statutory guidance, the JPC would provide for the maintenance and continued modernization of the Tissue Repository. DOD also noted that it had received the results of the study by Uniformed Services University of Health Sciences (USUHS). The study will assist DOD in developing a management plan for the repository and in developing a detailed implementation plan.
