Military Base Realignments and Closures:

Impact of Terminating, Relocating, or Outsourcing the Services of the Armed Forces Institute of Pathology

GAO-08-20: Published: Nov 9, 2007. Publicly Released: Dec 10, 2007.

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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 for Executive Action

  1. Status: Closed - Implemented

    Comments: In its comments on this report, DOD concurred with this recommendation. The Nat'l Defense Authorization Act of 2008 directed DOD to establish a federal Joint Pathology Center (JPC) in DOD which would provide diagnostic pathology consultations to DOD and other federal agencies. DOD's Initial Operating Capability for the JPC was October 1, 2010. Formal full operating capability for the JPC is expected to be September 15, 2011. The JPC's Diagnostic Consultative Service, which will include the Program Management Office, has been fully operational since April 1, 2011, and AFIP's Diagnostic Consultative Service ended on April 15, 2011.

    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

  2. Status: Closed - Implemented

    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, 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 pathology specimens. In a memo dated February 26, 2010, to the Acting Chief Financial Officer, the Acting Deputy Assistant Secretary of Defense for Clinical and Program Policy stated that this recommendation is complete. The DAMIS record shows it as being completed on April 20, 2010.

    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

  3. Status: Closed - Implemented

    Comments: In its comments on the GAO report, DOD concurred with this recommendation. On August 2008, DOD noted that the strategic plan for the Joint Pathology Center (JPC) had been developed, and in accordance with statutory guidance, would provide for the maintenance and modernization of the Tissue repository. Although the DOD DAMIS records dated April 20, 2010, June 20, 2011, and July 2012, all showed the status of this recommendation as closed, GAO did not close it because DOD did not show how the JPC would populate, manage, and use the unique assets of the repository. DOD asked Institute of Medicine (IOM) for a report on the appropriate use of AFIP's tissue repository following transfer to the JPC. In September 2012, the IOM issued a report from the Committee on its review of the appropriate use of AFIP's Tissue Repository following its transfer to the JPC. The report titled "Future Uses of the Department of Defense Joint Pathology Center Biorepository" provides detail on how the assets can be populated, managed, and used in the future. GAO followed up with DOD's IG to obtain information about whether it endorsed these strategies.

    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


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