GAO-08-20 by paulewick


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Military Base Realignments and Closures: Impact of
Terminating, Relocating, or Outsourcing the Services of
the Armed Forces Institute of Pathology
GAO-08-20 November 9, 2007
Highlights Page (PDF)   Full Report (PDF, 59 pages)   Accessible Text   Recommendations (HTML)

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The 2005 Base Realignment and Closure (BRAC) provision required the Department of Defense                  Army facilities
(DOD) to close the Armed Forces Institute of Pathology (AFIP). GAO was asked to address the                Army personnel
status and potential impact of implementing this BRAC provision. This report discusses (1) key
                                                                                                           Base closures
services AFIP provides to the military and civilian communities; (2) DOD's plans to terminate,
                                                                                                           Base realignments
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        Disease detection or diagnosis

this GAO report as it develops its plan for the reorganization of AFIP. GAO reviewed DOD's plans,          DOD Base Realignment and
                                                                                                           Closure Program
analysis, and other relevant information, and interviewed officials from the public and private sectors.
                                                                                                           Federal facility relocation

AFIP pathologists perform three key services--diagnostic consultations, education, and research--        Health care services
primarily for physicians from DOD, the Department of Veterans Affairs (VA), and civilian institutions. Military personnel
AFIP provides consultations when physicians cannot make a diagnosis or are unsure of their initial       Physicians
diagnosis. About half of its 40,000 consultations in 2006 were for DOD physicians, and the rest were
                                                                                                         Program evaluation
nearly equally divided between VA and civilian physicians. AFIP's educational services train physicians
                                                                                                         Program management
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.

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: Randall B. Williamson
Team: Government Accountability Office: Health Care
Phone: (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. In February 2009, the Commander, Joint Task Force
 Capital Medical Region, developed a strategic plan for the JPC that would ensure that DoD's
needs for diagnostic pathology services are met. The strategic plan was reviewed by JPC Work
Group and the Defense Health Board and the work group developed a detailed implementation
plan, and after review by the Defense Health Board, the plan was presented to the Assistant
Secretary of Defense(Health Affairs) in June 2009. In March 2010, DOD noted in DAMIS that the
JPC will be established under JTF CapMed. The JTF CapMed, with AFIP assistance, is finalizing
an implementation plan. The JTF CapMed established an inter-organizational implementation team
to review the concept of operations. The JPC is on schedule for full operating capability by mid-
September 2011.

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 the GAO 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. The DOD DAMIS record lists the status
of this recommendation as closed, as of April 20, 2010, because a contractor conducted an
assessment of the Tissue repository's assets. Indeed, on October 21, 2009, DOD forwarded a
report to Congress on the repository's assets and their potential research use, and DOD's strategies
for using the repository. DOD also sent the e-mail from DOD showing the desire to close the
recommendation. However, the report has no information that explains how repository and its
assets will be populated, managed, and used in the future.

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: 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.


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