Healthcare reform: Expanding the role of pathology

July 1, 2009

My wife was diagnosed with papillary thyroid cancer in
2006, and then a rare neuroendocrine tumor of the liver in 2008. One
night, I came across a bill for $5,000 from a pathology lab in
California. Our insurance company had denied payment, but I was
determined to fight that judgment, so I dove into the pathology report.
I soon realized I did not understand as much about my wife’s condition
as I thought I did, so I contacted the pathologist directly.

That conversation with her pathologist ultimately helped
us find the right treatment for my wife’s cancer. Having a pathologist and a
team of highly trained laboratory professionals taking an active role in my
wife’s care took us to a completely different place in her treatment. I
believe all patients should have that benefit, and with changes to the
healthcare system, they will.

In early 2008, the College of American Pathologists (CAP)
began sharing its vision for the future of pathology — a vision now
materially strengthened by the Obama administration’s healthcare reform
agenda. Current reform proposals, which emphasize care coordination through
a medical home, early detection and prevention, greater investment in
medical and information technology, and greater efficacy for healthcare
dollars spent, will be enhanced by pathologists as part of an integrated
healthcare team.

Pathologists understand disease at the molecular level,
enabling them to be among the best diagnostic innovators. This type
of innovation factors prominently in all scenarios of healthcare reform,
because if the diagnosis is wrong, nothing else matters.©

Pathologists are in the best position to ensure
appropriate test selection; help accurately diagnose diseases and assess
prognoses; determine the optimal course of therapy based on predictive
factors; and monitor key aspects of ongoing patient care. With laboratory
testing influencing 60% to 70% of healthcare decisions, pathologists can
contribute to improving patient care. With even the most expensive
diagnostic tests returning three to five times their cost in healthcare
savings, pathologists can help reduce healthcare costs by strategically
managing their institutions’ practice of lab-based diagnostic medicine.
Today, this role is more the exception than the rule — but this needs to

Having a pathologist working proactively with patients and other clinicians in diagnosing and selecting treatment therapies will, ultimately, reduce costs and improve outcomes.

Practitioners of laboratory medicine will secure an
enduring role in today’s healthcare by moving closer to patients and
physician colleagues, and by promoting their distinctive skills. The
unraveling of the human genome and subsequent increases in genetic testing
should, among other factors, help hasten this transition. In the last
decade, we have seen hundreds of new molecular, multigene and
multitechnology tests, and point-of-care diagnostics. The convergence of
technology, public policy, and innovation in diagnostic science presents a
rare opportunity for pathologists and laboratorians to have a real impact on
improving patient care.

Healthcare reform has brought laboratory professionals
the opportunity to raise awareness about the unique skills pathologists and
laboratorians bring to the modern primary healthcare team. To help
laboratory medicine progress, I am working with the CAP executives, board,
and 17,000 members to make sure laboratory medicine is at the forefront of
healthcare reform.

The College advocates for congressional support for
improving laboratory access to individual patient electronic health records.
Incentives for pathologists to initiate consultations with clinicians on
cases the pathologist deems necessary are also part
of reforming healthcare. Having a pathologist working proactively with
patients and other clinicians in diagnosing and selecting treatment
therapies will, ultimately, reduce costs and improve outcomes.

Guidelines like CAP’s electronic cancer checklists
and standards like Standardized Nomenclature of Medicine, or SNOMED,
help ensure more uniform diagnosis and treatment, and the highest
integrity transmission of medical information, respectively.

The College supports a graduated approach to ensuring
the safety of laboratory developed and waived tests. Thanks to highly
specialized training and rigorous procedures in place at all
CLIA-accredited labs, U.S. laboratory quality is already high, but the
increasing reliance on laboratory-developed tests, or LDTs, has raised
the stakes and the specialty needs to work with regulators to set
standards to ensure patient safety.

CAP also is committed to working with policymakers
and others to address the imminent shortage of laboratory professionals.
The inexorable move toward universal healthcare will have a direct
impact on laboratories: The volume of work is going to increase
significantly. The entire laboratory community must focus on eliminating
workforce shortages in order to maintain a high level of quality care
and fulfill the promise of diagnostic innovation.

When collective voices resonate with a clear, consistent, and
compelling argument change can happen. If laboratory medicine is
to have a powerful voice in how healthcare evolves, we need to come
together on the concerns we all share. I invite you to contact me or the CAP Advocacy office
[email protected]
 to find out more about how you can help.

Charles Roussel is the
executive vice president of the College of American Pathologists, where he is responsible for the daily operations of the College and reports to the board of governors.