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Healthcare reform: expanding the role of pathology.

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. 1 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.[c]

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 change.

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 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.

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Title Annotation:Washington report
Author:Roussel, Charles
Publication:Medical Laboratory Observer
Geographic Code:1USA
Date:Jul 1, 2009
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