No one knows for sure how pathologists will fit into ACOs, but it's worth thinking about before the structure of ACOs is finalized.  In this installment, I discuss a newly announced role for the College of American Pathologists (CAP) in the ACO discusion and the response of the American Society for Clinical Pathology (ASCP) to the request for information (RFI) from the Center for Medicare and Medicaid Services (CMS). In the prior post, I covered the definition of ACOs and discussed possibilities for the leadership of ACOs (hospitals versus physicians).

The College of American Pathologists (CAP) recently announced that it is joining the 2010-2011 Brookings-Dartmouth Accountable Care Organization (ACO) Learning Network. The announcement contains the following additional information about the Network:  “The Network is headed up by Dartmouth Institute for Health Policy and Clinical Practice’s Elliott Fisher, MD, and former CMS Administrator Mark McClellan, MD, PhD, who is now with the Brookings Institution’s Engelberg Center for Health Care Reform. Both Drs. Fisher and McClellan are leading experts on ACOs; Dr. Fisher is credited with launching the ACO concept.”  The web site for the Brookings-Dartmouth ACO Learning Network is being re-designed, but it already contains valuable information about the network as well as presentations by Drs. Fisher and McClellan at the National ACO Summit in June 2010. 

The stated goals for the CAP’s involvement in the Network are: 1) to maintain input into and awareness of the evolving structure of ACOs, and 2) to raise awareness of ACO issues that may disproportionately affect pathologists. The CAP also plans to launch an ACO Resource Center (it’s not ready yet; look for it on the Advocacy page of the CAP web site under CAP Issue Resource Centers).

The Center for Medicare and Medicaid Services (CMS) issued a Request for Information (RFI) on the development and structure of ACOs.  In response, The American Society for Clinical Pathology (ASCP) wrote a letter to Dr. Donald Berwick on Decmber 2, 2010, and the ASCP’s point of view was described in a recent e-policy news brief (excerpted below):

"…….ASCP outlined the contributions that pathologists can make to ACOs as part of their managing structure. The agency is developing regulations to establish, structure, and outline how ACOs will function in the provision of healthcare services now that the implementation of Affordable Care Act has begun.

In urging the inclusion of pathology, ASCP wrote, 'Given the considerable role that pathology and laboratory testing plays in patient care, ASCP believes that ACOs that include pathologists as part of their key physician specialties are better positioned to attain the important goals of reduced costs, increased quality, and improved patient experience.'

In addition to identifying pathologists among the physician specialties central to the ACO framework, ASCP urged that pathologists be able to participate in any gain-sharing arrangements available to other physician members of the ACO team. The CMS RFI comes in advance of the highly anticipated ACO rule, which should be published by the end of January."

What do you think?  Will the efforts of the CAP and ASCP manage to shape the debate on ACOs?  Will pathologists be part of the “managing structure” of ACOs?  Are the multiple professional societies for pathologists coordinating their efforts for maximum impact or diluting what little influence pathologists might have?

This concludes a two-part series on Accountable Care Organizations (ACOs).  In future poss we will turn our attention to changes in the regulation of Laboratory Developed Tests (LDTs).  Ben Calhoun

-- This post was written by Ben Calhoun, MD, PhD. Dr. Calhoun is a practicing surgical pathologist in Charlotte, North Carolina with expertise in breast pathology.  He trained at Yale and Vanderbilt and went to medical school and graduate school at the Medical College of Georgia. He is the Medical Director of Surgical Pathology for Carolinas Laboratory Network and, in his spare time, is an MBA student in the McColl School of Business at Queens University in Charlotte (anticipated graduation in December 2011).