September 2010

Stephen N. Bauer, MD

Building a fact-based case for change

As health care reform moves forward, changes in the landscape of medical practice and the roles of individual physicians are a certainty. The rapid pace of technological innovation continues to raise the stakes and accelerate demand for services that we should be prepared to provide. This month’s column is a progress report, an examination of the topics at hand, and an invitation to join in the conversation.

If we are to identify and secure optimal roles for pathologists in the evolving medical system, we must first articulate our vision for the future in terms that are relevant to the everyday practice of medicine and meaningful for pathologists, other physicians, and patients. We must define the new roles for pathologists and develop a plan to make sure the new roles are value based and compensated appropriately. Defining the path to reach that future requires that we understand the needs and interests of those with competing or compatible goals. This means durable connections with other physicians as well as nonphysician groups whose goals and priorities are intertwined with our own.

If we are to make transformation actionable and measurable, it must be fact based. This will require research on the potential for new roles, appropriate payment mechanisms, and the estimated pace and effect of technological innovation. We must understand how technology and medical practice changes will influence the supply of and demand for pathologists with the appropriate skill sets.

Last spring, recognizing that we should know more about what those outside the specialty think about transformational pathology, we commissioned a professional poll to survey four demographic groups (pathologists, other physicians, persons involved in health care policy, and ordinary Americans with an interest in health policy) about their views of our specialty. That first survey helped us identify where we need to be more concrete about the future shape of the health care environment and what our potential partners and competitors see as our place in it.

The Transformation Program Office, or TPO, began in recent months to conduct about 100 in-depth interviews with other specialists and another 150 interviews with technology experts, hospital administrators, and other stakeholders. The goal is to learn what they need most and to create a dialogue about what we can provide.

As those interviews progress, TPO teams will continue to build what we are calling the fact-based case for change, or C4C. Four C4C teams, or research modules, are now in place. Ninety people are participating at present, and members are encouraged to volunteer; the groups are expected to grow over time.

The four teams met for a two-day retreat with the Board of Governors in July to brainstorm goals for the transformation. The overarching purpose is to provide a firm, data-driven engine that tells us what needs to change, what opportunities are most promising, and what challenges should be tackled first. An important part of that is refining what the business types call our “value proposition”—needed services we can provide more effectively and efficiently than anyone else. One example might be the accountable care organizations envisioned under health care reform. The C4C research will tell us whether relevant stakeholders see a role for pathologists in the construction of ACOs in their communities (yes), and how we can demonstrate a willingness and ability to make a unique and valuable contribution to their work.

The research teams represent a cross-section of what Tom Malone, who heads up the TPO, calls the transformation ecosystem: individuals and entities whose purposes are related to or affected by our goals. Each C4C module has a charge and members selected for relevant expertise, and each includes pathologists and physicians in primary care and other specialties, CAP staff, and representatives of nonphysician groups. The last category takes in professionals from allied workforces, such as medical technologists and PhDs, as well as people from industry (including molecular diagnostics, pharmaceuticals, pathology imaging and informatics technologies, genomic sequencing, pathology practice management, and coding/reimbursement).

The research teams will develop detailed scenarios for the future of pathology by identifying the skills and services likely to be most in demand, the best business models for providing those services, how they can be most fairly reimbursed, and what workforce needs we should plan for.

Data-driven models will enable us to predict, with some accuracy, various scenarios for how changes in the greater environment will affect the future of pathology. We recognize that the modeled outputs will not be highly precise, particularly when dealing with changes further into the future. The idea is to create a set of reliable and flexible models in stages that get progressively more detailed and adapt to new information about technological change and about what our colleagues and partners need, enabling a rapid response to shifts in the marketplace over time.

The best way to establish our place in the emerging health care system is to build an irrefutable case for it by showing what we can do. As experience accumulates, we plan to demonstrate our value to the clinical care team and the health care system by funding pilot demonstration projects at the local level. A demonstration project can be as simple as providing a temporary stipend so that a community pathologist can contract out some of his or her routine responsibilities in order to devote time to providing in-house molecular diagnostics. We will create opportunities to do the things we say we can do.

While the level of interest in transformational roles is a personal matter, the choices of individual pathologists will shape our collective future. Each of us can fuel the engine of transformation by planning now for incremental and substantial changes in our practices. Solid research and intentional preparation will take us where our patients need us to go. Participate in the research and join the transformation conversation.