AFIP provides pathology expertise for all branches of the military. In 2006,  AFIP provided over 40,000 consultations, almost half of which were for  DOD physicians. DOD, VA, and civilian physicians use AFIP’s  educational services, but the civilian community uses AFIP’s educational  services more extensively than military physicians. Regarding its research  services, AFIP pathologists work individually and in partnership with  other federal and private researchers using material from the repository to  conduct research applicable to military operations as well as to diagnose  and treat diseases affecting military and civilian health. That is, when physicians—clinicians or general pathologists— at civilian, DOD, or VA medical centers cannot make a diagnosis or when  they are unsure of their initial diagnosis and are in need of another  opinion, they can send the case to AFIP’s subspecialty pathologists for  diagnostic consultation. DOD, VA, and civilian  physicians have access to AskAFIP. Studying these  samples allows for advances in diagnosis and treatment of diseases. DOD Has Specific Plans to Terminate Most Services Currently Provided by AFIP and Is Developing Plans to Relocate the Others

The 2005 BRAC provision specifies that AFIP be disestablished. With the exception of two educational courses, DOD does not plan to  retain and relocate the educational programs currently offered by AFIP. DOD plans to halt AFIP’s research and realign the repository, which is  AFIP’s primary research resource, to the Forest Glen Annex, Maryland,  under the management of USUHS. The BRAC provision allows DOD the flexibility to retain capabilities that  were not specifically addressed in the provision. In accordance with this  statutory authority, the ASD(HA) has retained four additional AFIP  services and is considering whether to retain six others. According to  DOD’s most recently developed implementation plan, dated February  2007, DOD had planned to begin implementation of the BRAC provision  relating to AFIP in July 2007 and to complete action by September 2011. However, a provision from the 2007 supplemental appropriations act  prevents DOD from reorganizing or relocating any AFIP functions until  after DOD has submitted detailed plans and timetables for the proposed  reorganization and relocation to Congress. Once the reorganization plan  has been submitted, DOD can resume reorganizing and relocating AFIP. Most of AFIP’s Services Will Be Terminated, but Some Will Be Relocated

DOD plans to terminate AFIP’s provision of diagnostic consultations and  outsource certain DOD diagnostic consultations to the private sector  through a newly established PMO. However, a smooth  transition depends on DOD’s actions to address key challenges involved in  developing new approaches to obtaining subspecialty pathology  consultations and managing the repository to facilitate its use for research. DOD and VA officials have begun to identify the challenges, but have not  decided upon strategies to address them. These challenges include determining how to  effectively use existing subspecialty pathology resources, obtain outside  expertise, and ensure coordination and funding of services to encourage  efficiency while avoiding disincentives to quality care. Research Could Be Affected Depending on How DOD Plans to Populate, Maintain, and Use the Repository in the Future

Because DOD has not developed its strategy regarding how it will  populate, maintain, and use the repository, some pathologists we  interviewed were concerned about the future of the repository and  whether it would continue to be a viable research tool. DOD  awarded a contract to study the usefulness of the material in the  repository, which it anticipates to be completed by the end of 2008. Appendix I: Scope and Methodology

To describe key services that the Armed Forces Institute of Pathology  (AFIP) provides to the Department of Defense (DOD), the Department of  Veterans Affairs (VA), and civilian communities, we reviewed recent  reports describing AFIP’s services and business practices, including a  previous GAO report and an Army Audit Agency report on AFIP’s  business plan and a BearingPoint report on AFIP’s capabilities, and other  relevant reports, including some from VA. We also interviewed officials  from AFIP, DOD, VA, the American Registry of Pathology (ARP),  pathology associations such as the College of American Pathologists  (CAP), the American Society for Investigative Pathology, and the  Association of Pathology Chairs, as well as radiology associations, such as  the American College of Radiology and the Canadian Radiology  Association, to collect information on AFIP’s core services. To describe DOD’s plans to terminate, relocate, or outsource services  currently provided by AFIP, as required by the Base Realignment and  Closure (BRAC) provision, we interviewed officials from DOD’s Offices of  the Surgeons General of the Army, Navy, and Air Force; the Office of the  Assistant Secretary of Defense for Health Affairs; the Office of the General  Counsel; the TRICARE Management Activity; the Office of the Deputy  Under Secretary of Defense (Installations and Environment); AFIP; and  the Uniformed Services University of the Health Sciences (USUHS).
Why GAO Did This Study

The 2005 Base Realignment and Closure (BRAC) provision required the Department of Defense (DOD) to close the Armed Forces Institute of Pathology (AFIP). GAO was asked to address the status and potential impact of implementing this BRAC provision. This report discusses (1) key services AFIP provides to the military and civilian communities; (2) DOD's plans to terminate, 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 this GAO report as it develops its plan for the reorganization of AFIP. GAO reviewed DOD's plans, analysis, and other relevant information, and interviewed officials from the public and private sectors.

What GAO Found

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