Occupy the Laboratory?

There have been many salutes to Rich Flaherty this year, marking his retirement after serving as AACC’s Executive Vice President for two decades. But it is unlikely that any will match the warm remembrance he himself offered at the recent fall meeting of the Southeast Local Section. On a particularly beautiful autumn evening in Alabama, Rich reflected on his thirty-five year career in healthcare, and offered advice for facing the challenges ahead.

Rich received his BA from Boston College in 1968. Many of the odd jobs he held during his college days exposed him to both the academic and nitty-gritty sides of healthcare delivery, and also eerily foreshadowed his future at AACC. He worked evenings at the Treadwell Library at Massachusetts General Hospital and also slung the hash at Harvard’s McLean Hospital, a noted psychiatric facility. He recounted having his pre-employment blood test drawn in an antiquated early 20th century laboratory at McLean’s which he later discovered had been the domain of Dr. Otto Folin, the biochemist who pioneered the use of protein-free filtrates for serum chemistry analyses. He mentioned the 16th annual meeting of the AACC held in Boston in 1964 and, having looked up the registration fee of $7.50, guessed that even then many probably thought this exorbitant.

Rich received his Masters of Health Administration from Duke University and was a research analyst for the American Blood Commission before joining the Health Industry Manufacturers Association. He held a variety of positions there, including Director of Diagnostic Standards, Director of Federal Affairs, and Vice President. He joined AACC in 1991 as Executive Vice President. That was, of course, shortly after the implementation of CLIA ’88 and Rich took us on a Washington-insider’s view of the “CLIAs”, beginning in 1965, when Dr. F. William Sunderman complained that government officials had “presented a distorted picture of the clinical laboratory to Congress”. In Rich’s view, the clinical laboratory industry is a model of self-regulation that other industries should emulate. It is true that there have been, are, and always will be a couple of bad apples in the basket. But, as Rich nicely outlined, by the time the first iteration of CLIA was being debated in Congress in the 1960s, the country’s laboratory leadership had already begun to put rigorous, if voluntary, constraints on the performance of laboratory testing.

The College of American Pathologists created an ad hoc committee to develop laboratory standards and an accreditation program in 1961. By 1964, CAP had accredited its first laboratory (in Birmingham, the site of the recent Southeast Local Section meeting) and these standards were universally recognized as more stringent that the ones passed by Congress in 1967. The same year that CLIA ’67 passed, representatives of thirty organizations met in Miami to form a provisional “National Committee for Clinical Laboratory Standards” (now the very influential Clinical Laboratory Standards Institute).  And, in Rich’s view, the progress of our industry’s own self-regulation continued unabated, with the AACC taking a major leadership role in supporting the National Academy of Clinical Biochemistry in the 1990s and its development of “Standards of Laboratory Practice” (now the well-regarded Laboratory Medicine Practice Guidelines).

It was interesting to learn that Rich did post-graduate work in the 1970s studying the National Health Service in the U.K. at King’s College in London. So it was appropriate that he moved the discussion to last year’s Affordable Care Act. This controversial law, the constitutionality of which will be reviewed by the Supreme Court in March, has no direct focus on clinical laboratory testing, of course. But Rich highlighted a few relatively minor components of the law which could have impact on laboratories, and which we should be discussing. One is the “Center for Medicare and Medicaid Innovation”. Related are the linking of payment to outcome, and a pilot program to improve the integration of medical services. The NACB’s LMPGs are a good start but we need a much more robust system for involvement of the AACC in the national discussion of these initiatives. Rich closed by noting that, although the AACC has accomplished much in the past 20 years - from establishing our meeting as the premier laboratory showcase; to the maturation of “Clinical Chemistry” into a scientific journal with a high impact factor; to the success of Lab Tests Online as a useful portal for general information – we have not been as active in government affairs as we should be.

Rich was not unaware of the challenges, and he presented a useful list of observations regarding the way members of Congress (Congressional staffers, really) view people attempting to influence legislation (OK, I’ll use the word – lobbyists). Being right isn’t good enough, he said, and a good anecdote trumps data; our obsession with accuracy and precision may be hurting us when we engage the body politic. But perhaps most importantly, Rich said, Congress doesn’t do nuance. There are too many individual organizations claiming to represent the clinical laboratory. We may need another big meeting in Miami like the one that created CLSI in order to all get together and agree on a single plan. But we also all need to take Rich’s advice and get more pumped up about politics. I don’t think an “Occupy the Laboratory” campaign is in order, but it would not be inappropriate for some sort of dramatic demonstration of the need for all laboratorians to become more involved on Capitol Hill. Any suggestions?