Dermatopathology in an Era of Health Care Reform

To predict the effects of health care reform on the practice of dermatopathology, one must be either omnipotent or foolish. The Patient Protection and Affordable Care Act (PPACA) established many requirements regarding health insurance coverage but mandated few specific changes to health care payment and delivery. The mechanisms by which physicians and hospitals eventually will be paid are far from certain, but it is fair to predict that reform efforts will emphasize coordinated care, quality improvement, and movement away from the fee-for-service payment model. Somewhat unpredictable changes to the practice of dermatopathology are likely to evolve as a direct result of the PPACA's health system reform measures, which includes accountable care organizations (ACOs), bundled payments, establishment of quality measures, outcome-based incentive payments, and perhaps the decisions of the independent payment advisory board. To complicate matters, the impact of various reforms will differ based on geographic location, practice type, and insurance mix. For the foreseeable future, there is no "one size fits all" approach to health care reform.