Cost, value, and accuracy in molecular diagnostics
A recent webinar from CAP Today offers insight into the finances of respiratory testing for clinical lab professionals. “Adapting Your Respiratory Testing Algorithm in a Changing Reimbursement Landscape” features two speakers, Charles Mathews, a vice president at Boston Healthcare, and Margie Morgan, scientific director of microbiology at the 900-bed Cedars-Sinai Medical Center in Los Angeles. The webinar is particularly useful for anyone seeking to optimize respiratory algorithms based on reimbursement.
The Dynamics of Respiratory Testing, Coding, and Payer Coverage
In the first talk, Mathews presents information about the dynamics of respiratory testing, coding options, and payer coverage, and how payment will evolve in the future. He explores the advantages that molecular testing has enabled for respiratory care cases, noting that cost has been an ongoing challenge despite benefits such as rapid results, multiplexing, and increased accuracy. Complexities around cost vary by setting: in-patients at hospitals, for example, are treated differently by payers than patients visiting a doctor’s office. There’s plenty of great detail about CPT codes, payment amounts by test type, the costs of PCR panel-based tests, specific payer policies, and more. One of the main shifts in payer coverage of tests, Mathews notes, was caused by increased use (and therefore cost) of molecular diagnostic tests; insurers are now paying more attention, seeking to understand the differences among tests and the justification for when to use a test. He anticipates that in the future, certain tests may only be covered for specific populations, with more restrictions for higher-cost tests.
Molecular Testing With Flexible Pricing
In her presentation, Morgan, who runs a large microbiology lab, speaks about embracing molecular tests for their advantages over culture-based tests. She says the shift to these tests has also necessitated a better understanding of business for lab directors, particularly for evaluating test options based on a range of clinical and economic factors. Another major shift is that patients are more aware of and sensitive to diagnostic costs as insurance plans place more of the burden to the individual. According to Morgan, current lab protocols can lead to expensive testing for cases where multiple instruments have to be used to accommodate a physician’s order of targets; lab directors must make careful decisions about which platforms and assays to bring in not just for test accuracy but also for test value. Morgan’s presentation includes helpful information about how to choose a test based on patient and physician needs, the value of antimicrobial stewardship programs for limiting the use of antibiotics, returning results in physician-friendly reports, and more. Finally, she shares her lab’s evolution in respiratory testing, leading to the implementation of the VERIGENE® RP Flex Test for a panel-based assay with flexible pricing. Morgan provides a step-by-step view of how her lab uses this assay for the hospital’s patient population and how it significantly reduced costs per test.
The webinar, which includes an audience Q&A at the end, is well worth a listen. Enjoy!
