I recently described some ways that genetic counselors reduce hospital liability in this blog post. Equally important to hospitals is finding cost-effective approaches to healthcare. The American College of Physicians (ACP) says that major drivers of health care costs are inappropriate utilization of advanced medical technology, lack of patient involvement in decision-making, high prices for services and a health care workforce that is not aligned with national needs. These are all issues for genomic medicine that can be addressed by genetic counselors.
With 68,000 genetic tests listed in the GeneTests database and a $4 billion spend in 2016, genomics technology continues to take off like a rocket. Once the purview of geneticists alone, genetic tests are being ordered by pathologists, oncologists, neurologists, cardiologists and other physicians. For better or for worse, it is often sales reps who are educating physicians about new advances in genetics.
Genetic counselors are health care providers who are genetics experts. They are board-certified, masters-level providers that are just the people you need to rein in the genetic testing rocket and save hospital dollars while delivering patient-centered care.
1. Help end a patient’s “diagnostic odyssey.”
A study by Duke University showed that 72% of genetics patients were diagnosed on the first visit but that up to 16 years and an average of $25,000 were spent on testing for patients who were not diagnosed on the first visit. Genetic counselors know the technical advantages and limitations of existing tests and can zero in on the best tests for patients early in the process, thereby saving money.
According to the Bureau of Labor Statistics, genetic counselors in the US earned a mean annual salary of $74,000 in 2016, significantly less than physicians.
3. Determine the best test.
In a particularly concerning study out of Columbia, physicians were asked about their knowledge of genetic testing. While nearly half of them said they’d ordered a genetic test, almost 90% said that they had poor knowledge of testing guidelines and 3/4 of them rated their knowledge of genetic tests as “poor or somewhat poor.” This lack of expertise leads to costly mistakes! It is not uncommon for physicians to order the wrong test or duplicate tests. In addition to other harms, the difference between ordering the wrong test and ordering the correct one can easily be thousands of dollars.
4. Manage test utilization, based on payer policies.
Most genetic tests are so specialized that they must be sent out to commercial reference labs. Most of the commercial labs don’t participate in Medicaid, leaving the hospital with the bill. Commercial payers are slowly catching up and have policies around reimbursement for some of the more common tests. Unless a physician orders particular test frequently, their physician office is unlikely to be adept at navigating payer reimbursement policies the way that genetic counselors are.
5. Choose a participating reference laboratory.
Genetic counselors can direct genetic tests to labs within the patient’s insurance policy network. Estimates by some suggest that up to 40% of genetic tests are sent to non-par labs instead of labs that participate in a patient’s insurance network. Labs outside the network do not have contracted rates with payers and are almost always more costly than a par lab. This not only costs the hospital money, but there are repercussions for the patient’s out-of-pocket costs as well (see this article if you’re interested in learning more about how messed up the financial aspects of this can be for patients).
6. Order the test correctly.
Genetics labs often require detailed information about the patient in order to do the interpretation, which many physicians don’t provide. Without this information, the results are not as robust (and are at risk for being misinterpreted, which exposes the hospital to liability). In one study by ARUP, one-third of tests orders had mistakes on the orders.