How to turn genetic testing from cost-prohibitive to cost-efficient

How to Turn Genetic Testing From Cost-Prohibitive to Cost-Efficient

The past decade has yielded remarkable progress in genetic testing.

However, this new methodology can come with some pretty steep expenses: new technologies, new processes, new volumes of data, new analytical needs and more.

While you likely recognize that the advantages strongly outweigh the expenses, your C-suite may have a different view. But don’t let upfront costs hamper your ability to support optimal care. Help gain approval for genetic testing by making a financial business case.

Here are our top three tips to show how you can turn genetic testing from cost-prohibitive to cost-efficient.

Article highlights:

  • Genetic testing brings unprecedented opportunities to support quality care

  • However, it brings potentially large costs that can derail C-suite buy-in

  • Follow these three tips to demonstrate how genetic testing can ultimately save costs and elevate the value of laboratory diagnostics

Contributing Lab Leader

Charles Mathews

Vice President, Boston Healthcare

Board Member, MassMedic

1. Conduct a utilization study

Share your findings with leaders of other labs in your institution as well as peers at outside labs. Compare your utilization ideas and find out how others have created more efficient genetic testing solutions.

Charles Mathews encourages lab leaders to pull back from the daily grind and assess how their lab would utilize genetic testing. According to Mathews, you’ll likely uncover myriad opportunities to save resources.

“Historically,” says Mathews, “there have been largely one-off individual tests, such as PCR tests for single genes. Payers would slowly get their minds around the idea that this gene is valuable and that gene is valuable, and you’d test for one at a time.”

“But multiplex testing has moved faster than payers and hospitals have. Technology has outpaced our current system. We need to consider that, in some cases, it may be more efficient and more valuable to do a panel than to go on a diagnostic odyssey, testing for single genes, one by one.”

Recognizing “the diagnostic odyssey”

Look for cases where clinicians order multiple single-factor tests for the same patient over a period of time. Consider the impact of this “hunt-and-peck” methodology:

  • Rising costs, staff utilization, and turnaround time

  • Delays in definitive diagnosis

  • Postponement of optimized treatment

 

How to assess current/future genetic testing utilization

Here are some essential questions Mathews recommends that lab leaders ask themselves and their colleagues:

  1. What tests are being ordered on the most regular basis?

  2. What are the clinician’s goals in ordering these tests?

  3. Are there genetic tests that could achieve the same goal?

    1. Could they achieve it faster, at less cost or with fewer steps?

    2. Could they provide other valuable information?

  4. Do you stock tests that you believe are underutilized by your institution?

 

2. Initiate collaboration with colleagues

After you’ve conducted your utilization study and identified some potential applications for genetic testing, pressure test your ideas with colleagues.

Soliciting best practices for utilization will help you refine your approach. It will also help expand ownership over the initiative—a key step in gaining alignment.

Here’s our guide on whom to engage and what topics to cover, before making recommendations to your institution’s executive leadership:

Fellow laboratorians

Share your findings with leaders of other labs in your institution as well as peers at outside labs. Compare your utilization ideas and find out how others have created more efficient genetic testing solutions.

“The onus is on us as a laboratory community to get unified. From a laboratorian’s perspective, it doesn’t make sense to run 15 different PCR tests one next to the other. We need to advocate for looking at things in a broader, more comprehensive way.”

Charles Mathews
Vice President, Boston Healthcare
MassMedic

Overcoming resistance

One of the big challenges you may face is the lab’s resistance to paying for novel testing methods. “Payers often say ‘Why should we pay for research?’” notes Matthews.

Here’s where you can start to sharpen your argument for cost-efficiency. Consider the value of identifying an infectious disease quickly through the use of a genetic panel, rather than overprescribing antibiotics while waiting for the results of multiple PCR tests

Clinicians

“Think about the situation hospital IT departments were in 10 years ago,” says Matthews. “That’s where we are now. They were the guys behind the scenes who clinicians yelled at when something went wrong.” Today, IT is a department that is relied upon for their expertise and contributions—what the lab needs to quickly become.

Laboratorians need to connect with clinicians over shared goals. When trying to gain buy-in on new testing options, keep the discussion centered on the care challenges that clinicians want to address. Cost is a factor, but don’t focus on it too soon.

Help them recognize the negative impact of the diagnostic odyssey on patients. They may be struggling—and you may be able to help.

Example topics for engaging clinical teams

Infectious disease
  • Discuss the potential to reduce empiric antibiotic use while waiting for cultures
  • Explain how genetic panels can identify multiple infections relatively quickly
  • Consider long-term economic benefits (better outcomes, reduced stays, efficient drug spend) of tailored antibiotics vs. overuse of vancomycin and other “big guns”
  • Discuss your institution’s HAI containment and prevention strategies

Oncology
  • Discuss challenges and opportunities around improving adherence to national guidelines

    For example: Broad molecular profiling is recommended for advanced NSCLC, but tests for EGFR and ALK are not ordered for approximately 30% of patients1
  • Explore the range of targeted companion diagnostics available
  • Consider shared advocacy regarding payer resistance to immuno-oncology testing and treatment
  • Discuss institutional value of consolidating all oncology testing to a single in-house lab for aggregated retrospective analysis

3. Put prospective vendors to work

In making the strongest cost-efficiency case for genetic testing, rely on vendor experts. Their knowledge of market challenges, products, lab workflows, etc. will be pivotal to your planning.

A good vendor is not just a transactor of products, but a true partner in your success. Do not hesitate to request the following:

  • All relevant publications that relate to your situation at hand
  • Specific examples of their successful implementation of this test/technology in other institutions
  • Critical success metrics for gauging success
  • Cost calculators than can quantify the impact of change

Your ultimate goal is to demonstrate the value of genetic testing—a methodology that can actually improve the quality of care while reducing the cost of it.

Reference:

1. Gutierrez ME, Choi K, Lanman RB, et al. Genomic profiling of advanced non-small cell lung cancer in community settings: gaps and opportunities. Clin Lung Canc. 2017. [Epub ahead of print]

 


Additional resources

Previous Article
The Pursuit of Excellence: Where does your lab rank on the quality continuum?
The Pursuit of Excellence: Where does your lab rank on the quality continuum?

Where does your lab rank on the quality continuum?

Next Article
The Tao of Labacoeconomics
The Tao of Labacoeconomics

×

LabLeaders.com has a new home. Tell us a bit about yourself.

Thank you!
Error - something went wrong!