J Molec Dx: A Quartet of Important Articles on Genomics Reimbursement

This week, I had the chance to chair one panel of a workshop on genomics policy at National Academy of Medicine and there was an excellent talk by Dr. Katrina Armstrong, Physician-In-Chief of MGH.  Therein, she included eye popping graphics from the 2016 paper by Lennerz et al. (MGH) on the insanity of genomics reimbursement processes and pathways.

The article appeared in Journal of Molecular Diagnostics, the journal of the Association for Molecular Pathology, and Lennerz et al. can be viewed as one of a quartet of articles on genomics reimbursement in this journal in 2016, 2017, and 2018.

click to enlarge

For one example of the interesting material in this quartet of articles, see Lennerz et al. figure for the reimbursement maze for a genomic test:

Lennerz Fig. 3

I've provided Pubmed links to each of the articles below; most are open access.

Lennerz et al. (2016)  Health Care Infrastructure for Financially Sustainable Clinical Genomics.  J Mol Diagn 18:697-706. [open]   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397703/

Sabatini et al. (2016)  Genomic Sequencing Procedure Microcosting Analysis and Health Economic Cost-Impact Analysis: Report of the AMP.  J Mol Diagn 18:319-328. [open]  https://www.ncbi.nlm.nih.gov/pubmed/?term=27080370 

Sireci et al. (2017) Clinical Genomic Profiling of a Diverse Array of Oncology Specimens at a Large Academic Cancer Center: Identification of Targetable Variants and Experience with Reimbursement.  J Mol Diagn 19:277-287. [open] https://www.ncbi.nlm.nih.gov/pubmed/?term=28024947

Hsiao et al. (2018)  The History and Impact of Molecular Coding Changes on Coverage and Reimbursement of Molecular Diagnostic Tests: Transition from Stacking Codes to the Current Molecular Code Set Including Genomic Sequencing Procedures.  J Mol Diagn 20:177-183. [subscription] https://www.ncbi.nlm.nih.gov/pubmed/?term=29269278    With op-ed by Farkas, here.


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For an additional current perspective, see Phillips et al. (2018) Genetic Test Availability and Spending: Where Are We Now?  Where Are We Going?    Health Affairs 37:710-716. [open access]  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987210/      Another open access source is Concert Genetics' annual white papers on the genomics market, here.