EAC101 Working Group, a Working Group of the Association for Molecular Pathology Economic Affairs Committee, Rockville, Maryland; Loxo Oncology, a wholly owned subsidiary of Eli Lilly, Stamford, Connecticut.
EAC101 Working Group, a Working Group of the Association for Molecular Pathology Economic Affairs Committee, Rockville, Maryland; Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, Utah.
J Mol Diagn. 2020 Aug;22(8):975-993. doi: 10.1016/j.jmoldx.2020.05.008. Epub 2020 Jun 3.
Widespread indications for use of molecular diagnostics in various aspects of clinical medicine have driven proliferation of testing. The rapid adoption and continuous technological evolution of molecular diagnostics have often strained the development and maintenance of a functional underlying framework of coding, coverage, and reimbursement policies, thereby presenting challenges to various stakeholders, including molecular professionals, payers, and patients. A multidisciplinary working group convened by the Association for Molecular Pathology Economic Affairs Committee was tasked to describe the complex landscape of molecular pathology economics and highlight opportunities for member engagement. In this article, on the basis of review and synthesis of government regulations and procedures, published payer policy documents, peer-reviewed literature, and expert consensus, the Working Group navigates the ecosystem of molecular pathology economics in terms of stakeholders, coding systems and processes, coverage policy determination, and pricing mechanisms. The composition and interrelatedness of various working groups and committees are emphasized to highlight the functional underpinnings of the system. Molecular professionals must be conversant in the language and complex inner workings of molecular pathology economics to lead successful, viable laboratories and advocate effectively for policy development on their behalf. This overview is provided to be a resource to molecular professionals as they navigate the reimbursement landscape.
在临床医学的各个方面广泛应用分子诊断的迹象推动了检测的普及。分子诊断的快速采用和不断的技术发展，往往对编码、覆盖范围和报销政策的基本功能框架的发展和维护造成压力，从而给包括分子专业人员、支付者和患者在内的各种利益相关者带来挑战。一个由美国病理学会分子病理学经济事务委员会召集的多学科工作组的任务是描述分子病理学经济学的复杂格局，并强调成员参与的机会。在本文中，工作组根据对政府法规和程序、已发表的支付者政策文件、同行评议文献和专家共识的审查和综合，从利益相关者、编码系统和流程、覆盖政策确定以及定价机制等方面探讨了分子病理学经济学的生态系统。强调了各个工作组和委员会的组成和相互关系，以突出该系统的功能基础。分子专业人员必须精通分子病理学经济学的语言和复杂内部运作，才能领导成功、可行的实验室，并代表他们有效地倡导政策制定。本文旨在为分子专业人员在报销领域提供参考。
