Center for Business Models in Healthcare, Glencoe, Illinois, USA.
Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, California, USA.
J Genet Couns. 2022 Dec;31(6):1394-1403. doi: 10.1002/jgc4.1614. Epub 2022 Jul 28.
Multi-cancer gene panels for hereditary cancer syndromes (hereditary cancer panels, HCPs) are widely available, and some laboratories have programs that limit patients' out-of-pocket (OOP) cost share. However, little is known about practices by cancer genetic counselors for discussing and ordering an HCP and how insurance reimbursement and patient out-of-pocket share impact these practices. We conducted a survey of cancer genetic counselors based in the United States through the National Society of Genetic Counselors to assess the impact of reimbursement and patient OOP share on ordering of an HCP and hereditary cancer genetic counseling. Data analyses were conducted using chi-square and t tests. We received 135 responses (16% response rate). We found that the vast majority of respondents (94%, 127/135) ordered an HCP for patients rather than single-gene tests to assess hereditary cancer predisposition. Two-thirds of respondents reported that their institution had no protocol related to discussing HCPs with patients. Most respondents (84%, 114/135) indicated clinical indications and patients' requests as important in selecting and ordering HCPs, while 42%, 57/135, considered reimbursement and patient OOP share factors important. We found statistically significant differences in reporting of insurance as a frequently used payment method for HCPs and in-person genetic counseling (84% versus 59%, respectively, p < 0.0001). Perceived patient willingness to pay more than $100 was significantly higher for HCPs than for genetic counseling(41% versus 22%, respectively, p < 0.01). In sum, genetic counselors' widespread selection and ordering of HCPs is driven more by clinical indications and patient preferences than payment considerations. Respondents perceived that testing is more often reimbursed by insurance than genetic counseling, and patients are more willing to pay for an HCP than for genetic counseling. Policy efforts should address this incongruence in reimbursement and patient OOP share. Patient-centered communication should educate patients on the benefit of genetic counseling.
多癌种基因panel 用于遗传性癌症综合征（遗传性癌症panel，HCP）的检测，目前已经广泛应用于临床，部分实验室的相关检测项目也会限制患者的自费部分（out-of-pocket，OOP）。然而，对于癌症遗传咨询师在讨论和安排 HCP 检测以及保险报销和患者自费部分如何影响这些实践的了解甚少。我们通过美国国家遗传咨询师协会对美国的癌症遗传咨询师进行了一项调查，以评估报销和患者自费部分对 HCP 检测和遗传性癌症遗传咨询的影响。数据分析采用卡方检验和 t 检验。我们收到了 135 份回复（16%的回复率）。结果发现，绝大多数受访者（94%，127/135）为患者订购 HCP 检测，而不是单项基因检测，以评估遗传性癌症易感性。三分之二的受访者报告说，他们的机构没有与患者讨论 HCP 的相关协议。大多数受访者（84%，114/135）表示，临床指征和患者的要求是选择和订购 HCP 的重要因素，而 42%（57/135）认为报销和患者自费部分是重要因素。我们发现，报告 HCP 经常使用保险支付和面对面遗传咨询的差异具有统计学意义（分别为 84%和 59%，p<0.0001）。与遗传咨询相比，患者更愿意为 HCP 支付超过 100 美元的费用（分别为 41%和 22%，p<0.01）。总之，遗传咨询师广泛选择和订购 HCP 的原因更多是基于临床指征和患者的偏好，而不是支付因素。受访者认为，与遗传咨询相比，检测通常由保险报销，患者更愿意为 HCP 付费，而不是遗传咨询。政策应该解决报销和患者自费部分的这种不一致性。以患者为中心的沟通应该教育患者遗传咨询的好处。
