Optimize genetic testing with a multidisciplinary team

Contributing lab leaders: Charles Mathews and Jessie Conta

Multi-disciplinary teams bring a multitude of benefits to an organization. Breaking out of traditional silos and working toward better integration not only enables better care delivery, but also more cost-effective care. And when dealing with costly genetic tests, cost efficiency is one thing you can’t afford to pass up.

With individual tests costing upward of thousands of dollars, institutions need to ensure they’re being used in the smartest, most cost-efficient way. The easiest way to do this is by having the right team in place for appropriate checks and balances.

Article highlights:

  • Partner with physicians to tailor the test protocol.
  • Genetic counselors play a role in developing a strong rationale for testing that can be explained to payers and increase reimbursement.
  • Pathologists contribute to a comprehensive care triad through knowledge of different testing options, costs associated, and interpreting results.

Genetic testing is a team sport

While many routine lab tests are straight-forward, there is a much wider knowledge base required to effectively order, interpret and act on genetic tests.

Considerations need to include:

  • Is genetic testing appropriate in this case?
  • What test(s) should be run?
  • What information will be needed now and in the future?
  • How much do the tests cost?
  • Will they be covered by a payer?
  • Are there any implications from the results to family members?
  • How do the results impact treatment options?

A multi-disciplinary team including a physician, pathologist and genetic counselor would be best equipped to appropriately address each of these considerations. By blending areas of expertise and taking these points into account prior to testing, tests can be used more sparingly and to their fullest extent.

Encourage closer collaboration between each of these team members to not only benefit patients, but your institution as well. Below, we examine the three most prominent case scenarios that could be optimized through further integration.

You need the pathologist to do the histology; you need the genetic counselor to work with the patient, or talk through the family history; and you need the physician to put it all in context.

Charles Mathews
ClearView Healthcare Partners

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1. Tailoring test order protocol

Who to involve: physician & pathologist

Test menus often comprise hundreds of testing options, all with various price points. While physicians may routinely rely on a select few, they may not always be the most appropriate for a given patient.

It is critical to consider if more information upfront will be beneficial in the long run, especially with costly genetic testing. Consulting with a pathologist on test orders can help ensure that the right test(s) is used at the right time.

The combined expertise of a pathologist and a physician ensures that the best decision is made in the context of each individual patient.

2. Making a stronger case for reimbursement

Who to involve: physician & genetic counselor

In many cases, payers are still reluctant to pay for genetic testing unless a specific need can be demonstrated. If this type of testing is thought to be valuable in an individual case, involving a genetic counselor early on can make it easier to get reimbursed later.

The role of a genetic counselor is multifaceted, but they can add significant value to your team by advocating for the patient. A genetic counselor will have the expertise to make a compelling argument for why a test is medically necessary. They will be able to develop a strong rationale that can be explained to payers to increase reimbursement.

In many ways, the key to furthering physician education is to realize that the laboratory isn't merely a standalone department—it's a critical repository of expert knowledge. When lab leaders find ways to share that knowledge effectively, physicians, laboratorians, and patients always win.

By combining a physician’s patient knowledge with the expertise of a genetic counselor, you can significantly reduce wasteful testing and make a stronger case to payers.

On insurance preauthorization for the right patients

Jessie Conta
Manager - Laboratory Stewardship Program & PLUGS®
Seattle Children's Hospital.

3. Driving comprehensive patient care

Who to involve: physician, pathologist & genetic counselor

The combination of a physician, pathologist and genetic counselor is the triad for supporting more comprehensive patient care. Their individual areas of expertise bring unique value to each case and can greatly benefit one another.

By joining efforts and working toward the common goal of delivering the best possible care, this integrated team can reduce costs while improving quality.

Genetic testing triad

Circle 1: Physicians
Where they can contribute the most:
  • Have intimate patient knowledge
  • Know the specifics of each case
  • Determine treatment options
Where they rely on others:
  • Aren’t always well-versed in broad testing menu
  • Don’t necessarily know the full implications of a result
Circle 2: Pathologists
Where they can contribute the most:
  • Have extensive knowledge of testing options
  • Know the costs associated with each test
  • Have a broad understanding of how and when various tests are applicable
Circle 3: Genetic counselors
Where they can contribute the most:
  • Determine when genetic testing is necessary
  • Coach patients and family members through testing process
  • Have superior ability to interpret results and guide treatment
  • Can advocate for patients with payers
Where they rely on others:
  • Can be seen as an afterthought
  • DNot typically brought in early enough
Circle 7: Pathologists
Where they can contribute the most:
  • Deliver the best possible care in the most cost-effective way
  • Determine the most appropriate tests and interpret results in the context of each individual patient
  • Provide better guidance to patients and their families

As genetic testing continues to advance and our ability to collect and analyze data grows, success depends on having the right experts on board. A multi-disciplinary team empowers your institution to make smarter, more informed decisions when it comes to ordering and acting on tests.

While no one person may be the “expert” on everything, bringing together teams will allow you to up the ante on care delivery through better integration and collaboration. This means delivering better care for your patients and taking better care of your bottom line.

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