OBJECTIVES:

Molecular testing is often used to guide practitioners and patients to select treatment or clinical trials. Payment coverage for molecular testing varies by technology and vendor. We examined the impact of billing practice changes for genomic testing (GT) on utilization in an academic hybrid, multi-site community-based cancer institute.

METHODS:

In June 2015, Levine Cancer Institute (LCI) standardized the availability and use of GT across its 26 sites. GT consisted of a commercially produced, tissue-based ~600 gene panel (Panel A) which guided treatment and clinical trial selection with a maximum cost to patient of $550. In June 2017, vendor-negotiated rates with public/private insurers were implemented increasing patient out-of-pocket (OOP) costs between 45% and 518% (insurance provider and cancer type dependent). LCI instituted financial consents in order to test samples to ensure patients understood OOP costs. A liquid biopsy panel (B; ~40 genes) was added in October 2016 for no charge to patients via institutional research agreement. Using institutional data on GT ordered and patient financial consent, we examined how GT utilization has changed and been impacted by billing changes.

RESULTS: Since its peak in April 2016 (n=122, 32 ordering physicians), Panel A’s utilization has decreased (May 2017, n=36, 28 ordering physicians). Panel B’s utilization remained constant until February 2017 when test volume increased (n=22, 3 ordering physicians) and continued increasing (May 2017, n=44, 6 ordering physicians; Feb-Jun2017 mean=32). In June 2017, orders for Panel A decreased (n=18, 10 ordering physicians). Nine financial consents were returned and specimens shipped for analysis. Panel B orders remained constant (n=30, 9 ordering physicians) in June 2017.

CONCLUSIONS: Preliminary data suggest billing practice changes could impact physician’s willingness-to-order and patient’s willingness-to-pay for genomic tests. While Panels A and B are imperfect substitutes, these data provide real-world evidence of how GT can be impacted by billing practices.