This finding is reinforced by the fact that high-deductible health plans are now the second most popular plan option offered by the nation’s employers
Getting paid for expensive genetic cancer tests is likely to be tougher for clinical laboratories when the patient is covered by a high-deductible health plan. There are two trends that are contributing to this situation, each highlighted by recently-published studies.
One trend is the rapid growth of consumer-driven health plans (CDHPs). The second trend is growing evidence that patients, if they need to pay much money out of pocket, will decline to undergo genetic testing that is suggested by their physicians.
Enrollment in CDHPs Has Picked Up in Recent Years
It is a fact that CDHPs are now the second most common plan design that U.S. employers now offer, recently surpassing HMOs. This was a finding in the survey conducted consultants Aon Hewitt, of Lincolnshire, Illinois.
The growth of CDHPs is important because it shows employers are shifting costs to employees. When costs shift to employees, clinical laboratories and anatomic pathology groups may be left with unpaid bills.
The report on Aon’s survey of nearly 2,000 U.S. employers showed that 58% offered CDHPs last year, compared to just 38% of employers that offered HMOs. The most popular plans were preferred provider organizations (PPOs), which 79% of employers offered last year. Aon reported these findings in a press release issued on September 17.
Clinical Labs Could Find It Tougher to Collect from Patients
These survey results should concern pathologists and clinical laboratory managers for an important reason. The survey provides evidence that a growing number of patients will be responsible for their own medical laboratory testing bills. In June, The Dark Report explained how consumer-directed or high-deductible health plans (HDHPs) were affecting labs as health insurers shifted costs to employees. (See The Dark Report, June 4, 2012, “Health Insurers Now Finding Ways to Cut Costs and Shed Risks”.)
Also in June, researchers at Fox Chase Cancer Center in Philadelphia, Pennsylvania, reported that not all patients will pay for genetic testing. The researchers further determined that most patients would limit their spending on these genetic tests to $500.
When presenting their report at the annual meeting of the American Society of Clinical Oncology in June, the Fox Chase researchers found that 82 people—21.3%—said they would undergo genetic testing only if it was paid for by their insurance. This reluctance by consumers to pay for genetic tests concerns some healthcare experts because of the essential role that genetic testing plays in a growing number of diseases.
“Genetic testing is now routinely integrated into cancer care,” said Jennifer M. Matro, M.D., a medical oncology fellow at Fox Chase and author of the study. “If someone develops colorectal cancer, for instance, a reflex preliminary screening test is done on the tumor to identify patients at risk for Lynch syndrome, which would put them at risk for other gastrointestinal cancers, endometrial, and renal cancers, among others.
“If the test is positive,” continued Matro, “the patient is then referred for additional testing to diagnose Lynch syndrome. If the screen is negative, no additional testing is done. This preliminary screen is generally covered by all insurers, but patients may be asked to pay some of the cost if additional testing is needed.”
Will Medical Labs “Get Stiffed” by Consumers for Genetic Tests?
For anatomic pathology and clinical laboratories seeking to avoid getting stiffed for the cost of expensive genetic testing, Matro recommended that researchers determine which patients are at the highest risk and would benefit most from a genetic test. This knowledge would support clinical guidelines that excluded individuals with fewer risk factors—thus helping them avoid the cost of an expensive genetic test that would not bring them much benefit.
“We need to discover more risk factors for genetic mutations, so we can spare those patients who really don’t need to pay for genetic testing,” Matro explained.
To determine whether costs affect patients’ decisions to obtain genetic testing, the Fox Chase researchers reviewed data collected from 406 patients whose doctors suspected they may have cancer-causing mutations based on their personal or family history. The researchers found that:
- Of this number, 82 people (21.3%) said they would undergo genetic testing only if their insurer paid for the tests.
- Among those willing to pay some of the costs, nearly 90% limited how much they would pay.
- Most of these patients set the limit at $500 or less, the researchers said.
The Fox Chase researchers also found that those patients who were more worried about their risk of cancer and had positive attitudes toward genetic testing were more willing to pay higher costs. Conversely, those, who were less likely to agree to high co-pays for genetic testing included women, patients who were less educated, and those with more first-degree relatives who had cancer, the Fox Chase study showed.
High Cost of Gene Tests Can Deter Patients
These findings led Matro to speculate that cost alone prevents patients from getting genetic tests. Patients with less education may also make less money, and women may not be the primary bread-winners in their households and so have less access to money, she explained.
“It’s counterintuitive that people with more relatives who had cancer would be willing to pay less for genetic testing,” she added. “Perhaps they assume the test will be positive, so don’t want to be saddled with a hefty co-pay. Alternatively, they may feel confident navigating the healthcare system after helping family members with cancer and believe they can handle whatever diagnosis they eventually receive.”
The findings of this study have at least one message for anatomic pathology laboratories and clinical laboratories that offer expensive genetic tests—particularly genetic tests used to diagnose cancer. Going forward, there may be price resistance from patients who must pay higher deductibles. Similarly, patients in health savings accounts and similar high-deductible health plans may balk at having to pay the full price for genetic test that cost several thousand dollars.