Health care infrastructure for financially sustainable clinical genomics
Next-generation sequencing has evolved technically and economically into the method of choice for interrogating the genome in cancer and inherited disorders. The introduction of procedural code sets for whole-exome and genome sequencing is a milestone toward financially sustainable clinical implemen...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article (Journal) |
| Language: | English |
| Published: |
25 July 2016
|
| In: |
The journal of molecular diagnostics
Year: 2016, Volume: 18, Issue: 5, Pages: 697-706 |
| ISSN: | 1943-7811 |
| DOI: | 10.1016/j.jmoldx.2016.04.003 |
| Online Access: | Verlag, kostenfrei, Volltext: http://dx.doi.org/10.1016/j.jmoldx.2016.04.003 Verlag, kostenfrei, Volltext: http://www.sciencedirect.com/science/article/pii/S1525157816300861 
|
| Author Notes: | Jochen K. Lennerz, Heather M. McLaughlin, Jason M. Baron, David Rasmussen, Meini Sumbada Shin, Nancy Berners-Lee, Julie Miller Batten, Kathryn J. Swoboda, Manish K. Gala, Harland S. Winter, Jeremy D. Schmahmann, David A. Sweetser, Marianne Boswell, Maciej Pacula, Albrecht Stenzinger, Long P. Le, William Hynes, Heidi L. Rehm, Anne Klibanski, Stephen W. Black-Schaffer, Jeffrey A. Golden, David N. Louis, Scott T. Weiss, and A. John Iafrate |
| Summary: | Next-generation sequencing has evolved technically and economically into the method of choice for interrogating the genome in cancer and inherited disorders. The introduction of procedural code sets for whole-exome and genome sequencing is a milestone toward financially sustainable clinical implementation; however, achieving reimbursement is currently a major challenge. As part of a prospective quality-improvement initiative to implement the new code sets, we adopted Agile, a development methodology originally devised in software development. We implemented eight functionally distinct modules (request review, cost estimation, preauthorization, accessioning, prebilling, testing, reporting, and reimbursement consultation) and obtained feedback via an anonymous survey. We managed 50 clinical requests (January to June 2015). The fraction of pursued-to-requested cases (n = 15/50; utilization management fraction, 0.3) aimed for a high rate of preauthorizations. In 13 of 15 patients the insurance plan required preauthorization, which we obtained in 70% and ultimately achieved reimbursement in 50%. Interoperability enabled assessment of 12 different combinations of modules that underline the importance of an adaptive workflow and policy tailoring to achieve higher yields of reimbursement. The survey confirmed a positive attitude toward self-organizing teams. We acknowledge the individuals and their interactions and termed the infrastructure: human pipeline. Nontechnical barriers currently are limiting the scope and availability of clinical genomic sequencing. The presented human pipeline is one approach toward long-term financial sustainability of clinical genomics. |
|---|---|
| Item Description: | Gesehen am 13.02.2018 |
| Physical Description: | Online Resource |
| ISSN: | 1943-7811 |
| DOI: | 10.1016/j.jmoldx.2016.04.003 |