This is a companion article to the feature, “Paying for Molecular Diagnostics.”
For laboratorians, reimbursement issues are a continual source of frustration. But for patients, an absence of coverage for molecular diagnostics can be devastating.
Many lab managers have been on the receiving end of angry calls from patients who have found out about the out-of-pocket costs for such tests only long after results have already been generated, and who cannot afford to pay those unreimbursed charges. Such calls can haunt clinical lab staffers who struggle daily to meet every demand, running the best tests and generating the most useful results, while also maximizing reimbursement and minimizing the financial burden on the patient.
Even laboratorians who have not been on the receiving end of such patient calls would be well advised to approach test selection with the needs of at least an imaginary patient in mind. Laboratory staff need to remember that the worst of the reimbursement challenges always falls to patients, where they often contribute to insurmountable medical bills.
Another way that reimbursement issues directly affect patients is through restrictions on the availability of tests. As coverage rates creep lower, more lab managers will find it untenable to continue offering the full range of molecular diagnostics now in their portfolios. Discontinuing tests with the worst reimbursement prospects may make financial sense for the laboratory, but it can be harmful to patients who may need the medical information provided by such tests.
By focusing on the patient experience, laboratorians may find creative ways of retaining access to such tests or replacing them with more reimbursement-friendly options.