By Stephanie Murg, Managing Director, G2 Intelligence
No discussion of next-generation sequencing (NGS) is complete without a reference to the swiftly plummeting cost of the technology, and yet little effort has made to put a dollar figure on the value of this type of analysis. The Association for Molecular Pathology (AMP) is seeking to change that. On March 4, the organization released cost analysis results and health economic evaluation models for several genomic sequencing procedure CPT codes as well as a micro-costing analysis template that molecular diagnostic laboratories can use to calculate the cost of the NGS assays they use to perform these procedures.
“Labs are performing NGS procedures and it’s imperative that they get paid for these necessary services,” said project leader Linda Sabatini, Ph.D., HCLD, of NorthShore University HealthSystem in a statement. “Demonstrating the value of genomic sequencing procedures to key payers and clinical stakeholders is critical to establishing favorable and transparent reimbursement.”
The launch of the tools comes at a critical time—as Medicare Administrative Contractors (MACs) are requesting input from providers to establish appropriate allowances for GSP codes. Medicare payment rates for these codes will be finalized in November 2015, and the national payment rates will go into effect on January 1, 2016.
In collaboration with Boston Healthcare Associates and Tynan Consulting, AMP worked with clinical diagnostic laboratories to evaluate real world costs and the health economic impact. Over a dozen laboratory protocols were collected to analyze cost information about assay validation, pre-analytics, sequencing, bioinformatics, and interpretation. To develop a template that would estimate the total cost of NGS assays, protocols were separated into steps and assigned reagent costs, equipment minutes of time used and associated costs, and the personnel hands-on time and skill level.
The health economic models address the examples of whole exome analysis, a tumor panel for non-small cell lung cancer, and hearing loss. These three customized models present advantages over current standards of diagnostic analysis and demonstrate the economic impact of payers adopting these procedures, according to the AMP.
The evaluation tools, webinar tutorial, and video-based instructions are available online by clicking here.