Exploring Barriers to Payer Utilization of Genetic Counselors
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ORIGINAL RESEARCH
Exploring Barriers to Payer Utilization of Genetic Counselors Nan Doyle & Allison Cirino & Amber Trivedi & Maureen Flynn
Received: 15 November 2013 / Accepted: 8 July 2014 / Published online: 20 August 2014 # National Society of Genetic Counselors, Inc. 2014
Abstract Access to genetic counselors’ services is neither universal nor automatic, due in part to the gatekeeper role of healthcare payers – the companies and agencies that purchase healthcare services on patients’ behalf and control the bulk of healthcare spending. This pilot study surveyed and analyzed the relative importance of barriers to expanded payer coverage of genetic counselors’ services. Surveys were mailed to 263 medical directors and quality assurance directors at health insurance carriers throughout the United States. Respondents provided demographic information and indicated the importance of nine possible barriers, plus an optional write-in “other.” Twenty-two surveys were analyzed. “Evidence that use of genetic counselors improves health outcomes” led the list of factors having a significant/very significant influence on coverage policy. Sixteen respondents (73 %) rated this factor “4” or “5” on a Likert scale; it also received the most #1 rankings and the highest score using a weighted-mean analysis. Provider practice guidelines, CMS/Medicare regulations, and genetic counselor licensure-all of which are outside of payers’ direct control-also ranked highly. The research demonstrates that although the potential barriers to expanded reimbursement for genetic counselors are numerous and complex, some are more consistently identified as important and therefore more deserving of legislative and advocacy resources to effect change. Future research should endeavor to increase survey response and include providers as well as payers. (222 words)
Keywords Genetic Counselor . Insurance . Payor . Payer . Coverage Policy . Reimbursement . Outcomes
N. Doyle (*) : M. Flynn Division of Graduate Medical Sciences, Boston University School of Medicine, 85 East Newton Street, M913, Boston, MA 02118, USA e-mail: [email protected]
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A. Cirino Cardiovascular Genetics Center, Brigham and Women’s Hospital, Boston,, MA, USA A. Trivedi InformedDNA, 360 Central Ave, St Petersburg, FL 33701, USA
Introduction Genetic Counseling: An Evolving, Maturing Profession The concept of genetic counseling as a distinct medical subspecialty was identified approximately fifty years ago when the advent of routine newborn screening for inherited disorders created the need for a specialist who could understand and interpret the results for patients and caregivers. Since then, genetic counselors have collectively worked to establish a visible role whose benefit is increasingly appreciated, to implement steps that assure consistent quality of service, and to formalize its presence within the healthcare ecosystem. Milestones include: & &
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1979: formation of a unified professional association, now the National Society of Genetic Counselors (Heimler 1997). 1981: America
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