Impact of Payer Constraints on Access to Genetic Testing

2017 ◽  
Vol 13 (1) ◽  
pp. e47-e56 ◽  
Author(s):  
Pat Whitworth ◽  
Peter Beitsch ◽  
Christopher Arnell ◽  
Hannah C. Cox ◽  
Krystal Brown ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Policy Implementation ◽  
National Comprehensive Cancer Network ◽  
Latin American ◽  
Transition Period ◽  
Genetic Counselor ◽  
European Ancestry ◽  
National Health Care ◽  
Before And After ◽  
Cancer Network

Background: With increased demand for hereditary cancer genetic testing, some large national health-care insurance payers (LNHPs) have implemented policies to minimize inappropriate testing by mandating consultation with a geneticist or genetic counselor (GC). We hypothesized such a restriction would reduce access and appropriate testing. Methods: Test cancellation rates (ie, tests ordered that did not result in a reported test result), mutation-positive rates, and turnaround times for comprehensive BRCA1/2 testing for a study LNHP that implemented a GC-mandate policy were determined over the 12 months before and after policy implementation (excluding a 4-month transition period). Cancellation rates were evaluated based on the reason for cancellation, National Comprehensive Cancer Network testing criteria, and self-identified ancestry. A control LNHP was evaluated over the same period for comparison. Results: The study LNHP cancellation rate increased from 13.3% to 42.1% ( P < .001) after policy implementation. This increase was also observed when only individuals who met National Comprehensive Cancer Network criteria for hereditary breast and ovarian cancer testing were considered (9.5% to 37.7%; P < .001). Cancellation rates increased after policy introduction for all ancestries; however, this was more pronounced among individuals of African or Latin American ancestry, for whom cancellation rates rose to 48.9% and 49.6%, respectively, compared with 33.9% for individuals of European ancestry. Over this same time period, control LNHP cancellation rates decreased or stayed the same for all subgroups. Conclusion: These findings demonstrate that a GC-mandate policy implemented by a LNHP substantially decreased access to appropriate genetic testing, disproportionately impacting minority populations without any evidence that inappropriate testing was decreased.

scholarly journals Direct-to-consumer genetic testing in the college classroom: Knowledge, attitudes, and concerns of introductory biology students

2014 ◽  
Author(s):  
Nicanor Austriaco
Keyword(s):  
Genetic Testing ◽  
Genetic Counselor ◽  
College Classroom ◽  
Undergraduate Biology ◽  
First Semester ◽  
Biology Students ◽  
Direct To Consumer ◽  
Before And After ◽  
Medical Health Care ◽  
Enhance Student Learning

Pioneered by companies like 23andMe.com, deCODEme.com, and Navigenics.com, direct-to-consumer genetic testing refers to genetic tests that are marketed directly to consumers via television, print media, or the Internet. This kind of testing provides access to a customer’s genetic information without necessarily involving either a medical health care professional or a genetic counselor in the process. In recent years, a course offered to medical and graduate students at Stanford University has included an option for students to undergo personal genotyping, raising the possibility that direct-to-consumer genetic testing could also be incorporated into undergraduate biology courses to enhance student learning. In this study, I assess the attitudes and concerns of college students enrolled in the first semester of an introductory majors course in biology, before and after they had completed the course, regarding the availability of this technology and its possible use in the college classroom. The pre-course survey revealed that these students were open to the possibility of using this technology in their courses, but that they had concerns about the confidentiality and the accuracy of their genetic results. Strikingly, however, completing the genetics, molecular and cellular biology semester-long portion of the yearlong introductory sequence in biology appeared to boost student confidence in this technology and its use in the undergraduate classroom.

scholarly journals Direct-to-consumer genetic testing in the college classroom: Knowledge, attitudes, and concerns of introductory biology students

2014 ◽  
Author(s):  
Nicanor Austriaco
Keyword(s):  
Genetic Testing ◽  
Genetic Counselor ◽  
College Classroom ◽  
Undergraduate Biology ◽  
First Semester ◽  
Biology Students ◽  
Direct To Consumer ◽  
Before And After ◽  
Medical Health Care ◽  
Enhance Student Learning

Pioneered by companies like 23andMe.com, deCODEme.com, and Navigenics.com, direct-to-consumer genetic testing refers to genetic tests that are marketed directly to consumers via television, print media, or the Internet. This kind of testing provides access to a customer’s genetic information without necessarily involving either a medical health care professional or a genetic counselor in the process. In recent years, a course offered to medical and graduate students at Stanford University has included an option for students to undergo personal genotyping, raising the possibility that direct-to-consumer genetic testing could also be incorporated into undergraduate biology courses to enhance student learning. In this study, I assess the attitudes and concerns of college students enrolled in the first semester of an introductory majors course in biology, before and after they had completed the course, regarding the availability of this technology and its possible use in the college classroom. The pre-course survey revealed that these students were open to the possibility of using this technology in their courses, but that they had concerns about the confidentiality and the accuracy of their genetic results. Strikingly, however, completing the genetics, molecular and cellular biology semester-long portion of the yearlong introductory sequence in biology appeared to boost student confidence in this technology and its use in the undergraduate classroom.

Psychology Staffing at Cancer Centers: Data From National Comprehensive Cancer Network Member Institutions

2020 ◽  
Vol 16 (11) ◽  
pp. e1343-e1354
Author(s):  
Laura Melton ◽  
Diana Krause ◽  
Jessica Sugalski
Keyword(s):  
National Comprehensive Cancer Network ◽  
Patient Care ◽  
Clinical Care ◽  
The United States ◽  
Direct Patient Care ◽  
Cancer Center ◽  
Network Member ◽  
Full Time ◽  
Cancer Centers ◽  
Cancer Network

PURPOSE: The field of psycho-oncology is relatively undeveloped, with little information existing regarding the use of psychologists at cancer centers. Comprising 30 leading cancer centers across the United States, the National Comprehensive Cancer Network (NCCN) set out to understand the trends in its Member Institutions. METHODS: The NCCN Best Practices Committee surveyed NCCN Member Institutions regarding their use of psychologists. The survey was administered electronically in the spring/summer of 2017. RESULTS: The survey was completed by 18 cancer centers. Across institutions, 94% have psychologists appointed to provide direct care to their cancer center patients. The number of licensed psychologist full-time equivalents (FTEs) on staff who provide direct patient care ranged from < 1.0 FTE (17%) to 17.0-17.9 FTEs (6%). Regarding psychologist appointments, 41% have both faculty and staff appointments, 41% have all faculty appointments, and 18% have all staff appointments. Forty-three percent of institutions indicated that some licensed psychologists at their centers (ranging from 1%-65%) do not provide any direct clinical care, and 57% indicated that all licensed psychologist on staff devote some amount of time to direct clinical care. The percent of clinical care time that is spent on direct clinical care ranged from 15%-90%. CONCLUSION: There is great variability in psychology staffing, academic appointments, and the amount of direct patient care provided by on-staff psychologists at cancer centers.

Self-Reported Ancestry and Craniofacial SNPs

2021 ◽  
Author(s):  
Kamar Afra ◽  
Michelle Hamilton ◽  
Bridget Algee-Hewitt
Keyword(s):  
Latin American ◽  
Tissue Expression ◽  
European Ancestry ◽  
Craniofacial Skeleton ◽  
Nucleotide Polymorphism ◽  
Single Nucleotide ◽  
Model Based Clustering ◽  
The Face ◽  
White Sample ◽  
Population Affinity

Genotype-phenotype studies increasingly link single nucleotide polymorphism (SNPs) to the dimensions of the face for presumed homogeneous populations. To appreciate the significance of these findings, it is essential to investigate how these results differ between the genetic and phenotypic profiles of individuals. In prior work, we investigated the connection between SNPs previously identified as informative of soft tissue expression and measurements of the craniofacial skeleton. Using matched genetic and skeletal information on 17 individuals who self-identified as White with presumed common continental ancestry (European), we obtained significant Spearman correlations for 11 SNPs. In the present study, we looked at self-identified ancestry to understand the intersectional background of the individual’s phenotype and genotype. We integrated our samples within a diverse dataset of 2,242 modern Americans and applied an unsupervised model-based clustering routine to 13 craniometrics. We generated a mean estimate of 69.65% (±SD = 18%) European ancestry for the White sample under an unsupervised cluster model. We estimated higher quantities of European ancestry, 88.5%–93%, for our subset of 17 individuals. These elevated estimates were of interest with respect to the distribution of population-informative SNPs; we found, for example, that one of our sampled self-identified White individuals displayed SNPs commonly associated with Latin American populations. These results underscore the complex interrelationship between environment and genetics, and the need for continued research into connections between population affinity, social identity, and morphogenetic expression.

scholarly journals Estimativa do custo do tratamento do câncer de pele tipo não-melanoma no Estado de São Paulo - Brasil

2011 ◽  
Vol 86 (4) ◽  
pp. 657-662 ◽  
Author(s):  
Reynaldo José Sant'Anna Pereira de Souza ◽  
Adriana P Mattedi ◽  
Marcelo P Corrêa ◽  
Marcelo L Rezende ◽  
Ana Cláudia Andrade Ferreira
Keyword(s):  
Clinical Practice ◽  
National Comprehensive Cancer Network ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Sao Paulo ◽  
São Paulo ◽  
Cancer Network ◽  
Impacto Económico

FUNDAMENTOS: O câncer de maior incidência no Brasil é o de pele não-melanoma, que afeta aproximadamente 0,06% da população. Não existem políticas públicas para sua prevenção e o impacto econômico do seu diagnóstico não tem sido avaliado. OBJETIVOS: Estimar os custos do diagnóstico e tratamento do câncer de pele não-melanoma no Estado de São Paulo entre 2000 a 2007 e compará-los com os do melanoma cutâneo no mesmo período. MÉTODOS: Foi utilizado como modelo de procedimento o projeto diretriz Clinical Practice Guidelines in Oncology, (National Comprehensive Cancer Network), adequado aos procedimentos da Fundação SOBECCan - Hospital do Câncer de Ribeirão Preto - SP. Os custos estimados baseiam-se nos valores do tratamento médico pagos pelos setores público e privado em 2007. RESULTADOS: Os valores médios de custo individual do tratamento anual do câncer de pele não-melanoma são muito mais baixos do que os estimados para o tratamento do melanoma cutâneo. Entretanto, observados os gastos totais no tratamento do câncer de pele não-melanoma, percebe-se que os 42.184 casos deste câncer em São Paulo, no período estudado, fazem com que o custo total do seu tratamento seja 14% superior ao dos 2.740 casos de melanoma cutâneo registrados no mesmo período para o SUS. Porém, para o sistema privado, o gasto total é, aproximadamente, 34% menor para o tratamento do câncer de pele não-melanoma. CONCLUSÃO: O elevado número de casos de câncer de pele não-melanoma no Brasil - com 114 mil novos casos previstos para 2010, sendo 95% diagnosticados em estágios precoces - representa um impacto financeiro ao sistema público e aos sistemas privados de saúde de cerca de R$ 37 milhões e R$ 26 milhões ao ano, respectivamente

Impact of a Vancomycin Restriction Policy on Use and Cost of Vancomycin and Incidence of Vancomycin-Resistant Enterococcus

1997 ◽  
Vol 31 (9) ◽  
pp. 970-973 ◽  
Author(s):  
Amy S Morgan ◽  
Patrick J Brennan ◽  
Neil O Fishman
Keyword(s):  
Policy Implementation ◽  
University Teaching ◽  
Vancomycin Resistant Enterococcus ◽  
Vancomycin Therapy ◽  
Billing Data ◽  
Restriction Policy ◽  
Number Of Patients ◽  
Before And After ◽  
Vancomycin Resistant ◽  
Prophylactic Use

Objective To review the appropriateness of vancomycin therapy, changes in vancomycin use, and the incidence of vancomycin-resistant Enterococcus (VRE) after implementation of a limited restriction policy requiring approval from the Infectious Diseases Approval service to continue vancomycin therapy beyond 72 hours. Design A prospective chart review was conducted in April 1995. Pharmacy billing data and infection control data were compared before and after policy implementation. Setting A 725-bed university teaching institution. Patients All patients receiving vancomycin during April 1995. Main outcome Measures Appropriateness of use was based on the Centers for Disease Control and Prevention (CDC) recommendations for prudent vancomycin use. Results A total of 333 courses of vancomycin therapy were reviewed. Vancomycin use was appropriate in 219 (66%) courses. Of the 114 courses that did not meet the CDC guidelines, 76 (67%) were for empiric use, 35 (31%) were for prophylactic use, and 3 (3%) were for therapeutic use. Overall, the total number of grams used decreased 9%, grams per 1000 patient-days decreased by 10, and the total number of patients exposed to vancomycin decreased 0.5%. Several services had large decreases in vancomycin use. Vancomycin expenditures decreased by $15 788 for the 7-month time period. The incidence of VRE remained unchanged, at 30% of all enterococcal isolates 2 years after policy implementation. Conclusions The limited restriction policy was effective in decreasing the total grams of vancomycin used. However, one-third of vancomycin therapy was inappropriate and the incidence of VRE was unchanged. A more stringent restriction policy could potentially increase appropriate use, further decrease the amount of vancomycin used, and decrease the incidence of VRE.

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