Detecting cancer and other serious diseases just got harder, thanks to a short-sighted decision from federal officials.
At issue are government payment rates for molecular diagnostic tests -- essentially, analyses of changes in a person’s genetic code and how those changes impact the individual’s disease.
Last year, the Centers for Medicare and Medicaid Services (CMS) proposed severely reducing the amount that the government would pay for such tests. And just last week, the agency announced that it would not revise its reimbursement policy for 2014 -- thereby building on its previous cuts.
By failing to pay adequately for these diagnostics, officials are putting lives at risk and raising health costs in the process. They must change their tune -- and ensure that reimbursement rates are sufficient for all Americans to have comprehensive access to these tests.
Molecular diagnostics represent among the most promising developments in medicine.
In fact, they can help patients suffering from an illness receive more targeted, individualized, and effective care.
Molecular diagnostics have been particularly powerful in the fight against cancer, which kills almost 1,600 Americans every day.
Consider lung cancer. Scientists at The Ohio State Comprehensive Cancer Center -- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute have found that by analyzing over 50 genes in a lung cancer patient’s tumor biopsy, they can tailor a patient’s treatment based on mutations in those genes.
For example, if a mutation is found in the EGFR gene, the medications erlotinib or afatinib can be prescribed. These drugs have a 75-percent response rate. Standard chemotherapy, on the other hand, would have a 25-to-30 percent response rate to this particular patient’s cancer.
Genetic testing has revolutionized not just the quality of care but its cost, too. The logic is simple -- better, faster diagnostics yield more precise, timely and less wasteful care. That saves money.