The Plight of the Genetic Counselor in Cancer Predisposition Testing

Skolnick TIME mag

Masters prepared.  Board Certified.  Most states now declare genetic counselors as independent providers.  But billing for services?  That’s another matter.  Even though there is a code for genetic counseling, it doesn’t work well when it comes to reimbursement for the genetic counselor, and for CMS, it doesn’t work at all.  So, what is the motivation to hire a board-certified genetic counselor into an oncology program when other “providers” with little or no training will be reimbursed well in excess of the genetic counselor.  In this era where money drives everything, the answer is “there’s not much motivation at all to hire a genetic counselor.”  It’s a sad testimony that when it comes to this niche, hospitals happily endorse the “It’s Okay” mantra, a standard we see in a current TV advertising campaign.  Yes, “it’s okay” for anyone to utilize the cookbook of genetic testing (apologies to those providers who have made a concerted effort to self-educate here).

But now there is a new bill introduced in Congress to change all that.  Will it even make it out of committee?  It didn’t make it out last year when a similar bill was introduced and died.  And with the current chaos in Washington, D.C., it’s hard to imagine it will get any attention this year either.  Nevertheless, here’s an article that came out in June of this year, making the announcement about H.R. 3235… 

Genetic Counseling Medicare Payment Bill Introduced in Congress

NEW YORK (GenomeWeb) – A bill granting the US Centers for Medicare & Medicaid Services the authority to recognize certified genetic counselors as healthcare providers and reimburse them for their services was introduced in the US Congress last week.

Currently, CMS doesn’t recognize genetic counselors as healthcare providers, and H.R. 3235, the “Access to Genetic Counselor Services Act of 2019,” would require that genetic counselors be reimbursed for counseling Medicare beneficiaries in the same way these services are covered when provided by a physician.

“Certified genetic counselors are not currently recognized by CMS even though genetic counseling is a covered benefit under Medicare,” and this limits Medicare beneficiaries’ access to trained healthcare professionals who have a master’s degree in genetic counseling, the National Society of Genetic Counselors said in a statement.

The bill was sponsored by Representatives Dave Loebsack (D-IA) and Mike Kelly (R-PA), and the NSGC worked with the legislators on the bill. This issue has been a priority for the genetic counselors’ group for well over a decade, and last year the NSGC was successful in getting a bill introduced for the first time in the 115th Congress, co-sponsored by Loebsack and Representative Erik Paulsen (R-Minn.).

“CMS recognition has been a priority for our organization because the services genetic counselors provide can have a huge impact on the health of individuals and their families, especially as both the benefits of personalized medicine and complexities of genetic testing are expanding,” Amy Sturm, NSGC president, said in a statement.

The society has tried to make the case that expanding access to genetic counselors makes good economic sense for CMS and commissioned healthcare consulting firm Dobson, DaVanzo & Associates to conduct an analysis. The study, which relied on interviews, published data, and a claims analysis, projected $4 billion in potential Medicare savings over a decade if certified genetic counselors were to help patients and physicians order the right genetic tests. Moreover, when genetic counselors provide such services, they are reimbursed at 85 percent of the fee that physicians get for the same services, which could lead to potential Medicare savings of $50.7 million over a decade.

With an estimated 14 new genetic tests entering the market daily, CMS has been concerned about its growing spending in this sector and about inappropriate utilization. “Adding genetic counselors as qualified Medicare providers is an important link in achieving optimal health system performance,” Sturm said.

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