Outcomes of prior authorization requests for genetic testing in outpatient pediatric genetics clinics
Purpose Genetic testing is an important diagnostic tool in pediatric genetics clinics, yet many patients face barriers to testing. We describe the outcomes of prior authorization requests (PARs) for genetic tests, one indicator of patient access to clinically recommended testing, in pediatric geneti...
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| Veröffentlicht in: | Genetics in medicine 2021-05, Vol.23 (5), p.950-955 |
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| container_title | Genetics in medicine |
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| creator | Smith, Hadley Stevens Franciskovich, Rachel Lewis, Andrea M. Gerard, Amanda Littlejohn, Rebecca O. Nugent, Kimberly Rodriguez, Janah Streff, Haley |
| description | Purpose
Genetic testing is an important diagnostic tool in pediatric genetics clinics, yet many patients face barriers to testing. We describe the outcomes of prior authorization requests (PARs) for genetic tests, one indicator of patient access to clinically recommended testing, in pediatric genetics clinics.
Methods
We retrospectively reviewed PARs for genetic tests (
n
= 4,535) recommended for patients |
| doi_str_mv | 10.1038/s41436-020-01081-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2479742908</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2479742908</sourcerecordid><originalsourceid>FETCH-LOGICAL-c419t-ecc7c02361ac490f681f4e294e34e6837e21a4e689dd68224513038c33af893f3</originalsourceid><addsrcrecordid>eNp9kU1vGyEQhlGVqE7c_oEcIqRcetkWGJZdjpWVNJEi-dKcEcWzLpYNDrCS019f_JFUyqGnGZhn3hnNS8gVZ185g_5bllyCaphgDeOs583uA7ngLdQnKHVWc6b7BhRjE3KZ84ox3oFgH8kEQO4zeUFwPhYXN5hpHOg2-ZioHcvvmPwfW3wMNOHziLlkOtTSEgMW72ipPz4sqQ80jmVbSQyFbnHhbUm1fuIydWsfavxEzge7zvj5FKfk6e725-y-eZz_eJh9f2yc5Lo06FznmADFrZOaDarng0ShJYJE1UOHgtt9phcL1QshWw71EA7ADr2GAabky1F3m-JhbbPx2eF6bQPGMRshO91JoVlf0Zt36CqOKdTtjGiF0KoVuq2UOFIuxZwTDqbeaGPTi-HM7E0wRxNMNcEcTDC72nR9kh5_bXDx1vJ69QrAEci1FJaY_s3-j-xfnYSTSQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2522965295</pqid></control><display><type>article</type><title>Outcomes of prior authorization requests for genetic testing in outpatient pediatric genetics clinics</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Smith, Hadley Stevens ; Franciskovich, Rachel ; Lewis, Andrea M. ; Gerard, Amanda ; Littlejohn, Rebecca O. ; Nugent, Kimberly ; Rodriguez, Janah ; Streff, Haley</creator><creatorcontrib>Smith, Hadley Stevens ; Franciskovich, Rachel ; Lewis, Andrea M. ; Gerard, Amanda ; Littlejohn, Rebecca O. ; Nugent, Kimberly ; Rodriguez, Janah ; Streff, Haley</creatorcontrib><description>Purpose
Genetic testing is an important diagnostic tool in pediatric genetics clinics, yet many patients face barriers to testing. We describe the outcomes of prior authorization requests (PARs) for genetic tests, one indicator of patient access to clinically recommended testing, in pediatric genetics clinics.
Methods
We retrospectively reviewed PARs for genetic tests (
n
= 4,535) recommended for patients <18 years of age (
n
= 2,798) by pediatric medical geneticists at two children’s hospitals in Texas, 2017–2018. We described PAR outcomes, accompanying diagnostic codes, and diagnostic yield.
Results
The majority (79.9%) of PARs received a favorable outcome. PARs submitted to public payers were more likely to receive a favorable outcome compared with private payers (85.5% vs. 70.3%, respectively;
p
< 0.001). No diagnostic codes were associated with higher likelihood of PAR approval for exome sequencing. Among the 2,685 tests approved and completed, 522 (19.4%) resulted in a diagnosis.
Conclusion
Though there was a high PAR approval rate, our findings suggest that insurance coverage remains one barrier to genetic testing. When completed, genetic testing had a high yield in our sample. Further evidence of clinical utility and development of clinical practice guidelines may inform payer medical policy development and improve access to testing in the future.</description><identifier>ISSN: 1098-3600</identifier><identifier>EISSN: 1530-0366</identifier><identifier>DOI: 10.1038/s41436-020-01081-x</identifier><identifier>PMID: 33473204</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>Biomedical and Life Sciences ; Biomedicine ; Child ; Genetic Testing ; Genetics ; Human Genetics ; Humans ; Laboratory Medicine ; Outpatients ; Pediatrics ; Prior Authorization ; Retrospective Studies ; Texas</subject><ispartof>Genetics in medicine, 2021-05, Vol.23 (5), p.950-955</ispartof><rights>The Author(s), under exclusive licence to the American College of Medical Genetics and Genomics 2021</rights><rights>The Author(s), under exclusive licence to the American College of Medical Genetics and Genomics 2021.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-ecc7c02361ac490f681f4e294e34e6837e21a4e689dd68224513038c33af893f3</citedby><cites>FETCH-LOGICAL-c419t-ecc7c02361ac490f681f4e294e34e6837e21a4e689dd68224513038c33af893f3</cites><orcidid>0000-0002-9829-649X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33473204$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith, Hadley Stevens</creatorcontrib><creatorcontrib>Franciskovich, Rachel</creatorcontrib><creatorcontrib>Lewis, Andrea M.</creatorcontrib><creatorcontrib>Gerard, Amanda</creatorcontrib><creatorcontrib>Littlejohn, Rebecca O.</creatorcontrib><creatorcontrib>Nugent, Kimberly</creatorcontrib><creatorcontrib>Rodriguez, Janah</creatorcontrib><creatorcontrib>Streff, Haley</creatorcontrib><title>Outcomes of prior authorization requests for genetic testing in outpatient pediatric genetics clinics</title><title>Genetics in medicine</title><addtitle>Genet Med</addtitle><addtitle>Genet Med</addtitle><description>Purpose
Genetic testing is an important diagnostic tool in pediatric genetics clinics, yet many patients face barriers to testing. We describe the outcomes of prior authorization requests (PARs) for genetic tests, one indicator of patient access to clinically recommended testing, in pediatric genetics clinics.
Methods
We retrospectively reviewed PARs for genetic tests (
n
= 4,535) recommended for patients <18 years of age (
n
= 2,798) by pediatric medical geneticists at two children’s hospitals in Texas, 2017–2018. We described PAR outcomes, accompanying diagnostic codes, and diagnostic yield.
Results
The majority (79.9%) of PARs received a favorable outcome. PARs submitted to public payers were more likely to receive a favorable outcome compared with private payers (85.5% vs. 70.3%, respectively;
p
< 0.001). No diagnostic codes were associated with higher likelihood of PAR approval for exome sequencing. Among the 2,685 tests approved and completed, 522 (19.4%) resulted in a diagnosis.
Conclusion
Though there was a high PAR approval rate, our findings suggest that insurance coverage remains one barrier to genetic testing. When completed, genetic testing had a high yield in our sample. Further evidence of clinical utility and development of clinical practice guidelines may inform payer medical policy development and improve access to testing in the future.</description><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Child</subject><subject>Genetic Testing</subject><subject>Genetics</subject><subject>Human Genetics</subject><subject>Humans</subject><subject>Laboratory Medicine</subject><subject>Outpatients</subject><subject>Pediatrics</subject><subject>Prior Authorization</subject><subject>Retrospective Studies</subject><subject>Texas</subject><issn>1098-3600</issn><issn>1530-0366</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1vGyEQhlGVqE7c_oEcIqRcetkWGJZdjpWVNJEi-dKcEcWzLpYNDrCS019f_JFUyqGnGZhn3hnNS8gVZ185g_5bllyCaphgDeOs583uA7ngLdQnKHVWc6b7BhRjE3KZ84ox3oFgH8kEQO4zeUFwPhYXN5hpHOg2-ZioHcvvmPwfW3wMNOHziLlkOtTSEgMW72ipPz4sqQ80jmVbSQyFbnHhbUm1fuIydWsfavxEzge7zvj5FKfk6e725-y-eZz_eJh9f2yc5Lo06FznmADFrZOaDarng0ShJYJE1UOHgtt9phcL1QshWw71EA7ADr2GAabky1F3m-JhbbPx2eF6bQPGMRshO91JoVlf0Zt36CqOKdTtjGiF0KoVuq2UOFIuxZwTDqbeaGPTi-HM7E0wRxNMNcEcTDC72nR9kh5_bXDx1vJ69QrAEci1FJaY_s3-j-xfnYSTSQ</recordid><startdate>20210501</startdate><enddate>20210501</enddate><creator>Smith, Hadley Stevens</creator><creator>Franciskovich, Rachel</creator><creator>Lewis, Andrea M.</creator><creator>Gerard, Amanda</creator><creator>Littlejohn, Rebecca O.</creator><creator>Nugent, Kimberly</creator><creator>Rodriguez, Janah</creator><creator>Streff, Haley</creator><general>Nature Publishing Group US</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9829-649X</orcidid></search><sort><creationdate>20210501</creationdate><title>Outcomes of prior authorization requests for genetic testing in outpatient pediatric genetics clinics</title><author>Smith, Hadley Stevens ; Franciskovich, Rachel ; Lewis, Andrea M. ; Gerard, Amanda ; Littlejohn, Rebecca O. ; Nugent, Kimberly ; Rodriguez, Janah ; Streff, Haley</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-ecc7c02361ac490f681f4e294e34e6837e21a4e689dd68224513038c33af893f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Child</topic><topic>Genetic Testing</topic><topic>Genetics</topic><topic>Human Genetics</topic><topic>Humans</topic><topic>Laboratory Medicine</topic><topic>Outpatients</topic><topic>Pediatrics</topic><topic>Prior Authorization</topic><topic>Retrospective Studies</topic><topic>Texas</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smith, Hadley Stevens</creatorcontrib><creatorcontrib>Franciskovich, Rachel</creatorcontrib><creatorcontrib>Lewis, Andrea M.</creatorcontrib><creatorcontrib>Gerard, Amanda</creatorcontrib><creatorcontrib>Littlejohn, Rebecca O.</creatorcontrib><creatorcontrib>Nugent, Kimberly</creatorcontrib><creatorcontrib>Rodriguez, Janah</creatorcontrib><creatorcontrib>Streff, Haley</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Genetics in medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smith, Hadley Stevens</au><au>Franciskovich, Rachel</au><au>Lewis, Andrea M.</au><au>Gerard, Amanda</au><au>Littlejohn, Rebecca O.</au><au>Nugent, Kimberly</au><au>Rodriguez, Janah</au><au>Streff, Haley</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of prior authorization requests for genetic testing in outpatient pediatric genetics clinics</atitle><jtitle>Genetics in medicine</jtitle><stitle>Genet Med</stitle><addtitle>Genet Med</addtitle><date>2021-05-01</date><risdate>2021</risdate><volume>23</volume><issue>5</issue><spage>950</spage><epage>955</epage><pages>950-955</pages><issn>1098-3600</issn><eissn>1530-0366</eissn><abstract>Purpose
Genetic testing is an important diagnostic tool in pediatric genetics clinics, yet many patients face barriers to testing. We describe the outcomes of prior authorization requests (PARs) for genetic tests, one indicator of patient access to clinically recommended testing, in pediatric genetics clinics.
Methods
We retrospectively reviewed PARs for genetic tests (
n
= 4,535) recommended for patients <18 years of age (
n
= 2,798) by pediatric medical geneticists at two children’s hospitals in Texas, 2017–2018. We described PAR outcomes, accompanying diagnostic codes, and diagnostic yield.
Results
The majority (79.9%) of PARs received a favorable outcome. PARs submitted to public payers were more likely to receive a favorable outcome compared with private payers (85.5% vs. 70.3%, respectively;
p
< 0.001). No diagnostic codes were associated with higher likelihood of PAR approval for exome sequencing. Among the 2,685 tests approved and completed, 522 (19.4%) resulted in a diagnosis.
Conclusion
Though there was a high PAR approval rate, our findings suggest that insurance coverage remains one barrier to genetic testing. When completed, genetic testing had a high yield in our sample. Further evidence of clinical utility and development of clinical practice guidelines may inform payer medical policy development and improve access to testing in the future.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>33473204</pmid><doi>10.1038/s41436-020-01081-x</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-9829-649X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Biomedical and Life Sciences Biomedicine Child Genetic Testing Genetics Human Genetics Humans Laboratory Medicine Outpatients Pediatrics Prior Authorization Retrospective Studies Texas |
| title | Outcomes of prior authorization requests for genetic testing in outpatient pediatric genetics clinics |
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