EVENTS | VIEW CALENDAR
Order out of chaos
CHICAGO—"The challenge of making choices among molecular tests and the lack of a lingua franca (standardized language)" were the motivating factors in a licensing relationship between the American Medical Association (AMA) and McKesson designed to offer the healthcare system a consistent and transparent way to identify and track molecular diagnostic (MDx) tests, according to Matthew Zubiller, vice president, decision management at McKesson Health Solutions. He adds, "Getting patients the right care means reducing confusion."
"In the last four or five years, there has been an explosion of molecular and genetic tests, with the number and complexity growing exponentially, so that there are now 4,000 of them," says Robert Mussachio, senior vice president, business products and services at the AMA.
According to Frost & Sullivan, MDx is the fastest growing sector of clinical pathology lab testing, with revenues expected to reach $6.2 billion by 2014 and a projected compound annual growth rate of more than 11 percent. The question is how to get payers, providers and laboratories on the same page to differentiate between tests, make good cost-benefit decisions and get the best results, or to "get from potential to decision making," as Zubiller says.
McKesson Z-Code Identifiers will be grouped and indexed with corresponding molecular pathology codes in the AMA's Current Procedural Terminology (CPT) code set, according to the agreement. With identifiers and codes working in tandem to create a comprehensive reference for identifying and tracking MDx tests, all of the players in the healthcare industry can better understand the growth in this area to support advanced diagnostics innovation. This will "marry the terminology with the identification, licensed under the AMA banner," Mussachio says.
McKesson, a pharmaceutical distributor and healthcare information technology company, provides systems for medical supply management, clinical workflow, practice management, pharmacy automation and care management. In 2011, the company created the McKesson Diagnostics Exchange, a software-as-a-service catalog. It shared a workflow solution that laboratories and diagnostics manufacturers can use to submit information about their specific MDx tests, and that providers and payers can use to understand and evaluate them. The McKesson Diagnostics Exchange issues a unique Z-Code Identifier to each test and catalogs it for reference and understanding by other stakeholders in the healthcare system.
The AMA's involvement in coding solutions for molecular pathology services (MOPATH) dates back to 1998. New, more detailed CPT codes for molecular pathology services became effective in 2012. Thus far, the MOPATH process has created more than 100 codes for reporting innovative diagnostic services. This collaboration complements the recent efforts that the AMA and McKesson have undertaken to work closely to share terminology with the National Institutes of Health's Genetic Testing Registry.
Mussachio explains that McKesson will bring software, an identification system and know-how to the collaboration, while the AMA will provide process and procedures with the MOPATH committee doing the review, creating the classification system and licensing the program. Zubiller says the new program combines AMA's reputation as a "convenor of the stakeholders of care" with the accessibility of McKesson's Diagnostic Exchange software.
The relationship between the AMA and McKesson will result in the creation of a new reference product that maps Z-Code Identifiers to CPT codes. The AMA will use the information that labs and manufacturers submit and then share in the McKesson Diagnostics Exchange to assign CPT code mappings where appropriate. Not all Z-Code Identifiers will immediately map to a CPT code, and in many cases, multiple Z-Code Identifiers will map to a single CPT code. The new product will be available for licensing from the AMA early in 2014.
Connecting Z-Code Identifiers with CPT codes is expected to yield many benefits. Laboratory tests can be mapped to CPT codes where appropriate, so the laboratories can identify exactly which test was performed and then reported with the appropriate CPT code, potentially improving efficiencies in the reimbursement process. Clinicians can access a tool to help them accurately identify and select tests. Payers can have additional detailed test information to help identify the tests being performed, thus providing the industry with the ability to track outcomes on specific tests and analyze the value of these tests. Patients will benefit from this collaboration as it supports medicine's overarching goals of reducing disease burdens and improving health outcomes.
Mussachio says he is glad to be "leveraging the AMA's expertise, demonstrating that we can be responsive to the market and improving outcomes for the public." Zubiller anticipates that everyone in the healthcare system will understand the benefits of molecular testing, both clinically and financially, as a result of the collaboration.