Introduction
Genetic counseling is a service where a patient’s personal and family medical history are reviewed to assess the risk for genetic disorders and other diseases. The service is typically provided by genetic counselors but can also be done by other medical professionals like a patient’s physician. Currently, Medicare does not reimburse genetic counselors, which limits their ability to get paid for their services.
The Access to Genetic Counselor Services Act is a proposed bill in Congress that would enable Medicare to reimburse genetic counselors for 85% of the amount it currently reimburses a patient’s physician.
Arguments in Favor
The Access to Genetic Counselor Services Act aims to enhance access to genetic counseling services for millions of Americans on Medicare by recognizing genetic counselors as independent Medicare providers, allowing them to bill directly. This change would alleviate the burden on physicians, freeing up more time for them to see other patients and streamlining the process for patients, who would no longer need to coordinate visits with multiple providers. This could lead to shorter wait times and improved access to care. According to the National Society of Genetic Counselors (NSGC), better access to genetic counseling can lead to earlier detection and treatment of diseases such as cancer, ultimately improving health outcomes.
Proponents of the Access to Genetic Counselor Services Act argue that it could save Medicare over $4 billion in the next decade. The potential savings are attributed to several factors: genetic counselors are poised to recommend the most appropriate tests for patients, thereby reducing unnecessary testing and expenses. Another significant source of savings is the reduction in wasteful spending. For example, one study highlighted by advocates reviewed a series of genetic tests and found that 22% were inappropriate, suggesting that genetic counselors can play a crucial role in enhancing the efficiency and effectiveness of healthcare spending.
Arguments Against
Opponents of the Access to Genetic Counselor Services Act express concerns primarily based on the scope of practice and potential for fraud. The American College of Medical Genetics and Genomics (ACMG) argues that independently ordering tests is considered a practice of medicine, a role for which genetic counselors are not fully qualified. Currently, genetic counselors work under physician supervision, a setup ACMG supports because it believes that collaborative care yields the best medical outcomes. ACMG suggests amending the bill to allow genetic counselors to still be reimbursed by Medicare but under the requirement that they work collaboratively with physicians, not independently.
Another significant concern is the risk of fraud within the rapidly expanding genetic testing industry. In 2019, federal agencies uncovered $2.1 billion in genetic testing fraud involving doctors bribed to order unnecessary and expensive tests reimbursed by Medicare. By expanding the number of professionals authorized to order reimbursable tests, the Access to Genetic Counselor Services Act could potentially increase the risk of similar fraud schemes, exacerbating challenges in an already vulnerable area.
