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By Assaf Halevy
Deep and significant changes across a multitude of personal and professional realities have marked the past 18 months. Prominent among them is healthcare’s swift acceptance of telemedicine.
The concept of virtual care and development of adaptive technologies have been on the healthcare scene for years. The onset of the COVID-19 pandemic drove seismic shifts in reimbursement policy and patient demand that effectively accelerated utilization. Beyond the critical need for organizations to continue delivering preventive and acute care for patients unable or unwilling to schedule in-person visits, healthcare providers also needed an innovative approach to counter a worrying decline in revenue, threatening business operations and future viability.
Telegenomics is a noteworthy subset within the telemedicine movement. Genetic/genomic testing enables providers to conduct reimbursable pre- and post-testing virtual encounters, with patients collecting samples from their cheeks and mailing the test to the lab themselves.
Extrapolating revenue potential
Precision medicine has become the standard of care across many specialties. At-home sample collection has become de rigueur, especially in rural or underserved areas, and can be applied in clinical use cases ranging from prenatal testing, to cancer predisposition, to a plethora rare and common genetic disorders. Even expansive diagnostic tests like whole exome sequencing (WES) and whole genome sequencing (WGS) can be conducted in this manner because saliva, not blood or tissue, is used and analyzed. This paradigm shift is further supported by enterprise technologies that span individual EHRs so providers across an organization can use test results in a meaningful way.
The combination of advanced testing procedures and in-workflow access to precision medicine insights enables providers to expand opportunities for telegenomics. Of course, the primary goal in doing so is to improve care – but its practice also enables clinicians to see more patients and drive more revenue from virtual visits.
Not long ago, for example, a colleague decided to extrapolate revenue that potentially could be generated by leveraging telegenomics with even a limited number of patients. This leader’s organization has about 425 physicians and projected the impact of adding just one telegenomics patient visit a week to each of their schedules – totaling 22,100 additional visits a year.
Patients could be scheduled for a pre-test virtual visit (likely coded 99213). After the consultation, the physician would order a PGx lab test sent to patients’ homes. After the test was processed and results returned to the physician, he/she could schedule a follow-up virtual visit (potentially coded 99214 if medication changes are indicated).
The projections, with just one additional visit a week across 425 physicians, was surprising:
- 425 physicians x 52 = 22,100 additional visits per year
- 11,050 coded as 99213 or about $83* per visit in additional revenue = $917,150
- 11,050 coded as 99214 or bout $120* per visit in additional revenue = $1,326,000
- Potential additional revenue per year = $2,243,150
Case in point: pharmacogenomics
While telegenomics can be leveraged broadly, consider its value in one specific area: improving medication safety and efficacy through pharmacogenomics (PGx).
Because their genetic makeup determines how well they process specific medications, patients with abnormal metabolic responses (fast or slow) are vulnerable to side effects and potential drug toxicity. In addition, it is unlikely they will achieve the therapeutic benefit or relief their doctors intend.
Potential PGx impact is not a rare consideration. It is estimated that 98 percent of patients have genetic variants that affect how well they do (or do not) metabolize specific medications, and approximately 80 percent of variability in drug efficacy and adverse drug reactions (ADR) can be explained by genomic variation. Importantly, 34 percent of all potential major ADRs are caused by patient genetics rather than drug-drug interactions. The capabilities of precision medicine have not gone unnoticed by the Federal Drug Administration (FDA), which now includes PGx alerts on the packaging of hundreds of medications. In fact, PGx labeling has nearly tripled since 2000 from 10.3 percent to 28.2 percent in 2020.
Healthcare leaders recognize the impact of PGx – and have embraced testing via telegenomics. Leaders at two organizations, in fact, conducted informal analyses of their patient populations to determine which subsets might benefit most from PGx testing. Both initially focused on Medicare patients taking five or more medications. One of the two found that the polypharmacy population with potential PGx risk contained 29 percent of elderly patients, while the other found 19 percent exhibited similar risks.
About 50 percent of the medications these cohorts were taking had PGx factors. Far and away, most of the concerning drugs were cardiovascular medications like statins and blood thinners. Others of note included pain management, behavioral health (e.g., antianxiety, antidepressants) and gastrointestinal medications – all commonly prescribed by primary care physicians and other specialists alike.
With examples like these in hand, the bottom line is unmistakable: the practice of telegenomics not only empowers healthcare organizations to engage with patients in new and user-friendly ways, but equips individual providers with critical insights to improve care and outcomes. As a final bonus, convenient access and the opportunity for remote testing opens a new channel for revenue based on virtual visits.
*Not reflective of geographically based reimbursement rate adjustments
Assaf Halevy is CEO and co-founder of 2bPrecise.