Segment 8: Challenges of Ordering, Paying for Diagnostic Tests

When tests with clinical utility haven't made it onto the guidelines yet, what should payers do?

Bryan Loy, MD, MBA, identified 2 challenges regarding the ordering of tests: first, the misuse in that the person ordering it is not in the position to decide whether to treat or not; and second, there is no discussion with the patient before the test is ordered to inform them about what it means, what to expect, and what will be done once the results are in.

Another challenge that Francisco J. Esteva, MD, PhD, mentioned was the fact that not all tests with clinical utility or promise are on the guidelines from the National Comprehensive Cancer Network (NCCN) or the American Society of Clinical Oncology. John L. Fox, MD, MHA, agrees with this issue from a payer perspective.

“We’ll pay for anything on the NCCN guidelines,” he said. “If we’ll pay for the drugs, we ought to pay for the test.”

However, when the test is not on the guidelines yet, they are left unsure about what to do.

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