Genetic screening and testing in an episode-based payment model: preserving patient autonomy

Area of Science:

• Healthcare Economics
• Maternal Health
• Medical Ethics

Background:

• Ohio is implementing an episode-based payment model for perinatal care.
• This model assigns all costs of care for a live birth to the delivering provider.
• Reimbursement will be tiered, with rewards or penalties based on cost and quality.

Purpose of the Study:

• To analyze the implications of Ohio's new episode-based payment model for perinatal care.
• To examine the potential conflict between physician financial incentives and patient autonomy in prenatal genetic testing.
• To assess the impact of this model on access to and utilization of prenatal diagnostic services.

Main Methods:

• Analysis of the proposed episode-based payment structure for perinatal services in Ohio.
• Review of current practices and guidelines for prenatal genetic screening and diagnostic testing.
• Ethical analysis of the impact on informed consent and patient decision-making.

Main Results:

• The model includes all costs of genetic screening and diagnostic testing in the episode calculation.
• This creates a potential conflict between physician financial incentives and the principle of patient autonomy.
• Physicians may face penalties for providing genetic testing, potentially limiting patient access.

Conclusions:

• The proposed payment model may create barriers to essential prenatal genetic services.
• Patient autonomy and informed decision-making regarding genetic testing could be compromised.
• A re-evaluation of the reimbursement structure is needed to align financial incentives with high-quality, patient-centered perinatal care.