The economics of clinical genetics services. III. Cognitive genetics services are not self-supporting
1Division of Medical Genetics, Johns Hopkins Hospital, Baltimore, MD 21205.
Insights
Cognitive genetics services are not self-supporting across various clinical settings, with significant gaps in cost coverage. Improving collections and seeking external funding are crucial for financial viability.
Area of Science:
- Medical Genetics
- Health Services Research
- Clinical Economics
Background:
- Cognitive genetics services are essential for patient care but their financial sustainability is often unclear.
- Understanding the time, charges, and reimbursement is critical for evaluating the economic viability of these services.
- Previous studies have not comprehensively assessed the financial aspects of cognitive genetics services across diverse clinical environments.
Purpose of the Study:
- To investigate the time, charges, and reimbursement associated with cognitive genetics services in four distinct clinical settings.
- To determine the extent to which patient charges cover personnel costs in these settings.
- To identify potential strategies for improving the financial base of cognitive genetics services.
Main Methods:
- Data collection on time spent, hourly charges, and reimbursement rates for cognitive genetics services.
- Analysis of financial data across a prenatal diagnostic center, a private specialty hospital genetics clinic, a pediatric genetics clinic, and a genetics outreach setting.
- Comparison of income from patient charges against personnel costs in each setting.
Main Results:
- Cognitive genetics services were not self-supporting in any of the four clinical settings studied.
- Reimbursement rates varied significantly, with collected amounts often falling far below charged amounts (e.g., <25% in one setting).
- Personnel costs were covered by patient charges at rates ranging from 49% to 69% in different settings.
Conclusions:
- Cognitive genetics services face significant financial challenges, with substantial shortfalls in covering personnel costs.
- Strategies to improve financial sustainability include enhancing collection rates, adjusting fee schedules, increasing efficiency, and securing external funding.
- Further research and policy development are needed to ensure the long-term viability of cognitive genetics services.
Abstract:
We investigated the amount of time required to provide, and the charges and reimbursement for, cognitive genetics services in four clinical settings. In a prenatal diagnostic center, a mean of 3 h/couple was required to provide counseling and follow-up services with a mean charge of $30/h and collection of $27/h. Only 49% of personnel costs were covered by income from patient charges. In a genetics clinic in a private specialty hospital, 5.5 and 2.75 h were required to provide cognitive services to each new and follow-up family, respectively. The mean charge for each new family was $25/h and for follow-up families $13/h. The amount collected was less than 25% of that charged. In a pediatric genetics clinic in a large teaching hospital, new families required a mean of 4 h and were charged $28/h; follow-up families also required a mean of 4 h, and were charged $15/h. Only 55% of the amounts charged were collected. Income from patient charges covered only 69% of personnel costs. In a genetics outreach setting, 5 and 4.5 h were required to serve new and follow-up families, respectively. Charges were $25/h and $12/h, and no monies were collected. In all clinic settings, less than one-half of the total service time was that of a physician, and more than one-half of the service time occurred before and after the clinic visit. In no clinic setting were cognitive genetics services self-supporting. Means to improve the financial base of cognitive genetics services include improving collections, increasing charges, developing fee schedules, providing services more efficiently, and seeking state, federal, and foundation support for services.
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