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Mar 1, 2013

AMA Enters Diagnostic Fray

  • The American Medical Association (AMA) and McKesson this week launched a joint effort to create a new standardized system intended to track the more than 3,000-and-growing number of molecular diagnostic tests now on the market.

    The joint effort is intended to produce a new reference product that groups and indexes McKesson’s Z-Code Identifiers with corresponding AMA’s CPT codes. AMA will use information from test manufacturers and laboratories to assign CPT code mappings for diagnostic tests, using McKesson’s Diagnostics Exchange. The exchange, created in 2011, is a software-as-a-service catalog and shared workflow solution allowing the labs and diagnostics manufacturers to submit information about their specific MDx tests for evaluation and possible use by healthcare providers and insurers.

    “Essentially, what we are trying to do is bring about some clarity & dispel some confusion that exists in the market right now. With any new tech, there’s often some uncertainty & confusion around the terminology,” Robert Musacchio, Ph.D., AMA’s senior vp, business products and services, told GEN.

    The reference product will uniquely identify tests while accounting for families of tests with common elements, akin to the genus and species system of classifying animals and plants.

    “When we assign an identifier, we’re taking into account the methodology of a test. We’re taking into account things that make a test unique. It could be the number of alleles,” Rich Young, assistant vp for lab strategy with McKesson Health Solutions, told GEN. “Anything that does make a test unique, we’re essentially just identifying this with a tag, and then back to AMA, which will then within their process roll that up and map that to their classifications.”

    AMA and McKesson caution that not all Z-Code Identifiers will immediately map to a CPT code, while in some cases, multiple Z-Code Identifiers will map to a single CPT code.

    The new product will be available for licensing from AMA early in 2014.

    AMA and McKesson say the reference product will benefit the U.S. healthcare system, already undergoing structural change under “Obamacare” or the Patient Protection and Affordable Care Act of 2010. Doctors would be better informed about the full range of available tests, they argue, while insurers would make better decisions about which specific tests to pay for, labs would be better able to differentiate their tests, and all would know more about the impacts of those tests on patient outcomes, clinical quality, and healthcare costs. McKesson discussed many of those challenges in a 2011 white paper, Unlocking the Promise of Molecular Diagnostics.

    AMA has been involved with developing coding for molecular pathology services since 1998. Last year a set of more detailed CPT codes for molecular pathology services became effective, with some 100 codes created for reporting diagnostic services. But the new codes drew some criticism that they were not granular enough to describe specific tests in all cases—something the AMA/McKesson effort is eager to avoid.

    Pricing for the combined reference product has not been set. Insurers would be the primary licensees, though said other licensees are expected to embrace the product, such as case management systems and care management systems, Matthew Zubiller, vp, decision management for McKesson Health Solutions, told GEN.

    “The idea is that by being able to use the identifiers and the CPT codes together, a more granular vocabulary will emerge to be able to describe these diagnostic tests,” Zubiller said. “You can also use those identifier-CPT code combinations to be able to capture the clinical data as well as financial data that come along with the use of these diagnostic tests, which hasn’t been as easy to do before.”


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