Letters to the Editor
(MLO, Nov. 2001), how can a patient be held financially liable in case of a denial if she refuses to sign an
ABN? Why would a physician perform a lab test on a person who refuses to be financially responsible in case of a denial? I thought the whole point of an ABN was to inform the patient in advance that the test may not be considered medically necessary, and give them an opportunity to say whether they still want the test or not. What am I missing?Terri Troutman
Laurel, MDJoan Szabos responseThe information in November Washington Report column comes directly from the Centers of Medicare & Medicaid Services (CMS). There are a number of scenarios described by CMS with regard to the financial liability of the laboratory. For more details on the various scenarios I refer you to
www.hcfa.gov/medlearn/refabn.htm. Once at the site, click on Laboratorys Responsibility and Liability FAQs for specific guidance.In addition, CMS announced draft carrier instructions for ABN in the Oct. 12 Federal Register. These instructions may shed additional light on the liability issue. Regarding pharmacogenetic testingI am a longtime reader of MLO and enjoy the format and pertinence of this publication very much. I feel compelled to respond to the article in the September 2001 issue entitled Practical Considerations for Pharmacogenetic Testing.While I believe I understand and appreciate the points the author wished to make, I am saddened by the heavy focus on cost in determining the practicality of adding pharmacogenetic tests to a laboratorys test menu. The example of using this testing as an aid in making the decision to abort a baby as one of the few financially practical uses of pharmacogenetics is disturbing. Certainly money would be saved in the hospitals not providing care for the child that was aborted, but there would just as certainly be no avoiding unnecessary physical suffering and emotional trauma for the woman, her family, and for the new life that was ended.Statements such as, Is an improvement in the quality of patient care worth the cost/expense of routine genetic testing? do not go down well with dedicated healthcare professionals. We understand the business aspect of laboratory medicine, and we know we must at times make tough decisions in order to survive in todays economic climate. But we never want to lose sight of our primary focus, which is quality patient care.I thought the second half of the article beginning with Cost versus savings provided a nice balance of information that could be used by laboratories in evaluating whether or not to bring pharmacogenetic testing in-house. When a test is unambiguously proven to have clinical importance, I hope labs will choose to offer that test regardless of the costs involved.Janet Schultz,
MT(ASCP)
Hematology Supervisor
Pathologists Associated
Medical Laboratories
Muncie, INPlease send letters to: Editor, MLO Nelson Publishing 2500 Tamiami Trail North Nokomis, FL 34275 or e-mail [email protected].©
2002 Nelson Publishing, Inc. All rights reserved.
Readers Respond
Defining purpose of Advanced Beneficiary NoticeIn reference to Joan Szabos Washington Report column dealing with ABNs(MLO, Nov. 2001), how can a patient be held financially liable in case of a denial if she refuses to sign an
ABN? Why would a physician perform a lab test on a person who refuses to be financially responsible in case of a denial? I thought the whole point of an ABN was to inform the patient in advance that the test may not be considered medically necessary, and give them an opportunity to say whether they still want the test or not. What am I missing?Terri Troutman
Laurel, MDJoan Szabos responseThe information in November Washington Report column comes directly from the Centers of Medicare & Medicaid Services (CMS). There are a number of scenarios described by CMS with regard to the financial liability of the laboratory. For more details on the various scenarios I refer you to
www.hcfa.gov/medlearn/refabn.htm. Once at the site, click on Laboratorys Responsibility and Liability FAQs for specific guidance.In addition, CMS announced draft carrier instructions for ABN in the Oct. 12 Federal Register. These instructions may shed additional light on the liability issue. Regarding pharmacogenetic testingI am a longtime reader of MLO and enjoy the format and pertinence of this publication very much. I feel compelled to respond to the article in the September 2001 issue entitled Practical Considerations for Pharmacogenetic Testing.While I believe I understand and appreciate the points the author wished to make, I am saddened by the heavy focus on cost in determining the practicality of adding pharmacogenetic tests to a laboratorys test menu. The example of using this testing as an aid in making the decision to abort a baby as one of the few financially practical uses of pharmacogenetics is disturbing. Certainly money would be saved in the hospitals not providing care for the child that was aborted, but there would just as certainly be no avoiding unnecessary physical suffering and emotional trauma for the woman, her family, and for the new life that was ended.Statements such as, Is an improvement in the quality of patient care worth the cost/expense of routine genetic testing? do not go down well with dedicated healthcare professionals. We understand the business aspect of laboratory medicine, and we know we must at times make tough decisions in order to survive in todays economic climate. But we never want to lose sight of our primary focus, which is quality patient care.I thought the second half of the article beginning with Cost versus savings provided a nice balance of information that could be used by laboratories in evaluating whether or not to bring pharmacogenetic testing in-house. When a test is unambiguously proven to have clinical importance, I hope labs will choose to offer that test regardless of the costs involved.Janet Schultz,
MT(ASCP)
Hematology Supervisor
Pathologists Associated
Medical Laboratories
Muncie, INPlease send letters to: Editor, MLO Nelson Publishing 2500 Tamiami Trail North Nokomis, FL 34275 or e-mail [email protected].©
2002 Nelson Publishing, Inc. All rights reserved.
