2023: 5 Transformative Shifts in the Diagnostic Testing Landscape
January 19, 2024
A Watershed Year
The year 2023 marked a significant turning point for the diagnostics, as the COVID-19 pandemic transitioned from a global crisis to an endemic challenge. As the United States moved away from the pandemic’s peak and officially ended the Public Health Emergency on May 11, the healthcare sector experienced remarkable transformations, with a renewed focus on prevention, treatment, and technological advancements. In this blog post, we share key insights and observations from the full-year data in the XiFin Lab Volume Index and explore how the laboratory and diagnostic industry adapted to the changing healthcare landscape in 2023 and what lies ahead in 2024.
1. Telehealth and Remote Healthcare Services
One of the most notable shifts brought about by the COVID-19 pandemic was the increased demand for telehealth and remote healthcare services. The need to limit exposure to the virus, coupled with staffing shortages, prompted healthcare providers to embrace digital solutions, and this shift was not limited to clinical consultations but also extended to laboratory and other diagnostic services as well. Many “flexibilities” that were put in place during COVID have been extended through December 31, 2024, and others have been made permanent. Although there are numerous non-COVID benefits from these capabilities, in many ways the industry is still grappling with how best to utilize and cover them. Remote patient monitoring is one such area where changes in coverage policies are ongoing.
2. Digital Pathology Emerges
Bolstered by advances in telehealth and remote healthcare services, digital pathology services emerged as a crucial component of remote healthcare during the pandemic. This innovative approach allowed pathologists to review and diagnose specimens remotely, reducing the need for in-person consultations and minimizing potential exposure risks. In response to this growing trend, 13 new Category III CPT codes for Digital Pathology were introduced in 2023, with an additional 30 codes slated for 2024.
While the adoption of digital pathology services has varied across the industry, it represents a significant leap forward in the future of healthcare. The ability to share and analyze pathology data remotely not only enhances patient care but also opens up opportunities for collaboration and second opinions among experts worldwide.
3. The Expansion of Testing Methodologies
The laboratory industry played a pivotal role in the rapid response to the COVID-19 virus through testing methodologies like polymerase chain reaction (PCR). These methodologies, initially developed to detect the novel coronavirus, have found new applications in the detection of other infectious diseases. Moreover, point-of-care (POC) and over-the-counter (OTC) testing have become more commonplace.
As the laboratory industry diversified its testing capabilities beyond COVID-19, payors began to institute more stringent policies around infectious disease testing. This included the implementation of Prior Authorization requirements to ensure that testing is performed appropriately and efficiently.
4. Hereditary Cancer Testing and Non-Invasive Prenatal Testing
While payors have become more selective in covering infectious disease testing, they have concurrently expanded coverage for other critical areas of healthcare. Notably, hereditary cancer testing and non-invasive prenatal testing (NIPT) have gained wider acceptance among payors.
In July 2023, Cigna removed Precertification requirements for the 81229 Chromosomal Microarray test. This genetic test plays a crucial role in detecting chromosomal abnormalities that can lead to certain medical conditions. This policy change signifies a positive shift in payor support for genetic testing that can have a significant impact on patient care and early disease detection.
5. Whole Exome Sequencing (WES)
Another notable development in genetic testing coverage occurred in 2023 when Medicaid North Carolina added the 81415 procedure code to its fee schedule. This decision allowed for retroactive coverage to November 2022, signaling broader payment trends in Whole Exome Sequencing (WES). WES is a powerful tool for identifying genetic mutations that may contribute to various medical conditions, paving the way for more precise diagnoses and treatment strategies.
Looking Ahead to 2024: 3 Trends to Watch
As we step into 2024, the laboratory industry continues to evolve and adapt to the changing healthcare landscape. Molecular and genetic testing is expected to drive improvements in patient care and outcomes, offering personalized treatment options and early disease detection. However, these advancements come with their share of challenges, primarily in navigating the complex and evolving payor policy landscape.
1. Challenges in Payor Policy
The laboratory industry faces ongoing challenges in negotiating with payors regarding reimbursement and coverage policies. As the field of molecular and genetic testing expands, payors may introduce new criteria and requirements for test authorization.
Labs must stay vigilant and proactive in ensuring that their services align with these evolving policies to secure adequate reimbursement. To support our customers with insights on trends in in-network contracted rates for diagnostic testing, we launched the Payor Rate Transparency Monitor to help laboratories and diagnostic providers benchmark their contract rates against the market.
2. Continued Growth in Genetic Testing
Despite the challenges posed by payor policies, the laboratory industry anticipates continued growth in the realm of molecular and genetic testing. This growth is driven by the increasing recognition of the clinical utility of genetic information in patient care. Genetic testing can identify inherited risk factors, guide treatment decisions, and facilitate early disease detection, making it an essential component of modern healthcare.
3. Consumer-Driven Healthcare
Consumers are increasingly involved with their healthcare choices and care. They continue to demand more control and more access to information, with focus on both cost-conscious options and convenience. Their interest and rising influence will have broad-reaching effects, including the potential for a deeper understanding of their own health, demands for more personalized test and treatment options, and greater interest in remote patient monitoring capabilities. The patient experience and engagement, and desire for knowledge will continue to influence innovation and delivery of healthcare in the coming year.
Conclusion
The diagnostic industry’s journey in 2023 showcased resilience and adaptability in the face of healthcare’s shifting landscape. From the rise of telehealth and digital pathology to the expansion of genetic testing coverage, the industry has made significant strides toward enhancing patient care and outcomes.
Navigating regulatory and legislative issues as well as the complexities of payor policies will be crucial tasks for this industry again in 2024. The diagnostic industry remains a critical component of healthcare, and as always, XiFin is committed to helping customers—and the industry—navigate this volatile landscape through innovation, expertise, and advocacy.
Explore these and other trends with XiFin Lab Volume Index and the Payor Rate Transparency Monitor, and sign up to receive alerts.