Hospital Administrators
If your medical center is like most, you spend approximately $440,000 per year on un-reimbursed second biopsy expenses.
Subjecting patients to second biopsies becomes necessary when oncologists order molecular testing on tumor cells, but the patient’s biopsy specimen has been exhausted. When that happens, you are confronted with a lose-lose decision tree for your resource allocation committees. You either:
(a) Say no to the second biopsy on the basis that it won’t be reimbursed by the patient’s insurer. This potentially subjects the patient to the devasting side effects of chemotherapy when he/she may have been a candidate for a precision medicine alternative or clinical trial. Or you
(b) Say yes to the second biopsy, and thereby provide your clinical lab with the cellular material it needs to perform next generation sequencing. But you lose approximately $6,000 each time you do that.
Subjecting patients to second biopsies becomes necessary when oncologists order molecular testing on tumor cells, but the patient’s biopsy specimen has been exhausted. When that happens, you are confronted with a lose-lose decision tree for your resource allocation committees. You either:
(a) Say no to the second biopsy on the basis that it won’t be reimbursed by the patient’s insurer. This potentially subjects the patient to the devasting side effects of chemotherapy when he/she may have been a candidate for a precision medicine alternative or clinical trial. Or you
(b) Say yes to the second biopsy, and thereby provide your clinical lab with the cellular material it needs to perform next generation sequencing. But you lose approximately $6,000 each time you do that.
Second biopsies are expensive
Re-biopsy costs are reported in the literature:
“…As calculated for a hospital setting in the United States in 2015, FNAB(1) for a palpable breast lump costs $522, rising to $3,800 for ultrasound-guided FNAB. The corresponding cost for image-guided CNB was estimated at $5,946.”(2)
Also, consider all the resources that are NOT needed to deploy the Crow’s Nest in your hospital:
“…As calculated for a hospital setting in the United States in 2015, FNAB(1) for a palpable breast lump costs $522, rising to $3,800 for ultrasound-guided FNAB. The corresponding cost for image-guided CNB was estimated at $5,946.”(2)
Also, consider all the resources that are NOT needed to deploy the Crow’s Nest in your hospital:
- No instrumentation
- No additional personnel
- No training period
- No space or significant time will be needed to carry out the Crow’s Nest simple protocol.
Second biopsies are common
Of the 20% of core needle biopsies that test positive for cancer, an average of 46% of them lack sufficient tissue to perform genetic testing to find out what drugs the cancer may be susceptible to, and hence 9% of patients are subjected to a second biopsy.
That means the average U.S. hospital performs approximately 72 second biopsies per year (not including second biopsies due to missing the target tissue the first time), costing it nearly half a million dollars that is not reimbursed by insurers. If that same hospital uses the Crow’s Nest on every one of its average 700 biopsies per year at a cost of $200 per unit, it would spend just 1/3 of that amount, and avoid the second biopsies, because each patient would already have a second specimen to use for genetic testing.
Use of the Crow’s Nest after every core needle biopsy provides a source of fresh, undamaged cells from each patient’s tumor, available for molecular testing, and costs significantly less than the amount it saves by avoiding unreimbursed second biopsies.
That means the average U.S. hospital performs approximately 72 second biopsies per year (not including second biopsies due to missing the target tissue the first time), costing it nearly half a million dollars that is not reimbursed by insurers. If that same hospital uses the Crow’s Nest on every one of its average 700 biopsies per year at a cost of $200 per unit, it would spend just 1/3 of that amount, and avoid the second biopsies, because each patient would already have a second specimen to use for genetic testing.
Use of the Crow’s Nest after every core needle biopsy provides a source of fresh, undamaged cells from each patient’s tumor, available for molecular testing, and costs significantly less than the amount it saves by avoiding unreimbursed second biopsies.
Financial conclusion
So in addition to all the clinical benefits, the Crow’s Nest saves money.
The procedure of segregating biopsied tissue into two specimens (one solid tissue for microscopic examination and one loose cells for molecular testing) can warrant its own procedure reimbursement.
If you are a hospital administrator interested in trialing the Crow’s Nest at your institution, contact us about becoming an alpha testing center.
REFERENCES
(1) FNAB is an acronym for Fine Needle Aspirate Biopsy
(2) Masood S, et. al. Comparative cost-effectiveness of fine needle aspiration biopsy versus image guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of Affordable Care Act: a changing landscape. Diagnostic Cytopathology 2015;43(8): 605–612.
The procedure of segregating biopsied tissue into two specimens (one solid tissue for microscopic examination and one loose cells for molecular testing) can warrant its own procedure reimbursement.
If you are a hospital administrator interested in trialing the Crow’s Nest at your institution, contact us about becoming an alpha testing center.
REFERENCES
(1) FNAB is an acronym for Fine Needle Aspirate Biopsy
(2) Masood S, et. al. Comparative cost-effectiveness of fine needle aspiration biopsy versus image guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of Affordable Care Act: a changing landscape. Diagnostic Cytopathology 2015;43(8): 605–612.
