Washington, DC — In a joint Position Statement released today, the American College of Obstetricians and Gynecologists and the American Congress of Obstetricians and Gynecologists (collectively ACOG) warn that recent proposals by health insurers to restrict access to genetic testing will limit patient care.
By imposing unnecessary barriers, these proposals – which stipulate who can order genetic testing or which set burdensome prior authorization requirements – only make it harder for patients to get the care they need at a time when delays may lead to worse outcomes. Reflecting the negative impact these requirements would have on women, the Position Statement states: "ACOG opposes such attempts to restrict the scope of practice of obstetrician-gynecologists, who are fully qualified to provide pre-test counseling to their patients."
Board certified ob-gyns are skilled, dedicated health care professionals with more-than-sufficient training to order genetic testing and to counsel patients prior to and after testing. In many cases, a woman's trusted ob-gyn is the ideal and preferred messenger of health information.
Requiring women to receive genetic testing orders from genetic counselors will particularly hurt patients in areas of the country with few of these professionals. ACOG's statement adds, "With relatively few genetic counselors in the U.S., a requirement for all persons for which genetic testing is indicated to undergo pre-testing counseling by a 'genetics professional' would markedly limit access to needed testing."
ACOG's Committee Opinion on Ethical Issues in Genetic Testing lays out the role ob-gyns play in genetic counseling: "The obstetrician-gynecologist who orders genetic tests should be aware of when it is appropriate to test, which particular test to order, and 'what information the test can provide, the limitations of the test, how to interpret positive and negative results in light of the patient's medical or family history, and the medical management options available.'" Moreover, the Committee Opinion states that the ob-gyn should be prepared to refer patients as needed to an appropriate specialist for treatment.
"Ob-gyns around the country screen women for a variety of cancers every day," said Mark S. DeFrancesco, MD, MBA, President of ACOG. "Ob-gyns know how to discuss the risk of cancer with their patients, and women are accustomed to having these important conversations with their ob-gyns. We are dedicated to ensuring that our patients receive the care they need, when they need it, and by physicians they trust."
Clearly, ob-gyns are well suited to order genetic tests, to counsel patients before and after, and to take the necessary steps for patients who need additional specialized care.
However, insurers are increasingly making it harder for ob-gyns to order genetic tests, delaying the ability of women to get the testing that they need and to work with their physicians to create treatment and prevention plans that are right for them. These restrictions are not medically indicated and negatively impact patient care at a time when access to information is of utmost importance. Postponing access to testing exposes women to delays in which a hereditary cancer might develop, thus potentially worsening outcomes.
For example, beginning January 1, United Health Care will impose a burdensome prior authorization requirement before the insurer will cover BRCA testing. BRCA gene mutations, which are hereditary, are associated with elevated risk of breast cancer and ovarian cancer. About 1 in 300 people carry a BRCA1 mutation, and 1 in 800 carry a BRCA2 mutation.
Ob-gyns already screen patients for breast cancer; this includes evaluating a woman's family history of breast and ovarian cancers and ordering BRCA testing when appropriate. In fact, given the small number of genetic counselors in the U.S., it is clear that the majority of BRCA testing has historically been ordered by ob-gyns.
"Imposing non-medically necessary prior authorization requirements that block a woman's trusted physician from ordering appropriate care for patients is contradictory to quality medical care, and is bad medicine," added Dr. DeFrancesco.
ACOG opposes restrictions and delays to needed medical care, and will continue to monitor insurer decisions in order to ensure that patients are receiving the care that they need in a timely manner.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org