Order out of chaos

CHICAGO—"The challenge of making choices among moleculartests and the lack of a lingua franca(standardized language)" were the motivating factors in a licensingrelationship between the American Medical Association (AMA) and McKessondesigned to offer the healthcare system a consistent and transparent way toidentify and track molecular diagnostic (MDx) tests, according to MatthewZubiller, vice president, decision management at McKesson Health Solutions. Headds, "Getting patients the right care means reducing confusion."

"In the last four or five years, there has been an explosionof molecular and genetic tests, with the number and complexity growingexponentially, so that there are now 4,000 of them," says Robert Mussachio,senior vice president, business products and services at the AMA.

According to Frost & Sullivan, MDx is the fastestgrowing sector of clinical pathology lab testing, with revenues expected toreach $6.2 billion by 2014 and a projected compound annual growth rate of morethan 11 percent. The question is how to get payers, providers and laboratorieson the same page to differentiate between tests, make good cost-benefitdecisions and get the best results, or to "get from potential to decisionmaking," as Zubiller says.

McKesson Z-Code Identifiers will be grouped and indexed withcorresponding molecular pathology codes in the AMA's Current ProceduralTerminology (CPT) code set, according to the agreement. With identifiers andcodes working in tandem to create a comprehensive reference for identifying andtracking MDx tests, all of the players in the healthcare industry can betterunderstand the growth in this area to support advanced diagnostics innovation.This will "marry the terminology with the identification, licensed under theAMA banner," Mussachio says.

McKesson, a pharmaceutical distributor and healthcareinformation technology company, provides systems for medical supply management,clinical workflow, practice management, pharmacy automation and caremanagement. In 2011, the company created the McKesson Diagnostics Exchange, asoftware-as-a-service catalog. It shared a workflow solution that laboratoriesand diagnostics manufacturers can use to submit information about theirspecific MDx tests, and that providers and payers can use to understand andevaluate them. The McKesson Diagnostics Exchange issues a unique Z-CodeIdentifier to each test and catalogs it for reference and understanding byother stakeholders in the healthcare system.

The AMA's involvement in coding solutions for molecularpathology services (MOPATH) dates back to 1998. New, more detailed CPT codesfor molecular pathology services became effective in 2012. Thus far, the MOPATHprocess has created more than 100 codes for reporting innovative diagnosticservices. This collaboration complements the recent efforts that the AMA andMcKesson have undertaken to work closely to share terminology with the NationalInstitutes of Health's Genetic Testing Registry.

Mussachio explains that McKesson will bring software, anidentification system and know-how to the collaboration, while the AMA willprovide process and procedures with the MOPATH committee doing the review,creating the classification system and licensing the program. Zubiller says thenew program combines AMA's reputation as a "convenor of the stakeholders ofcare" with the accessibility of McKesson's Diagnostic Exchange software.

The relationship between the AMA and McKesson will result inthe creation of a new reference product that maps Z-Code Identifiers to CPTcodes. The AMA will use the information that labs and manufacturers submit andthen share in the McKesson Diagnostics Exchange to assign CPT code mappingswhere appropriate. Not all Z-Code Identifiers will immediately map to a CPTcode, and in many cases, multiple Z-Code Identifiers will map to a single CPTcode. The new product will be available for licensing from the AMA early in2014.

Connecting Z-Code Identifiers with CPT codes is expected toyield many benefits. Laboratory testscan be mapped to CPT codes where appropriate, so the laboratories can identifyexactly which test was performed and then reported with the appropriate CPTcode, potentially improving efficiencies in the reimbursement process.Clinicians can access a tool to help them accurately identify and select tests.Payers can have additional detailed test information to help identify the testsbeing performed, thus providing the industry with the ability to track outcomeson specific tests and analyze the value of these tests. Patients will benefitfrom this collaboration as it supports medicine's overarching goals of reducingdisease burdens and improving health outcomes.

Mussachio says he is glad to be "leveraging the AMA'sexpertise, demonstrating that we can be responsive to the market and improvingoutcomes for the public." Zubiller anticipates that everyone in the healthcaresystem will understand the benefits of molecular testing, both clinically andfinancially, as a result of the collaboration.