GeneTests currently lists 593 laboratories testing for 2,305 diseases — 2,040 clinically based and 265 research based. Check out their chart of lab and test growth over the years 1993-2009.
With this exponential growth of labs and tests with various panels offering different sensitivities for different conditions, how does one choose a lab and how does one choose certain panels over others? In my primarily prenatal role in an academic university hospital, genetic testing is very accessible to my patients as there is patient interest, insurance coverage, and private monies to really make it happen. So, access is no longer the primary issue I deal with and the patients look to me as their genetic counselor to determine which lab offers “the best” test that is most up-to-date. How quickly do we modify what we offer? How does your center choose and vet which labs to use?
Labs are always sending out notices of new panels, sending representatives to educate us about their tests. But, how quickly do you start offering a new panel once you have been educated about it?
Here are some things I think seem to dictate how I choose a lab, in no particular order:
1. What is the sensitivity and specificity of the test?
2. Does the lab provide pre-verification of insurance benefits?
3. Is the customer service accessible and available to strategize regarding the testing plan i.e. are there genetic counselors and laboratory directors that I can speak with?
4. Does this lab have a great deal of experience working with this gene or disease?
5. How quickly do they report their results? Will they expedite prenatal cases?
6. Is the format of their reports accessible?
7. Do they have educational materials about their tests for providers? For patients?
8. Are there logistical shipping issues/costs?
9. For NYS, do I need a permit?
All these things weigh differently in every case, depending on the needs of the patient. But, patients do not always know what is out there or what they need – it can become our job to make the best laboratory choices to fit their needs. Sometimes, this is a challenge for me. And sometimes, I feel like a laboratory sales representative.
It seems to me that if we do not offer a test, it essentially does not exist to a patient. Sometimes patients do not know they want a test out there simply because they do not know about it.
So, when a new panel of tests comes out, how does your center decide what to offer the patients? Is there a departmental debate? Does it have to meet certain internal requirements?
When faced with a handful of lab options sequencing the same gene, how do you chose the lab?
Please share you thoughts and strategies regarding this. I am truly very curious.
The DNA Exchange 
Most of the time it seems that I am choosing labs depending on insurance. We have a lot of patients with medicaid, so if a lab takes Montana Medicaid, they are my first choice. I will also choose a lab that does insurance pre-auth and billing, everything else the same. I do like labs that offer panels and reflex testing. If I can get all the genes we are looking at done at one lab, with dup/del testing, I will go with that one. I think it also depends on the individual patient, and what kind of testing we are looking for.
I get stuck with the question of whether or not to offer testing to a patient just because I can. You are correct in that if I don’t mention a test, the patient does not know it is there. We do not have a center policy on offering a new panel/test. We are a small enough group we just discuss amongst ourselves. I am running into this issue with CHEK2. It is available, do I offer testing to some of my patients, all my breast cancer patients, what does it really mean if they are positive, or negative? If I don’t offer it, my patients do not know it is an option.
I think this is an interesting topic that genetic counselors deal with on a regular basis as part of our job. I think all the points Jessica mentions are things I use to consider which lab(s) to use. In my institution, the outpatient laboratory is run by a local commercial lab, so we have a very close relationship with them. Insurance also will often dictate (unfortunately) what tests are available to a patient, due to thier own financial limitations if their insurance company doesn’t cover the cost of testing. . I also like to listen to what the patient is telling me is important to them as far as testing. Some patients tell me they want to check for everything, and some of my patients are not as concerned about having a child with certain disorders and are not interested in testing.
One of the criteria we have used at my institution is if there is a research registry for the particular condition we are testing for, or if the lab has ongoing research opportunities. One such example would be testing for Beckwith-Wiedeman, being that that University of Washington has a registry.
Otherwise we are left with what contracts we have with the labs so that the insurance can cover the testing.
This is an excellent consideration to bring up! Thank you for sharing as I do not think I keep this in my matrix of thinking.