Financial incentive for genesight testing?

[annoyedpsychiatrist]

Are these private practice doctors getting some kind of billing/financial/etc incentive by offering this for every patient or does it just make them look like they are a cutting edge provider and its done for show? I ask because i see all these private clinics that do it first visit for basically everyone

I dont think ive ever thought of genesight testing as particularly useful in most people outside of its limited indications

---

Members don't see this ad.

 

[Ironspy]

I advertise that I offer it but usually talk patients out of getting it after discussing the limitations of the results. Some patients want it for peace of mind even knowing it’s unlikely to change the treatment. The main utility IMO is justifying high doses of meds for ultra fast metabolizes though you can certainly do this with clinical judgement alone. I order <5 of these tests/year.

There is no financial incentive I am aware of though many cash patients want a personalized approach and genetic testing fits within this framework.

 

[lobstar]

I think it is exactly done for show like you said. Pomp and circus. Sure some people metabolize quickly/slowly but like Ironspy said that can be manged without a test for most people. I think it's like vitafusion, microdosed ketamine IV, tamiflu, the high dose benzo stimulant combos...people will pay you to do things even if those things aren't proven effective, particularly in a private practice where cash pay patietns want to see something a little extra, something with a little razzle dazzle.

 

[calvnandhobbs68]

Yeah there's no financial incentive as far as I'm aware, it's just to say you do genetic testing or whatever so you look super cutting edge...I have a stack of them in my office I haven't touched for 3 years lol.

 

[smalltownpsych]

If you are competent, then you don’t need to do the razzle dazzle. Whether it is NPs doing genetic testing and neurofeedback or LPCs doing brain spotting, tapping, and EMDR, it seems like the same dynamic. I don’t do any woo woo crap in my practice and wish I had referrals for psychiatrists who don’t but in my area there aren’t any. We are going to try a new psychiatrist that is about 45 minutes away so hopefully he is competent. I do worry because he takes insurance and my patients are cash pay and require extra care due to increased severity and complexity.

 

[Sushirolls]

In my area its ARNPs ordering them. Some FM. And decent amount of therapists pushing their patients to request it.
I routinely tell patients its a waste of money.

 

[mistafab]

From my experience, it is usually the patients pushing to get this done. There is the undercurrent promise that the testing will reveal the elusive "answer" that makes everything "make sense" and helps them get "completely fixed." Their diagnosis does make sense to them, but it is unfortunately easy for companies and financially interested parties to prey on people who are suffering.

In my experience from the clinician side, it can be somewhat helpful for people have never been trialed on medicines. It may also help build the patient's confidence in treatment who have experienced many, many failed med trials - which increases compliance and ergo, results. Also, the testing usually includes MTHFR data which can be helpful in treatment resistant depression groups.

 

[calvnandhobbs68]

In my experience from the clinician side, it can be somewhat helpful for people have never been trialed on medicines. It may also help build the patient's confidence in treatment who have experienced many, many failed med trials - which increases compliance and ergo, results. Also, the testing usually includes MTHFR data which can be helpful in treatment resistant depression groups.

Somewhat helpful in what way? There are even less studies for people who are completely treatment naive and APA still recommends against PGx tools.

Pharmacogenomic Clinical Support Tools for the Treatment of Depression | American Journal of Psychiatry

Objective: In this review, the authors update the 2018 report of the American Psychiatric Association Council of Research Workgroup on Biomarkers and Novel Treatments on pharmacogenomic (PGx) tools for treatment selection in depression. Methods: The literature was reviewed for new clinical...

www.psychiatryonline.org

Also, the usual Genesight panel doesn't include MTHFR data. It's a completely separate test that's just an MTHFR test...you'd think it would make sense to include it as part of the panel but nope.

 

[Merovinge]

Somewhat helpful in what way? There are even less studies for people who are completely treatment naive and APA still recommends against PGx tools.

Pharmacogenomic Clinical Support Tools for the Treatment of Depression | American Journal of Psychiatry

Objective: In this review, the authors update the 2018 report of the American Psychiatric Association Council of Research Workgroup on Biomarkers and Novel Treatments on pharmacogenomic (PGx) tools for treatment selection in depression. Methods: The literature was reviewed for new clinical...

www.psychiatryonline.org

Also, the usual Genesight panel doesn't include MTHFR data. It's a completely separate test that's just an MTHFR test...you'd think it would make sense to include it as part of the panel but nope.

Is there any new data to support MTHFR mattering at all? The last time I saw an international review around 3 years ago there was no evidence to support this. I have seen several patients taking l-methylfolate and none that found it made a notable difference although my patient population is very biased to the sick due to working exclusively at PHP/IOP these days.

 

[Atreides]

Patients will think you’re more up-to-date if you order it. I neither advertise nor utilize it but I can see why someone who knows it’s useless would order it for the placebo effect.

 

[Stagg737]

I get a lot of patients referred to me in my consult clinic who have had genesight testing already (probably ~50%) done by their PCP or NP. Almost all of them have been misinformed about the stupid color system that "red" medications are "bad" and can't be prescribed and think that meds in the "green" column are supposed to work. I spend most of my time talking about how these tests don't actually direct us about what meds will actually work, just when we may have to adjust dosing from the standard recommendations based on metabolism.

I've only ordered it once myself in the past 2-3 years and that was because the patient was insistent they wanted it and was fine shelling out a couple of hundred bucks for it. It did not change our treatment plan and patient was fine with that when they barely had any abnormalities.

Is there any new data to support MTHFR mattering at all? The last time I saw an international review around 3 years ago there was no evidence to support this. I have seen several patients taking l-methylfolate and none that found it made a notable difference although my patient population is very biased to the sick due to working exclusively at PHP/IOP these days.

Last I checked there is some data for MTHFR but it's pretty weak and certainly not something I generally worry about. When patients get genesight you just check another box for the MTHFR testing and it's not an extra charge. That said, I have had a small number of patients who noted a significant difference in symptoms after starting supplementation when they had severe deficiency. Whether that's placebo or physiologic effect for them idk, but I don't completely write it off.

 

[MedMan80]

It gets some patients comfortable with the process, seeing all the colors and suchs

 

[Sushirolls]

The shamanastic side of medicine.

This undercurrent in medicine is rising, and what so many people want, and can very easily sweep away those who are more allopathic purest.

Shamanism just won't die. But hey, at least we are being inclusive of diverse treatments and even allowing the equity to pay for it and fufu practitioners at the level of CMS.

 

[Merovinge]

The shamanastic side of medicine.

This undercurrent in medicine is rising, and what so many people want, and can very easily sweep away those who are more allopathic purest.

Shamanism just won't die. But hey, at least we are being inclusive of diverse treatments and even allowing the equity to pay for it and fufu practitioners at the level of CMS.

It doesn't need to die, it just needs to not be reimbursed by health insurance and not practiced by doctors. Chiropractors and homeopaths should be allowed to practice, but certainly should not be getting that funded by the government/tax payer.

I wouldn't say this is a rising current, shamanism practices were medical practices historically. EBM is new from a human evolution perspective and a lot of people really are interested in what the best science recommends. Sure some people called COVID a hoax as they were being intubated and died, my pulm/crit friend has unreal stories from the pandemic, but I'm actually a bit surprised how many people prefer prescription medications to reasonable interventions like melatonin and Silexan (which would be prescription meds in Europe, but I can't import them directly here).

 

[calvnandhobbs68]

The shamanastic side of medicine.

This undercurrent in medicine is rising, and what so many people want, and can very easily sweep away those who are more allopathic purest.

Shamanism just won't die. But hey, at least we are being inclusive of diverse treatments and even allowing the equity to pay for it and fufu practitioners at the level of CMS.

I feel like I'm starting to pull together the criteria of a condition newly known as DIEDS (Diversity Inclusion and Equity Derangement Syndrome).

One of the criteria will be frequent insertion of at least any two out of these three words into a completely unrelated subject matter.

 

[mistafab]

Somewhat helpful in what way? There are even less studies for people who are completely treatment naive and APA still recommends against PGx tools.

Pharmacogenomic Clinical Support Tools for the Treatment of Depression | American Journal of Psychiatry

Objective: In this review, the authors update the 2018 report of the American Psychiatric Association Council of Research Workgroup on Biomarkers and Novel Treatments on pharmacogenomic (PGx) tools for treatment selection in depression. Methods: The literature was reviewed for new clinical...

www.psychiatryonline.org

Also, the usual Genesight panel doesn't include MTHFR data. It's a completely separate test that's just an MTHFR test...you'd think it would make sense to include it as part of the panel but nope.

If they have been on zero medication trials and they want genetic testing BEFORE making a trial, they are generally very bought into treatment afterwards. I'm thinking this is because they are maximizing placebo effect. They see something "objective" that says X medicine will work, thus their belief that X will work goes up.

I do not push patients to get these tests. Very often the situation is that the patient comes to me requesting this to be ordered. I'm pragmatic about data, and this data rarely effects my prescribing practice. So on the clinician side, it is generally a net positive for my relationship with the patient if they want it and I order it, and tends to make them be more complaint with treatment. For treatment resistant folks, they tend to want as much data as possible since they are in various stages of treatments failing. In those patients, they generally want genetic testing and If they do, MTHFR testing can often be included.

Is there any new data to support MTHFR mattering at all? The last time I saw an international review around 3 years ago there was no evidence to support this. I have seen several patients taking l-methylfolate and none that found it made a notable difference although my patient population is very biased to the sick due to working exclusively at PHP/IOP these days.

The data on MTHFR is not great, but I have personally reviewed the relevant science. A 2015 pretty well designed study looked at the rate of the mutation in folks with MDD and TRD and noted no difference in rate of the depression or response to treatment. However they noted women with a specific mutation on this gene had higher depression. Unfortunately, they did not actually supplement the folks with the genetic mutation to see if response to treatment changed afterwards.

The data for if supplementation helps with depression is also poor. The studies that supplemented with it did not actually test the patients to see if they had the mutation before they tested it. So bascially, they randomly gave depressed patients L-Methylfolate and saw what happened; they conducted poor science.

So I think the science on genetic testing is far from saying it is helpful, at all. The data does not show that genetic testing helps treatment. Clinically, it helps me because it increases buy in for those that request the testing, especially for prior to treatment folks, or folks burned out from many failed treatments. Additionally, in the treatment-resistant depression land of poor science outside of big guns (interventional), you tend to be wading into the waters of clinical experience and best guesses based on data.

 

[Sushirolls]

I feel like I'm starting to pull together the criteria of a condition newly known as DIEDS (Diversity Inclusion and Equity Derangement Syndrome).

One of the criteria will be frequent insertion of at least any two out of these three words into a completely unrelated subject matter.

If you have lived or practiced in areas of the country where DCs NDs and ARNPs all have full autonomous practice rights, can bill CMS, and be considered "primary care." And supplements, or cannabis are pushed as the elixir of life. That "holistic" psychiatry practices pop up often, shelling their supplements, too. The oxygen bars, the vitamin IV infusions, the barometric pressure container treatments... Reviewing websites of other people in area, and you start to see that only the Big Box shops are deficient in these things and you start to see, it isn't a syndrome but a real rising issue. It is spreading. Those are underlying ideas/policies that have hastened it's spread.

I wish I didn't care as much... and then I too would start embracing the shamanistic Kumbaya Koolaid to fleece people out of their money. Talk about standard of care lexapro for a minute, then segway over to custom made compounded supplement, topped with 30 minutes in the barometric chamber, while finishing up with some Reiki and a final chat about chakras with a complimentary Turkey Tail Tea in hand [*of course, only ethically sourced, mushroom tea, organic, fair trade compensated from a small rural farmer in PEI Canada, with a 10 acre wood lot utilization coppicing techniques on 'weed' type oak variety]. Cash please...

 

[Merovinge]

If you have lived or practiced in areas of the country where DCs NDs and ARNPs all have full autonomous practice rights, can bill CMS, and be considered "primary care." And supplements, or cannabis are pushed as the elixir of life. That "holistic" psychiatry practices pop up often, shelling their supplements, too. The oxygen bars, the vitamin IV infusions, the barometric pressure container treatments... Reviewing websites of other people in area, and you start to see that only the Big Box shops are deficient in these things and you start to see, it isn't a syndrome but a real rising issue. It is spreading. Those are underlying ideas/policies that have hastened it's spread.

I wish I didn't care as much... and then I too would start embracing the shamanistic Kumbaya Koolaid to fleece people out of their money. Talk about standard of care lexapro for a minute, then segway over to custom made compounded supplement, topped with 30 minutes in the barometric chamber, while finishing up with some Reiki and a final chat about chakras with a complimentary Turkey Tail Tea in hand [*of course, only ethically sourced, mushroom tea, organic, fair trade compensated from a small rural farmer in PEI Canada, with a 10 acre wood lot utilization coppicing techniques on 'weed' type oak variety]. Cash please...

First of all, yes, absolutely, all of that stuff is complete and utter nonsense and it should be called out more than it is. We have failed in effective lobbying for our patients to their health detriment when NDs are billing CMS and considered primary care. THC as a medical treatment is far less effective and carries more side effects than the general population believes, largely due to huge industry forces that push it.

However, anti-science positions are far from a rallying cry of the left. I can't tell you how many rural/right wing folks I have worked with that are deeply mistrusting of the medical institution/interventions. Lets not forget that antivax started as a far right position before spreading to the far left. There's now plenty of bipartisan crazies on both the far left and far right that rally around anti-science positions. If the far-left and far-right ever agree on anything, folks are going to be in for a baaaaad time.

 

[comp1]

Concur that anti-science beliefs are not partisan. However, I do think grouping NPs with DCs and NDs isn't exactly accurate.

 

[Sushirolls]

First of all, yes, absolutely, all of that stuff is complete and utter nonsense and it should be called out more than it is. We have failed in effective lobbying for our patients to their health detriment when NDs are billing CMS and considered primary care. THC as a medical treatment is far less effective and carries more side effects than the general population believes, largely due to huge industry forces that push it.

However, anti-science positions are far from a rallying cry of the left. I can't tell you how many rural/right wing folks I have worked with that are deeply mistrusting of the medical institution/interventions. Lets not forget that antivax started as a far right position before spreading to the far left. There's now plenty of bipartisan crazies on both the far left and far right that rally around anti-science positions. If the far-left and far-right ever agree on anything, folks are going to be in for a baaaaad time.

Sadly, it used to be just a tiny fraction of population of far right anti vaxers.

But Covid era policies, mandates, and CDC handling changed that. It will now be an ongoing, and generational issue where people on right won't trust. The only solution is for the CDC, government, and numerous health agencies, heck even hospitals - to all collectively hold a day of apology. To say yes we screwed up. We were wrong, here, here, here, and yep here; sorry about lying about XYZ. Without that, this mistrust will persist for generations. No amount of education CME of 'how to talk with rural patients' or 'vaccine hesitant' will effect real change.

 

[FlowRate]

I've always assumed it's the "look at me I'm so scientific and cutting edge" (even though it's NOT scientific, as far as the evidence base for clinical utility.)

I do wonder about the psychiatrists who dip into more "naturopathic" type add-ons, like urine neurotransmitter metabolite testing, where the company that does the testing also sets both a reference range and a "recommended range" and also sells their own brand of supplements. That one, to me, seems like a kickback, especially if the physician purchases the supplements then sells them for margin to patients (not sure if that's how they usually arrange things.)

 

[calvnandhobbs68]

I've always assumed it's the "look at me I'm so scientific and cutting edge" (even though it's NOT scientific, as far as the evidence base for clinical utility.)

I do wonder about the psychiatrists who dip into more "naturopathic" type add-ons, like urine neurotransmitter metabolite testing, where the company that does the testing also sets both a reference range and a "recommended range" and also sells their own brand of supplements. That one, to me, seems like a kickback, especially if the physician purchases the supplements then sells them for margin to patients (not sure if that's how they usually arrange things.)

Oh yeah there's clearly an incentive for some of that. If you look at some of the cash pay places, they charge you a flat rate to send out these "labs" which is highly likely to be higher than what the lab charges them. Supplements for sure too.

 

[Sushirolls]

Even pharmacists are now encouraging patients to ask for it.

 

[annoyedpsychiatrist]

The worst part is ive certainly noticed a huge uptick in all of this- natural remedies, "supplements", "specialized testing". A large number of people have been brainwashed into this garbage

 

[MedMan80]

Even pharmacists are now encouraging patients to ask for it.

"Roll with it" (Steve Rollnick)