MoPath Spending In and Out of MOLDX States

 In a previous blog, I used recently released 2019 Part B payment data to compare MoPath spending per beneficiary in Medicare B in New York (the largest Non-MolDx state) and in California (the largest MolDx state).   I got a remarkable difference of $9 vs $0.61.  In addition, the 2018/2019 spending trend in CA was slightly up (about 4%) while the New York spend 2018/2019 was sharply down (about 40% down).

This data seemed odd to me, but it was simple data (I summed spending for codes 81162-81599).

I took another stab at it.  

For the most recent year where CMS has released complete cloud claims data, 2017, I looked at the total national spending 812xx 813xx 814xx 815xx.   It was $577,615,000, which sounds about right based on other reports.   I then entered every MolDx state: there are 28 in 2020 (I'm not sure if JM was already in Palmetto in 2017 or not).   This gave $408,983,000 in spending in MolDx states.  This leaves $168,632 in spending in non-MolDx states.*

Ok, so grossly, Mopath spending is a lot higher in MolDx states in 2017.   What about per capita?  Using 2020 data (which won't be much different than 2017), there are 18,941,000 Medicare Part B patients in MolDx states, and 21,068,000 in other states.   

This gives per bene spend per year of about $21.59 in MolDx states on average and about $8.00 in non-MolDx states.   

I'm mixing in 2020 people data and 2017 spend data, and I'm using 812 813 814 815 as CPT approximations of MoPath spend, so it's a back of envelop thing, but the general result is obvious.

It also shows the typical New York State CY2019 spend of $1 or less per bene per year on this code set is not typical of any larger collection of states in the U.S. 

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*

For some purposes, one might even pull out the couple hundred million for Cologuard, controlled by an NCD, from Wisconsin, a non-MolDx state.  Then even less spending is left for the non-MolDx states.  the other main test controlled by an NCD is FMI F1, in Massachusetts, which leaves even less money left for "general mopath spending' in the many non-MolDx states.