Innovative medical laboratories are developing ways to deliver more value to physicians ordering and using lab tests
TEMPLE, TEXAS—Changes now happening to healthcare and the practice of medical laboratory medicine were upfront and personal here during last Friday’s meeting of the Texas Section of the American Association of Clinical Chemistry (AACC).
An impressive crowd of more than 120 pathologists, Ph.D.s, and clinical laboratory professionals were present to learn from an all-star panel of lab industry innovators. Space does not allow a full report of all 10 speakers who addressed this conference, but a nugget or two from three of the morning speakers will illustrate some of the latest thinking on how medical laboratories and pathology groups can make the transition from a transactional business model (fee-for-service payment) to a value-added clinical model (bundled or shared per-patient-per-month fee).
After an opening presentation by your Dark Daily editor, Robert L. Michel, who identified the primary dynamics propelling healthcare’s transformation, the next speaker launched into the key issue associated with how clinical labs and pathology groups can deliver value.
Delivering More Value with Lab Testing Services
In his presentation, Michael Laposta, M.D., Ph.D., Chair of Pathology at the University of Texas Medical Branch—Galveston, shared the progress made by diagnostic management teams (DMTs)—particularly at Vanderbilt University Medical Center in Nashville Tennessee—to successfully address both the overutilization and underutilization of medical laboratory tests.
Overutilization (unnecessary utilization) gets much attention. However, Laposta was careful to point out that underutilization is a fertile opportunity for pathologists and clinical laboratory professionals to collaborate with physicians to unlock major improvements in patient outcomes.
“Underutilization is a major contributing factor to the most common misdiagnoses associated with disorders that are frequently seen by physicians,” noted Laposata. “For adults, such conditions include lung cancer, acute MI (myocardial infarction), colorectal cancer, pulmonary embolism, and acute stroke.
“In children, the most common misdiagnoses are associated with meningitis, pneumonia, malignant tumors, benign tumors, and appendicitis,” he added. “These findings were published by The Doctors Company, based on studies of their medical malpractice claims database.
Helping Physicians Use Clinical Laboratory Tests To Improve Diagnoses
“For each of these diseases and medical conditions, laboratory professionals have the diagnostic tools and the expertise to help physicians make an earlier and more accurate diagnosis,” stated Laposta. “This would also address the underutilization of essential medical laboratory tests for these diseases.”
The next speaker at this program was Gregory Sossaman, M.D., Chair of Pathology and Laboratory Medicine at the Ochsner Health System in New Orleans, Louisiana. He shared a case study about standardizing lab services across a multi-hospital system, specifically to improve the value of lab testing that his lab organization delivers to physicians.
“Three strategies guided our efforts to improve lab test utilization in ways that would add more clinical value,” observed Sossaman. “First, we established a lab test formulary that had three tiers. This was supported by evidence-based medicine guidelines and CPOE (computerized physician order entry).
More Physicians Ordering Genetic and Molecular Tests
“Like most labs, our physicians are ordering more genetic tests and molecular assays,” he continued. “Thus, we’ve developed a genetic test formulary. Supporting this are workflow recommendations. In appropriate circumstances, this includes referring the ordering physician to a genetic counselor.
“The third strategy is to develop our molecular pathology program,” said Sossaman. “We are looking at the molecular tests we send out with an eye to bringing those assays in-house. What helps is that there are more automated molecular testing systems (today, than ever before). Moreover, in some cases, we replace conventional tests, such as viral cultures, with molecular assays.”
Improving Utilization of Medical Lab Tests at Seattle Children’s Hospital
Ending the morning session on a high note of energy and humor was the voluble Michael L. Astion, M.D., Ph.D., Medical Director, Department of Pathology and Laboratories, Seattle Children’s Hospital. Improved utilization of medical laboratory tests is a priority at his hospital, and a utilization review committee establishes ordering guidelines and regularly reviews the success of this effort.
Scott & White Memorial Hospital in Temple, Texas, is a 636-bed specialty care and teaching hospital and Level I trauma center. Clinical laboratory services for that region of the BaylorScott and White Health system are consolidated at this hospital. Pictured above in the automated laboratory is Robert L. Michel (left), Editor-in-Chief of The Dark Report, and Amin Mohammed (right) Ph.D., DABCC, FACB. He is Professor of Pathology, Medical Director of the Pathology Informatic Center, and Clinical Chemist at Baylor Scott & White Healthcare. Mohammed was chair of the program committee for last Friday’s one-day conference conducted by the Texas Region of the American Association of Clinical Chemistry. (Photo copyright The Dark Report)
“To address the issue of physicians ordering expensive genetic tests, we came up with a fast-to-implement solution that is working well for us,” explained Astion. “When our lab receives a genetic test order, we send a template email to the physician if he or she is not a medical geneticist.
“This email notes that ‘the lab received an expensive, unusual request on your patient,’” he said. “It then gives the physician three options. First, does he/she want to involve a genetic counselor or the labs genetic specialist for a consultation? Second, would he/she like the lab to hold the test order while pre-authorization is obtained from the patient’s insurer? Third, would he/she like us to proceed to order the genetic test after contacting the patient to tell them what the cost of the genetic test will be (in case the patient will be responsible for payment)?”
Reduction in Orders for Unnecessary Genetic Tests
Since implementing this template email, Astion said that, on 696 patients, the email had resulted in 25% of the genetic tests being canceled or reduced to a lesser-cost and more appropriate genetic test.
“Without this intervention, about $2.2 million of genetic tests would have been ordered on 876 cases,” he continued. “With the intervention that cost was reduced to $1.8 million. This saved $385,000, or $440 per genetic test request.
What these three speakers have in common is their energy and enthusiasm to guide their respective clinical laboratory organizations toward a mix of medical lab testing services that deliver more value to their customers, be they physicians, patients, or payers. Each is an example of how a premier lab organization is making the transition away from away from traditional lab management and toward the collaborative, value-driven model of laboratory tests that represent the future of laboratory medicine.
Your Dark Daily Editor,
Robert L. Michel
Related Information:
Powerful Patient Safety Interventions in the Clinical Laboratory; Michael Astion, M.D., Ph.D.
Postanalytic Error: Cases, Concepts and Interventions – Michael Astion, M.D., Ph.D.
School of Medicine appoints Dr. Michael Laposata as new Chair of Pathology
