Researchers note medical laboratories uniquely qualified to help doctors optimize lab test utilization, and to educate physicians on testing trends and improvements
Automation and informatics have revolutionized the modern medical laboratory. These same technologies also are powering the next generation of healthcare through precision medicine, genomics, and an increased ability to assess and leverage population health trends. In fact, exciting work is being done to use these technologies to help physicians and clinical laboratory professionals better work together.
When it comes to how physicians order and use medical laboratory tests, changing their long-standing habits can be a lengthy process. By using dedicated systems to define proper lab test usage, track lab orders and patient outcomes, and share data between clinical laboratory and healthcare environments, pathologists, medical laboratory scientists, and physicians could seamlessly access the knowledge needed to improve decision making.
Low-Value versus High-Value Care Ordering
Research published recently in the Journal of the American Medical Association Internal Medicine (JAMA Internal Medicine) investigated the order rates and utilization of low-value medical laboratory services and other diagnostic tests associated with headaches, respiratory tract infections, and back pain.
Their findings indicated that physicians in hospital-based practices ordered more “low-value care” than physicians in community-based practices. According to the research, low-value care includes:
- Computed tomography (CT scan);
- Magnetic resonance imaging (MRI); and
- Radiographs (X-rays).
The researchers found similar patterns in specialty referrals when comparing hospital-owned community practices and physician-owned practices.
The study authors noted, “Visits with a generalist other than the patient’s primary care provider were associated with greater provision of low-value care, but mainly within hospital-based settings.”
Medical Laboratories Critical to Increasing Care Value/Reimbursements
According to the study, physicians often develop routines and habits when ordering diagnostic testing and when utilizing clinical laboratory services. By taking a proactive role in educating physicians and managing lab test utilization, laboratories could assist physicians in shifting these habits and reduce the number of low-value or outmoded tests ordered.
Avoiding low-value or unwarranted testing:
- Reduces order load on the laboratory;
- Improves efficiency for healthcare providers; and
- Improves the quality of care for patients.
This is particularly critical as value-based care continues to change the way both laboratories and healthcare facilities get reimbursed for services.
In a press release, Janet B. Kreizman, CEO of the American Association for Clinical Chemistry (AACC) stated, “The changing Medicare payment paradigm creates new opportunities for health systems to advance patient care while more efficiently and effectively utilizing their resources. Laboratory medicine experts are uniquely positioned to ensure this is achieved by working with physicians to devise optimal diagnostic and therapeutic protocols, leading to better health outcomes and reduced costs.”
Graphic above from the Institutes of Medicine (IOM) report, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” (Graphic copyright: National Academy of Sciences, Engineering, and Medicine.)
A study published in the American Journal of Clinical Pathology (AJCP) noted that among 32,000 primary care physicians surveyed:
- 7% were uncertain about which diagnostic tests to order;
- 3% were uncertain on how to interpret results; and
- Respondents only consulted with pathology or laboratory experts 6% of the time.
Thus, an important opportunity exists for laboratory experts to work with PCPs—both within hospitals and outpatient settings—to further improve understanding of the ever-shifting menu of testing options and how to best utilize available lab services.
Optimizing the Cost and Safety of Care through Cooperation
In “‘Choosing Wisely’ Program Wants to Encourage Better Utilization of Clinical Pathology Laboratory Tests,” Dark Daily reported on a program created by the American Board of Internal Medicine Foundation (ABIMF) and Consumer Reports that sought to identify overused diagnostic procedures and medical laboratory testing.
The program asked nearly 400,000 physicians to name five diagnostic test and procedures related to their specialty that offered questionable value to patients and outcomes. In a Kaiser Health News (KHN) article, Daniel Wolfson, COO at ABIMF, attributed the “Choosing Wisely” campaign to launching a national conversation on unwarranted and low-value care.
The KHN report also noted the impact of “Choosing Wisely” on Cedars-Sinai in Los Angeles, one of the largest hospitals in the nation. Harry Sax, MD, Executive Vice Chairman for Surgery at Cedars-Sinai explained how the hospital avoided $6-million in spending in 2013 alone by implementing program recommendations, and by being more selective regarding tests and procedures utilized at the hospital.
Using Lab Utilization Management Technology to Improve Testing Value
A study published in the American Journal of Clinical Pathology (AJCP) highlights how combining expert laboratory advice with a dedicated electronic laboratory utilization management system might shape the future of testing and help educate healthcare providers on the diagnostic options available to them.
The authors of the AJCP study compared testing costs at the Richard L. Roudebush VA Medical Center in Indianapolis before and after implementing an electronic laboratory utilization management system. They attributed six-figure savings to a reduction in high-volume large-panel testing and redundant tests. Savings were realized without increasing length-of-stay or adversely effecting patient care.
Dark Daily recently reported on the value to clinical laboratories of implementing utilization management systems in “Biggest Opportunity for Clinical Laboratory Industry is Utilization Management of Lab Tests, But Only If It Is Done Well.”
As big data continues to shape the future of healthcare, and clinical laboratories continue to implement lean laboratory routines to maintain growth, these systems could offer increased opportunities to help physicians become better at ordering the right test at the right time for the right patient, while helping the clinical laboratories performing these tests to further trim waste, increase the value of care, increase reimbursement, and improve outcomes for patients.
—Jon Stone
Related Information:
Hospital-based Physicians Provide More Unnecessary Services
Lab Experts Help Providers Reduce Low-value Resource Use, Costs
Primary Care Physicians and the Laboratory: Now and the Future
Putting a Lid on Waste: Needless Medical Tests Not Only Cost $200B—They Can Do Harm
