How to reduce inappropriate laboratory ordering to control costs and utilization

The number and complexity of available lab tests has increased rapidly in recent years, making it difficult for clinicians to stay on top of the best, most appropriate tests to order. This can lead to over- or under-utilization as well as inappropriate test selection, thereby increasing costs and workload.

In a featured session from Becker's Healthcare Virtual Laboratory Forum sponsored by Change Healthcare, Caroline Juarez, product manager of CareSelect® Lab at Change Healthcare, discussed current clinical and financial obstacles facing hospital-based laboratories, the effect of inappropriate ordering on the laboratory's financial health and strategies to identify and address inappropriate ordering.

Four key takeaways were:

  1. Hospital-based laboratories face multiple obstacles. Lab testing volumes are rising as new tests and methodologies come to market faster than before. Highly specialized tests, genetic testing and niche labs add to the complexity of lab ordering today. "This makes it difficult for clinicians to know what is the best test to order and when they should be ordering it," Ms. Juarez said. "It puts a lot of pressure on providers to stay up to date with new [lab testing] recommendations."

    Another obstacle is that "patients are often coming into doctors' offices and requesting certain tests based on what they've found online," she said, but these tests may not be reimbursed by insurance, such as genetic tests, raising questions from patients. There is also decreased reimbursement linked to various federal initiatives and increased price pressure from national reference laboratories.

    These challenges come on the heels of the pandemic, which has left lab providers burned out and short-staffed, with capacity limited and medical supplies in high demand.

  1. Existing laboratory stewardship programs must be supported by data. According to Ms. Juarez, stewardship is not only a matter of monitoring laboratory ordering but being able to intervene strategically. "Obviously, we can track how many tests are being ordered in a certain time period and which clinicians are ordering them," she said. "But if we don't know if those tests are being ordered appropriately by comparing to some kind of content source, it can be hard to know where to start to address over-utilization concerns." EHRs provide the opportunity to examine laboratory ordering data. "Data is the starting point to effect change to provider-ordering behavior," Ms. Juarez said.

    CareSelect Lab, a comprehensive laboratory utilization management solution, adjudicates the appropriateness of every unique lab order using more than 1,800 guidelines authored by Mayo Clinic, analyzes ordering patterns to identify acute areas of over-utilization and opportunities for improvement and addresses areas of acute need with point-of-order guidance or alternative interventions.

  1. A comprehensive utilization index identifies industry-wide over-utilization and common culprits. The Change Healthcare 2021 Laboratory Ordering Utilization Index is based on an internal analysis of about 3.4 million provider ordering transactions processed by the CareSelect® Lab over a three-month span. Transactions were sourced from 84 geographically dispersed hospitals and focused on roughly 150 unique laboratory exams with more than 325 clinical indications. The research showed that 7.7 percent of lab tests (1 out of 13) were inappropriate as they failed to meet appropriateness criteria. Overall unnecessary spend reached about 12 percent. Nearly two-thirds of inappropriate tests were inherited genetic tests.

  2. Educational initiatives based on collected data generate immediate and long-lasting results. Juarez shared the experience of a Midwest hospital that targeted four low-value daily labs with an alert. "By adding point-of-order guidance in front of their clinicians when any of these tests were ordered too frequently, this hospital saw a 22 percent reduction in those orders within the first month and a 20 percent reduction in labs per discharge. They were also able to rethink how they used their staff in the mornings."

By using data-driven analytics, hospitals can transform their laboratory utilization, which will boost efficiencies, improve diagnosis and patient care, reduce costs and maximize revenue.

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