How HRM can help labs reduce unnecessary tests

Measuring and tracking unnecessary or repetitive testing can be a daunting task for any healthcare organization, especially as keeping current with uncertain government regulations presents challenges of its own.

While the future of the Affordable Care Act may be foggy, one thing that’s clear is that today’s “volume to value” transition is here to stay, and that makes reining in test utilization and costs an essential priority.

By reducing unnecessary tests, labs and hospitals will benefit from a stronger bottom line and better customer relationships by reducing wasted dollars and saving the patient time, physical discomfort, and money.

This will be helpful regardless of which way the winds blow in Washington. That’s because of the six billion clinical lab tests performed annually in the United States, an estimated 30 percent of them are unnecessary, according to a study conducted by Beth Israel Deaconess Medical Center. Compounding this is the fact that although clinical laboratory testing accounts for just 2-3 percent of the national healthcare budget, the FDA Center for Devices and Radiological Health believes that lab results affect an estimated 80 percent of healthcare decisions and costs.

By leveraging data already available within health systems, these organizations can better understand their lab operations and take action on utilization in order to reduce costs, guide physician behavior, fuel growth, and deliver on the promise of value-based healthcare.

Tracking utilization from beginning to end
Most labs store huge amounts of data related to test ordering patterns, yet few are able to quickly and easily access this data and translate it into meaningful, actionable insights.

The culprit? Disparate systems housing the data and the manual reporting processes used in most health systems. In fact, it’s not unusual today for labs to take up to 90 days to compile utilization trends. By this time, the information is out of date and no longer actionable.

Labs are sorely in need of real-time access to data that enables healthcare professionals to immediately know who is ordering which tests, and then organize that data by physician, specialty, and diagnosis. Easy access to this information allows health systems to take action to ensure that physicians are ordering the right tests.

Healthcare relationship management platforms (HRM) can fill this void by pulling information from disparate systems into one platform where data is analyzed and findings are presented via easy to understand dashboards.

HRM solutions allow users to identify adoption trends among physicians to determine if the right tests are being ordered, which physicians are over and under utilizing tests, and if test ordering conforms with industry benchmarks.

With real-time insight into all facets of appropriateness, lab managers can track physician progress, create tasks to follow up with physicians, and aggregate issues over time to create a holistic utilization picture.

Improving reimbursements
Access to real-time utilization information also helps health systems boost their bottom-line by improving reimbursements, which is especially important as lab spending comes under increased scrutiny by providers and government entities looking for ways to put a lid on rising costs. In 2012 alone, spending for clinical laboratory services for Medicare patients increased 9.1 percent, according to the Medicare Payment Advisory Commission.

Often in health systems, physicians order tests with little attention to best practices, putting the lab at risk of losing money by ordering tests not covered by certain insurance carriers. Having a handle on which tests are covered by payers can potentially save a health system millions of dollars each year.

Labs are uniquely positioned to play an important role in boosting reimbursements since they provide more than 80 percent of the information in a patient’s Electronic Medical Record (EMR). The key is having the right insight to drive change in ordering behaviors.

HRM platforms can provide the information needed, including the kind and number of tests declined by diagnosis, specialty, and provider. Lab managers can use this information to develop targeted physician education programs.

Educating physicians on best ordering practices
Clinical diagnostics can be complex, and physicians don’t always order the correct tests for patients or they order tests that are unnecessary. For example, physicians batch order a panel of tests when one or two will do. This behavior may result from the pressure physicians feel to see more patients (it’s easier to check one box and be done), physicians’ fear of malpractice suits, or it may just be habit. Regardless of the reason, the goal of improved utilization is to shift to best ordering practices.

HRM platforms can give insight into critical ordering patterns, enabling labs to become a valuable source of education to their physician clients. By accessing test-specific and physician-specific benchmarks, real-time utilization insight enables labs to guide physicians and for patients to reap the benefits of better decision-making.

Having detailed insight into tests and best practice benchmarks also creates growth opportunities for the laboratory. For example, labs can build a profile of a successful and profitable practice, then use targeted marketing resources to educate similar practices about additional services.

Health systems may be inclined to delay their attention on diagnostic testing because it currently represents about three percent of healthcare spending. Yet as the population ages and new, expensive tests are introduced to diagnose and treat diseases, these numbers are likely to rise.

Reducing unnecessary testing and promoting appropriate testing enables health systems to grow profitably and provide better customer service to patients and providers. HRM platforms will play a critical role in helping health systems accomplish this.

(About the author)
Diane Janowiak, Vice President of Premium Client Solutions at the world's leading healthcare relationship management platform.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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