Strategies to Drive Effective Laboratory Test Utilization BY L E E H . H I L B O R N E , M D , M P H ; T E R R A E . W H I T E , P H D; A N D D O N N A D . C O O P E R , M S , M B A
With over 12 billion tests performed annually, laboratory testing is the highest volume healthcare service that patients receive.1 Individually, most tests are lowcost, but collectively, they represent between 2%-4% of the healthcare budget. Some studies suggest that 20% or more of testing services may be the result of overuse.2 Irrespective of the exact percentage, a clear opportunity exists to use laboratory stewardship (LS) to promote effective test utilization. Ordering unnecessary or less-appropriate tests carries many risks. Those risks impact the patient, medical practices, the laboratory, and society. Because many, if not most, clinical decisions are influenced by laboratory testing, inappropriate testing poses direct risks to patient care. If the wrong test is ordered and not recognized, treatment decisions could be based on inaccurate, incomplete, or misleading information. A falsely positive result on an incorrect test can send a patient down a rabbit hole of unnecessary—and sometimes risky—diagnostic procedures.
Lee H. Hilborne, MD, MPH
Inappropriate tests also increase the cost of care and are a concern for health plans. Like other medical services, laboratory claims to payers are usually covered when there is evidence of medical necessity. Absent this evidence, financial responsibility may fall to the laboratory, the patient, or the ordering clinician. Reducing unnecessary testing and avoidable claims denials—while ensuring access to needed services—benefits all stakeholders. Furthermore, given recent supply shortages, eliminating unnecessary tests conserves resources that can be deployed to patients who need them.3 Terra E. White, PhD
STRATEGIES FOR EFFECTIVE TEST UTILIZATION Physician practices play an important role in driving effective test utilization. The following are suggested strategies to increase appropriate testing and ultimately assure quality patient care: 1. Identify opportunities to engage in LS initiatives. Some hospitals and health systems have already embarked on an LS journey. These programs seek to reduce variations in care and improve overall quality by ensuring patients receive the right test, for the right patient, at the right time. Many reference laboratories also offer LS services. Wherever your laboratory services are performed, ask about LS initiatives, request time with an LS subject matter expert, and review test utilization data and related ordering practices. 2. Consult guideline recommendations. Compare your testing practices to national guidelines and policies. Specialty societies have guidelines that can be used to assess how well practices align with national recommendations. 32 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Spring 2022
Donna D. Cooper, MS, MBA
