The Clinical Laboratory Management Association is encouraging medical laboratories to submit abstracts about their programs to deliver more value to patients and physicians through the use of clinical pathology laboratory tests
Now, more than ever, the house of laboratory medicine needs to be publishing clinic studies and evidence that the money spent on appropriate medical laboratory testing is returned tenfold from improved patient outcomes and substantial reductions in the cost per episode of care that can be associated with the use of those lab tests.
It is this credible evidence that can help shape healthcare policy in positive ways, while encouraging government and private payers to recognize the true value of clinical laboratory tests and thus establish adequate reimbursement to insure the continuation of high-quality lab testing services in the United States.
Encouraging Clinical Laboratories to Share Successes in Improving Patient Care
In fact, these are among the goals of the Clinical Laboratory Management Association (CLMA) and the project it calls “Increasing Clinical Effectiveness” (ICE) initiative. CLMA initiated this program last year by asking lab organizations to step forward and share successes in leveraging the value of lab testing to the benefit of patients, physicians, and payers.
Among the entries submitted last year, the one judged best by CLMA’s experts was an innovative “patient-centric” project that enabled the Seattle Children’s Hospital Department of Laboratories to identify when certain genetic tests were unnecessary or incorrectly ordered.
The annual ICE awards underscore the trend in healthcare in the United States away from reactive acute care and towards proactive, integrated clinical care. As the number of patients served by integrated clinical care organizations such as accountable care organizations (ACOs) and patient-centered medical homes (PSMHs) increases, clinical laboratories and anatomic pathology groups need to understand how to deliver patient-centric lab testing services.
Recognizing First-movers and Early-adopter Clinical Labs
CLMA, along with partners Orchard Software of Carmel, Indiana, and The Dark Report of Spicewood, Texas, is identifying and recognizing first-mover and early-adopter clinical labs that have successfully advanced patient-centric care within their organizations and communities.
Genetic Counselor Jessie Conta, M.S., CGC, of Seattle Children’s Hospital (SCH) is the 2015 ICE Abstract winner. Her abstract was titled, “From Order to Result: Helping the Patient Get the Right Test.” .
Conta outlined the Lab Utilization Management (UM) program developed at Seattle Children’s Hospital that led to 32% of requests for genetic tests between September 2011-March 2014 being modified or cancelled after case review and adjudication and consultation with the ordering physician. The UM techniques saved more than $660,614 and corrected 74 (6%) requests directly impacting patient safety. Order entry errors accounted for 10% of modifications and 27% of cancellations.
Genetic Counselors Lower Costs
In her May 2015 presentation at the Executive War College Conference on Laboratory and Pathology Management, Conta stated that the growing number of available genetic tests, combined with increased national spending on testing (projected to reach as high as $25 billion by 2021), as well as changing healthcare models and reimbursement rates, create the need for UM programs to ensure the appropriate use of genetic testing.
“Our focus has been on inserting a laboratory genetic counselor in the process of test ordering to ensure we’re getting the best test for patients,” Conta said. “Our program was actually born out of patient complaints related to unexpected large bills for genetic testing. We hypothesized that by implementing a review process for these expensive tests, we could actually reduce costs and improve the value of testing for patients.”
At Seattle Children’s Hospital, tests costing $700 or more get flagged for UM committee review. The review team includes laboratory genetic counselors, pathologists, clinical chemists, a medical geneticist, specialty labs manager, and the lab business operations manager as well as an exome-sequencing subcommittee.
When a send-out test order is placed in “timeout,” the UM team asks:
• Was the correct test ordered?
• Is the test medically necessary?
• Is insurance pre-authorization required?
• Can sequential testing be considered?
• Are there alternate tests that are more appropriate?
• Has the optimal test and reference laboratory been selected?
“Our approach is like being the bumper lanes in the bowling alley,” Costa told the Executive War College. “It is not to point fingers and police the providers, but it is really to partner with them and gently guide them back to what seems like the normative or appropriate test order. Partner with them to get the best test for the patient.”
Genetic Counselors Directly Impact Patient Care
Conta said genetic counselors bring a “special sauce” to the UM review process because of their knowledge of genetics, teamwork, communication and problem-solving skills and understanding of the inner workings of a healthcare system. She noted that the money the UM team saves families, hospitals, and insurance companies—roughly $470 in savings for every test request of $1,000 or more and an average of $740 in savings for every test request exceeding $2,500—helps justify a laboratory genetic counselor position and other costs associated with UM.
“It is a little counterintuitive because you would think: ‘I’m the reference lab. I want you to send me everything. Why would I try to drive business away from myself or reduce the revenue stream?’” Conta stated. “But in the end it is the right thing to do.”
Conta appreciates the platform the ICE Award provides. “We talk so much about guiding others in this process and often don’t get to tell the details of our story,” she said in a comment posted on the CLMA website. “For me as a genetic counselor, it’s really impactful because I know from each of the cases described, we have a direct impact on patient care and are really improving the value of testing.”
Submitting Abstracts to CLMA Knowledge Lab
Organizations interested in the 2016 ICE program are invited to submit abstracts of patient-centered initiatives. The 2016 submission period will close on December 2015.
Abstracts that meet submission criteria will be invited to create a poster for display at CLMA’s 2016 KnowledgeLab (attendance is required) on March 20-23, 2016, in Orlando, Florida.
Submitters of the best abstracts will be invited to present their findings orally:
- during a KnowledgeLab general session,
- at the Executive War College in New Orleans (April 26-27, 2016), and,
- at the 2017 International Federation of Clinical Chemistry and Laboratory Medicine meeting in Athens, Greece.
Travel and hotel expenses will be awarded to the oral presenters.
More information about the “Increasing Clinical Effectiveness” program can be found at
“All laboratory organizations are encouraged to submit abstracts of their patient-centric initiatives involving medical laboratory testing,” CLMA former President Paul Epner announced when launching the ICE initiative last year. “Of interest are projects that resulted in such improved patient outcomes as decreased length of stay, reduction in antibiotic use, decreased time to diagnosis, and a decline in adverse events. Of course, labs are equally welcome to submit other innovative projects that use medical lab testing to deliver added value to physicians and patients.”
—Andrea Downing Peck