News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
Sign In

Studies Show Utilization Management Systems Help Clinical Laboratories Remove Physician Uncertainty Over Availability of Diagnostic Tests and How to Properly Interpret Results

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:

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

Association of Primary Care Practice Location and Ownership with the Provision of Low-value Care in the United States

Lab Experts Help Providers Reduce Low-value Resource Use, Costs

Laboratory Medicine Experts, Physicians Must Team up to Improve Use of Lab Tests, Advance Patient Care, and Cut Healthcare Costs

Primary Care Physicians and the Laboratory: Now and the Future

Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a Us Government Veterans Affairs Hospital

Putting a Lid on Waste: Needless Medical Tests Not Only Cost $200B—They Can Do Harm

“Choosing Wisely” Program Wants to Encourage Better Utilization of Clinical Pathology Laboratory Tests

Physicians and Pathologists at Atrius Health Collaborate to Reduce Unnecessary Clinical Laboratory Test Orders and End up Saving $1 Million Annually

As Medical Laboratory Test Utilization Grows, Health Insurers Develop Programs to Manage Rising Costs

Biggest Opportunity for Clinical Laboratory Industry is Utilization Management of Lab Tests, But Only If It Is Done Well

Harvard Researchers Find that 83% of Radiologists Fail to See Gorilla in the Midst—of a Lung Scan!

Pathologists and clinical laboratory managers should be aware of the possibility of ‘inattentional blindness’ as a potential cause for diagnostic and laboratory error

Pathologists and clinical laboratory professionals who regularly analyze images will be interested in the findings of a research study designed to assess how the phenomenon called “inattentional blindness” among radiologists could cause them to possibly miss things hiding in plain sight.

‘Inattentional Blindness’ Occurs Even Among Highly-trained Radiologists

In a recent study, psychological scientists from Harvard’s Brigham and Women’s Hospital found that 83% of radiologists didn’t notice an image of a gorilla embedded in a computed tomography (CT) lung scan. (more…)

Pathology Study Team Recommends Replacing Traditional Autopsies with Non-invasive, Imaging-based Alternative for the United Kingdom

Evolving imaging technology could begin to replace some traditional autopsy methodologies and encourage an increase in the number of autopsies performed

New imaging technology may give pathologists in the United Kingdom a new way to perform non-invasive autopsies. It is another example of how long-standing clinical practices can be transformed by the capabilities of newly developed technologies.

Leading experts within the field of post-mortem cross-sectional imaging in Britain have recommended that England’s National Health Service (NHS) introduce alternative techniques for performing non-invasive autopsies. A review of current procedures in the NHS system showed that alternative autopsy methodologies offer important advantages. In some circumstances, the non-invasive approach could replace traditional autopsy methods. (more…)

Mobile Stroke Unit (MSU) Brings the Laboratory to the Patient at the Point of Care

Clinical laboratories will increasingly provide emergency diagnostic services through mobile-unit near-patient testing

In an innovation designed to bring the laboratory to the patient, use of a mobile stroke unit (MSU) shortened the time to treatment decision for acute stroke patients. MSUs equipped with imaging systems and medical laboratory point-of-care testing proved capable of providing early diagnosis and intervention.

Pathologists and clinical laboratory managers will immediately recognize the implications of these findings. This study demonstrates how clinicians are taking steps to move clinical laboratory testing out of the traditional central/core laboratory and bring it closer to the patient specifically to reduce the time-to-answer for certain medical conditions, like acute stroke.

One conclusion from this clinical study is that use of a mobile stroke unit offers a potential solution to the medical problem of stroke patients arriving at the hospital too late for treatment, wrote researchers in a study published in the medical journal The Lancet.


FDA Clears First Mobile Radiology Diagnostic App. Is Digital Pathology Next?

Image quality of wireless device screens may already be good enough for basic digital pathology use

When the U.S. Food and Drug Administration (FDA) recently cleared—for the first time—a mobile application (app) for Radiology Diagnostics, it set the scene for similar mobile apps to gain FDA clearance for use in evaluating digital pathology images.

Both pathologists and clinical laboratory managers are likely to be intrigued with how swiftly mobile computing technology can adapted for use with healthcare images. Earning the honors as the first mobile app to be cleared by the FDA for use with radiology images is the Mobile MIM software, developed by MIM Software, Inc. of Cleveland, Ohio.