Improve Lab Orders by Educating Physicians & Optimizing Utilization

More blood tests may not be better for hospitalized patients, a widely publicized national report proclaims.

Also drawing attention to laboratory tests’ costs and use: healthcare reform, pay-for-value reimbursement models and other market forces.

But how can ordering physicians be certain of their decisions? How can they order the right test for the right patient at the right time?

Fortunately, research suggests appropriate messages and electronic alerts to physicians can result in less unnecessary lab testing and treatments. Hospitals contain costs, as well.

Pathologists and lab leaders have an opportunity to educate their colleagues. And the lab must also be equipped with the strategic resources necessary for enabling better decisions about tests orders.

Teach Doctors, Decrease Tests & Costs

In its Choosing Wisely report, the Society of Hospital Medicine (SHM) ranked repetitive complete blood count (CBC) testing and chemistry testing among the top five practices to question in adult medicine. Read full blog post . . .

The data inspired a process improvement initiative at Vanderbilt University Medical Center, Nashville. Researchers there found education and feedback helped doctors to order less blood tests for hospitalized patients; medical center costs decreased, too, according to a Medscape article about the study.

Staff teams and direct-care hospitalists received presentation fliers and e-mails. Messages encouraged them to “order blood tests mindfully rather than reflexively,” Medscape reported on the study, which was presented earlier this year at a SHM annual meeting.

Costs of CBCs ($88) and basic metabolic profiles ($160) were prominently displayed at workstations, as well.

The study showed a decrease in tests ordered by the house-staff teams resulted in a weekly cost savings of about $20,288. The hospitalist teams averaged a weekly cost savings of $16,733.

”Reducing inappropriate phlebotomy is a strategy for cost-containment and may also improve the patient experience,” said Kelly Cunningham Sponsler, MD, of Vanderbuilt University, in the Medscape news story.

Electronic Alerts Advise Physicians

Still other reports reveal how sophisticated electronic medical systems can impact lab tests costs, treatment orders and providers’ bottom lines.

At Cedars-Sinai Health System, Los Angeles, Choosing Wisely recommendations are included in the hospital’s electronic health record (EHR) system. The hospital leaders aimed to ensure patients received care they needed but “nothing more,” according to an article, posted earlier this year, on the Healthcare Financial Management Association Leadership blog.

Pop-up alerts remind doctors when their orders deviate from Choosing Wisely recommendations. Hospital officials estimate they will save about $3 million each year as a result of including the messages in the EHR.

And in Massachusetts, primary care physicians affiliated with Atrius Health obtained real-time information on lab costs for 27 tests as they electronically ordered them. Another group of doctors in the study did not.

The ordering rates of both high and low cost-range tests significantly decreased when doctors saw in real-time the cost of them, pointed out a ScienceDaily article on the research.

“It’s like putting price labels on goods you buy in the supermarket. When you know the prices, you tend to buy more strategically,” Thomas D. Sequist, MD, MPH, of Atrius Health, told Science Daily. He is the senior author of the study published in the Journal of General Internal Medicine.

ATLAS Utilization Optimization Popular

Indeed, doctors are price-checking. So, it’s no surprise that Atlas Medical has seen its Utilization Optimization solution grow in popularity among forward-thinking lab leaders. Powered by the Company’s Coordinated Diagnostics Platform™ (Platform), ATLAS Utilization Optimization makes it possible to electronically share important test cost messages and more content about best practice recommendations with ordering doctors.

How does it do it? An easy-to-use algorithm and rule-authoring environment enables providers to develop messages. For instance, an expensive test algorithm may have an intervention description as follows: “You are ordering a test that is over $900. In order to order this test, you will need pre-authorization.”

The Atlas Medical Platform solutions are not only aimed at aiding healthcare executives in managing overutilization of tests. The solutions also enable opportunities to improve underutilization of tests and care outcomes, according to Robert Atlas, President and CEO of Atlas Medical. “Our Platform helps providers leverage diagnostics data to better optimize lab testing,” he says.

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