Introducing The Change Healthcare 2021 Laboratory Ordering Utilization Index
Inappropriate Laboratory Ordering Remains Pervasive
While electronic ordering and systems integrations have made it easier than ever to order laboratory testing, misutilization persists. Our latest research on laboratory utilization—an analysis of ~3.4 million provider ordering transactions over a three-month span—found that for every 13 laboratory orders, one was inappropriate. The alarm sounds a little louder when we look at it from the perspective of spend: The 7.7% of inappropriate orders resulted in 12% of total laboratory spend being unnecessary.
Ordering transactions for this analysis were sourced from 84 geographically dispersed hospitals with a broad range of laboratory volumes, including multiple academic medical centers. The analysis focuses on ~150 unique laboratory exams and more than 325 clinical indications that are representative of frequently ordered laboratory testing, including routine screens and daily labs. All ordering transactions were processed by the CareSelect® Lab decision support solution and leveraged clinical appropriateness criteria authored and maintained by experts at Mayo Clinic.
Where Do Inappropriate Ordering and Unnecessary Spend Originate?
Looking deeper into the findings, we get a better sense of why many organizations have struggled to identify costly ordering patterns.
Focusing on clinical sources of misutilization, we see that testing of the subgroup known as “inherited genetics” has the highest rate of inappropriate ordering. Due to its extremely high cost-per-test, “inherited genetics” also causes the most unnecessary spend. Despite being easy to identify as a source of misutilization, ordering genetic testing has become increasingly complicated as the test catalog expands and diversifies.
For inappropriate ordering’s other sources, there can be a stark difference between the rate of inappropriate ordering and its effect. To put it another way, if your primary goal is to reduce unnecessary spend, starting with the most consistently inappropriate ordering could mislead you. For instance, “routine labs” has an inappropriateness rate of only 5.9%, but its extremely high volumes and frequent ordering move it all the way up to the third-highest subgroup for unnecessary spend in our analysis.
Opportunities to Improve the Patient Outcomes and Experience
Reducing inappropriate ordering begins with understanding not just where inappropriate ordering is most likely to occur but where its reduction will create the greatest impact. Identifying orders that are routinely placed inappropriately is a good start, but it’s also critical to be able to identify ordering patterns that can disproportionally affect clinical, operational, and financial outcomes.
Patient outcomes and satisfaction must also be considered. Due to their high volumes and frequent ordering, “daily labs” represent a unique opportunity for organizations that want to increase laboratory efficiency and directly affect patient outcomes. Rachael Hulshizer, manager of clinical products and services value-based medicine at Mayo Collaborative Services, understands the importance and impact of this problem. “Daily labs make up such a high volume of inpatient laboratory testing that they have an outsized impact on patient outcomes. Reducing lab tests per discharge by effectively managing daily labs presents a distinct opportunity to improve patient quality of care while reducing risk of hospital-acquired anemia.”
A Data-Driven Approach to Laboratory Stewardship
Health systems vary widely in how they approach laboratory stewardship and how they manage misutilization. While some systems have full-blown laboratory- stewardship and utilization committees driven by senior leadership, others lack the full resources to be able to effectively and confidently make needed changes.
Creating a governance structure to oversee utilization management programs and supplying that group with up-to-date data is crucial to help align clinical goals with financial targets and provide the necessary oversight to put in place remediation strategies. Provider education, EHR configuration updates, and point-of-order guidance can all serve as successful interventions when their implementation is based on relevant data and aligned with actions that will maximize impact.
Explore the rest of the findings and discover additional advice on managing laboratory misutilization with The Change Healthcare 2021 Laboratory Ordering Utilization Index.
Caroline Juarez is the product manager for Change Healthcare’s CareSelect® Lab solution. Prior to this role, Caroline led the CareSelect Lab implementation team, working directly with organizations to optimize their laboratory ordering and help providers address unnecessary and low-value care.