Administrative interventions to reduce unnecessary lab tests
Below is a list of administrative interventions that have been proven to reduce the number of unnecessary laboratory tests.
- Duplicate checking for frequency of repeat testing
- Reflex testing policy
- Standing order policy reviewed and limited
- Physician profiling & report cards for utilization feedback
- Review payment denials
- Review test menu and discontinue obsolete tests
- Review preoperative lab tests by specialty
- Establish a test utilization oversight committee
- Develop a lab formulary to limit inpatient testing
Effective lab formularies have been established at the University of Rochester (Clin Lab News, Jan 2012), Brigham and Women’s Hospital, Massachusetts General Hospital (AJCP 2011;135:108-118) and the University of Michigan (AJCP 2013;139:289-97)
Other effective administrative strategies include pathologist triage of ancillary studies on bone marrow based on morphology. This strategy has worked well at Intermountain Health Care (CAP Today, June 2011). A send and hold process can be used where labile specimens such as cytogenetics are sent to a reference lab but not acted upon until notified by the referring pathologist.
Several strategies have proven effective in reining in unnecessary send out test requests:
- Require attending to approve all requests for send out tests
- Determine if esoteric test is necessary for inpatient treatment
- If not, defer nonessential tests to outpatient setting so can seek payment outside of Medicare’s DRG reimbursement system
- Have reference lab bill insurance or patient directly when reimbursement is less than ref lab bill
- VA Connecticut & Cleveland Clinic use financial cutoff for send out tests
- Tests above cutoff must be reviewed for inpatient necessity
- Say “NO” to requests for pseudoscience tests
- Require pathologist approval of send out tests in real time
- Request send out test summaries from each reference lab
- ARUP ATOP (Analysis of Test Ordering Patterns)
- Consolidate reference labs
