Laboratory testing is critically important to a person’s healthcare journey. In fact, lab test results inform 70% of medical decisions despite only accounting for less than 3% of healthcare spending.
However, with the great power of the lab, comes great fiscal responsibility. In this article, Todd Berman, payor solutions director of stewardship strategies at Labcorp, outlines the three lab stewardship rights, with an in-depth look at underutilization.
Thirteen years ago, as a member of the U.S. Army JAG Corps, one drill sergeant had a saying about the five “rights/writes”: be at the right place, at the right time, in the right uniform, with something to write on, and have something to write with.
Today, as the payer solutions director of stewardship strategies at Labcorp, I again find my days focused on “rights.” But now they are the three rights often attributed to laboratory stewardship: ensure the right patient receives the right test at the right time.
At its core, these rights center on appropriate utilization of laboratory testing.
Appropriate utilization is typically divided into two components:
1. Reducing overutilization (either ordering a wrong or medically unnecessary test)
2. Combating underutilization (using an incorrect test or not ordering a medically necessary test)
Of the two, utilization management efforts tend to target overutilization because of the immediate cost savings.
However, these efforts don’t necessarily align with patient care. Underutilization is estimated to be two to three times more common than overutilization.
Excessive efforts to combat overutilization, such as complex and opaque medical policies or arduous prior authorization processes can exacerbate underutilization. In fact, an American Medical Association survey found 78% of physicians indicated the prior authorization process led patients to sometimes or often abandon their recommended treatment.
A major reason underutilization has historically received less focus is because the associated health outcomes and dollars and cents surrounding it are harder to quantify. However, such impacts are likely more meaningful to both patients and the healthcare ecosystem.
While quantifying the impacts of underutilization compared to overutilization is significantly more challenging, there are undoubtedly substantial impacts for both payers and patients. These impacts include:
Underutilization, especially with high-risk patients, has a devastating impact. One study showed high-risk patients at an emergency department that conducts higher rates of testing have dramatically lower likelihood of adverse events as well as one-year mortality rates 34% lower than high-risk patients seen at emergency departments with lower rates of diagnostic testing. Diagnostic errors rarely result from errors in the laboratory test itself, but rather because the necessary test is not ordered, or the result is misinterpreted.
Prolonged periods without the appropriate diagnosis can also lead to worsening health outcomes, diminished functionality, increased long-term costs, and heightened patient dissatisfaction with their healthcare providers and payers.
In fact, some studies indicate 40,000 to 80,000 deaths per year are caused by diagnostic error. And numerous case reviews illustrate grave impacts.
For instance, 9% of stroke patients in emergency rooms face missed or delayed diagnoses, which is crucial because diagnosis time impacts outcomes significantly. Additionally, children with asthma often experience a median delay of three years and up to seven clinic or emergency room visits before receiving the correct diagnosis.
These instances underscore the complex economic and patient impacts of underutilization.
Given the volume of missed or incorrect diagnoses and the transformative potential of appropriate lab testing, it’s imperative the healthcare community unites in a concerted effort to enhance both aspects of utilization management via effort to support the three “rights.” While quantifying the positive impact of combating underutilization remains challenging, ensuring the right patient gets the right test at the right time benefits all stakeholders in the healthcare ecosystem.
Labcorp’s Insight Analytics data solution produces detailed test utilization reports to easily identify ordering patterns, mis-ordered tests, and testing inefficiencies based on national guidelines and best practices.
This level of lab stewardship can show gaps in care to help mitigate the long-term costs associated with diagnostic delays or misdiagnoses. Additionally, there is a dashboard that helps identify patients who haven’t been properly coded with chronic conditions and may warrant further follow-up– supporting improved population health management and patient outcomes.
Labcorp Diagnostic Assistant™ provides a more complete view of a patient’s medical history by showing tests ordered by other providers.
This delivers guidelines-based clinical decision support to physicians to help reduce duplicative tests and increase patient satisfaction—all in the electronic health record in real time at the point of care.
We’re on a journey and we’re in this together. Let’s unite to create more effective utilization, increase timely diagnoses and support better health condition management that saves lives and improves overall quality of life.
Todd Berman, payor solutions director of stewardship strategies, supports Labcorp’s lab stewardship initiatives. His main objective is to collaborate with internal and external stakeholders to ensure the value and sustainability of Labcorp’s offerings.
Berman received his Juris Doctor from The College of William & Mary School of Law and his Bachelor of Arts in philosophy and politics from Brandeis University.
