Cleveland Clinic Lab dramatically reduces doctors ordering unnecessary tests

Lab utilization management project cuts doctors ordering unnecessary tests, saves $5 million

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This is an excerpt from a 2,920-word article in the May 7, 2018 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. 

doctors ordering unnecessary spending increases healthcare costsCEO SUMMARY: In an insightful report, THE DARK REPORT shows how one lab is cutting unnecessary and improving patient care in the new laboratory era of adding value. Cleveland Clinic lab’s seven-year effort has prevented 160,072 tests, preventing doctors ordering unnecessary tests and duplicates, and saved more than $5 million. These specific lessons can be leveraged by lab managers everywhere, and highlight how the future of laboratory medicine is focused on improving outcomes.

IMPROVING HOW PHYSICIANS use laboratory tests is becoming a widely-used operating strategy in hospital and health system laboratories today.

This strategy is popular for two reasons. First, when a lab works with physicians to eliminate the problem of doctors ordering unnecessary tests, or duplicate tests, the cost savings are immediate. Second, when physicians get better at ordering the right test at the right time, patient outcomes and patient satisfaction scores improve.

In 2011, the Cleveland Clinic laboratories launched an initiative to improve lab test utilization that in two years prevented more than 12,000 duplicate or inappropriate test orders, saving almost $1.2 million. (See TDR, June 1, 2015.)

The lab test utilization projects in 2011 and 2012 went after the low-hanging fruit, such as reducing duplicate orders and aligning standing lab test order sets to eliminate outmoded or inappropriate tests. These early projects gave the lab team experience in how to approach physicians to gain their cooperation and how to sustain improvements from these projects.

In 2011 and 2012, Gary Procop, MD, the clinic’s laboratory Co-Chairman of the Laboratory Stewardship Committee, oversaw the lab’s utilization management and then used the lessons learned from the first two years to launch a second generation of lab utilization initiatives in 2013 that produced more impressive results. In this second phase, the clinic prevented more than 80,000 test orders and saved $5 million.

“From our first initiatives in 2011 we saw how our utilization management efforts changed our standing at the Cleveland Clinic. This fueled our second generation of utilization changes,” he explained at THE DARK REPORT’S Lab Quality Confab in October 2017. “After starting this program, we learned that it’s about much more than saving money. It’s about adding value to the healthcare system.

“In our first-generation initiatives, we built trust in every lab throughout the Cleveland Clinic system,” he said. “From that experience we gained the confidence to escalate the lab test utilization management program so that today we are truly changing our practice for the better.

“Every lab in the United States needs to address affordability immediately and our lab test utilization management program does that,” he explained. “As pathologists and lab directors, we know that if we cut costs, we get almost an immediate positive response. But in addition to cutting costs, we also have to increase value for our healthcare system. I promise that by doing the right test, good things will follow— such as lower costs—but also by doing what’s best for patients.

“Consider what happens when lab directors ask a group of healthcare providers, ‘Who wants to do another cost-cutting project?’ ” said Procop. “You may not get a positive reply from everyone. But if you ask the same group, ‘Who wants to improve the rate of indigent women getting Pap smears?’ you get many positive replies.

Improving Patient Care

“When this happens, then your clinical lab has embarked on population health management and you’ll have staff members—particularly the physicians and nurses—invested for the right reasons and for the long term, both of which are more sustaining than simple cost cutting,” he advised.

“Our lab-test utilization management program is based on the universal principle of doing what’s best for patients,” noted Procop. “When our lab does this, we improve quality and patient safety while also enhancing both patient care and patient experience. At the same time, we increase our laboratory effectiveness and efficiency, cut costs, and save the clinic a lot of money.

“In addition, the projects are elevating the laboratory’s position in our health system,” Procop added. “Previously, no one from pathology or laboratory medicine was on the most important clinic committees. Now it’s significant that we’re sitting at the table when key decisions are made.

“All of this results from asking the question: Who’s going to be the leader?” advised Procop. “For lab directors and pathologists, now is the time to step up.”

Five Primary Goals 

After challenging lab directors and pathologists to assume more leadership roles in hospitals and health systems, Procop explained the five primary goals of the lab test utilization management program:

  1. Improve quality and patient safety,
  2. Enhance patient care and the patient experience,
  3. Increase laboratory efficiency and effectiveness,
  4. Reduce costs, and,
  5. Enhance the lab’s position on healthcare delivery teams.

For his presentation at Lab Quality Confab, Procop explained that the program cut costs while improving quality and value by using evidence-based best practices. “When our lab does this each time we take on a project, that project is automatically patient-centered,” he said.

“In addition to being patient-centered, our interventions—except for our laboratory-based genetics counselor—are done through the informatics system,” explained Procop. “These interventions happen at the point of order entry. That enables us to communicate with ordering physicians at the exact moment when they are placing orders, not after the blood has been drawn and it arrives in the clinical laboratory.”

That means the system automatically steps when doctors order unnecessary tests that have already been ordered or even run.

One of the first lab test utilization initiatives was an effort to stop same-day duplicate orders. “This happened as a result of a complaint to the former CEO about a patient being over-phlebotomized,” Procop explained. “That sounds like a problem for the lab, but, actually, it created an opportunity for us.”

Has your lab undertaken any projects to cut unnecessary and duplicate lab tests? Please share your experiences with us in the comments below.

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