Children's Hospitals Today - Fall 2017 - 16

FEATURE / LAB TESTING

noticed this test had been competed
in 2004 and was positive. The genetic
counselor identified the results for
the physician and canceled the order,
avoiding $600 in costs.

Avoiding unnecessary tests
Clinically inappropriate tests can be
intimidating to approach, but are the
most significant type of testing error
in patient care. In one example, a GI
doctor ordered genetic testing for colon cancer for a specific type of tumor,
and upon chart review, the lab noticed
the pathology for this tumor had not
been returned. After a discussion with
the physician, she agreed to wait a day
for the report. It confirmed the tumor
type was not what the doctor initially
suspected, and the lab changed the
genetic test order.
If the initial order had gone out
as directed, the hospital would have
conducted an unnecessary test,
which would have created a delay
in diagnosing this pediatric cancer
patient. In the effort to provide the
most clinically accurate testing for
this patient, the hospital avoided
more than $1,700 in costs.

A closer look at the savings
When Arkansas Children's started taking a closer look at reducing lab costs
in 2012, the hospital avoided costs of
more than $100,000 just by canceling
orders. In 2013, the hospital avoided
$150,000 in costs by canceling orders
and bringing the highest volume order
in house. And a year later, with the
highest volume test in house, the hospital avoided costs of almost $100,000.
In 2014, the hospital hit a turning point. A reduction of canceled
orders meant providers were on the
right track, and the hospital avoided
unnecessary blood draws for a significant number of patients. In 2015,

CHILDREN'S HOSPITAL S TODAY Fall 2017

when the hospital implemented insurance pre-authorization for genetic
tests, savings increased to more than
$140,000 a year. From July 2015 to the
end of that year, the TUM program at
Arkansas Children's avoided costs of
more than $500,000.

Cost-saving strategies
In addition to the case review process,
there are other ways to cut lab costs,
such as negotiating prices with a vendor. Consider negotiating contracts

Clinically
inappropriate
tests are the most
significant type
of testing error in
patient care.

can partner with providers to make
sure patients get the care they need,
and they can also provide checks and
balances. When it comes to working
with providers, labs must work within
parameters, such as:
 Value providers' input
 Question processes more
than orders
 Reflect, don't reprimand
 Remember the provider is the one
caring for the patient
And for providers who are interested
in working with lab TUM groups, here
are some tips:
 Participate; don't patronize
 Set an example
 Get appropriate consent
when asked
 Consider your case thoughtfully
 Be conscious of the benefit
of testing
 Provide clinical information for
complex testing

with current vendors, or switch vendors to get a better price. Arkansas
Children's looked at a single genetic test
that the lab sent a volume of 17 tests per
year. The hospital cut costs by using
two different vendors and eventually
reduced costs for this test by $60,000.
Another cost-cutting strategy is to
review contracts with reference labs.
Because genetic testing is rapidly
changing, the prices change often,
so review contracts annually. Ask
preferred reference labs to match a
reasonable, competitive market price.
They will often negotiate to keep a
hospital's business.

Tips for communicating
The relationship between lab and
provider is vital. Lab team members

TUM programs are an important part
of clinical care, but there is no onesize-fits-all model. To see the biggest
costs avoided, be flexible when implementing a program. It can be an overwhelming process, so it helps to know
where to start. A small pilot study
can help with data collection to justify additional expenses or initiatives.
Constantly evaluate and analyze the
approach, efficacy, provider satisfaction and the quality of patient care.
Julie Kaylor, M.S., CGC, was the laboratory genetic counselor at Arkansas
Children's Hospital in Little Rock.
She is now a consultant with InformedDNA in St. Petersburg, Florida.
Send questions or comments to
magazine@childrenshospitals.org.

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