Follow along as we live blog the Mayo Medical Laboratories Utilization Management 2013 Conference on Oct. 8 in Atlanta, Ga. We will be posting presentation summaries, photos and other multimedia throughout the conference. If you are on Twitter, follow the conference hashtag, which is #2013Utilize.
Posted at 5:35 p.m.
Mayo Medical Laboratories would like to thank all of this year's attendees and presenters for an awesome day-long discussion of test utilization management. As you can see in the photo below, this year's conference spawned countless conversations. We would encourage all laboratory and pathology personnel to continue the discussion at health care organizations around the country. Together, we can make sure clinical laboratories and pathologists are leading efforts to solve many of the pressing issues facing health care organizations today and in the future.
Posted at 4:55 p.m.
All of the conference presenters took questions from the audience and each other to cap of the 2013 Utilization Management Conference.
Posted at 4:25 p.m.
"Value of Utilization Management to Payors" by Mike Snyder
Utilization management processes represent an opportunity for hospital laboratories and payors to collaborate to assure proper patient care and to increase the value for diagnostic services.
During his presentation, Mr. Snyder highlighted the importance of the following items during the development of utilization management programs:
- Demonstrate a direct tie to clinical practice
- Include passive and active activities that influence the ordering physician’s use of laboratory diagnostics
- Relate to measureable outcomes
- Include economic data where possible
- Be transportable/translatable outside of the Center of Excellence
Posted at 3:15 p.m.
"Pathologist-driven Algorithms and Guidelines" by Curt Hanson, M.D.
Dr. Hanson started his presentation discussing the test utilization issues faced by the complicated relationships between health systems, providers, clinical laboratories, and patients.
One of the most effective tools in test utilization is algorithms. In practice, there are four kinds of test algorithms:
- IT-driven: Clinical input and information drive what testing gets ordered or not
- Laboratory-driven: Laboratory results drive subsequent test selection. Testing is performed by laboratories using available specimens; specimens are shared between labs
- Pathologist-driven: Review of pathology findings determine next steps in testing algorithms; cancel or add appropriate next steps
- Genetic Counselor-driven: Review of genetic test requests require genetic experts with laboratory knowledge; make phone calls to add or cancel testing
Dr. Hanson profiled a recent activity at Mayo Clinic to tackle test utilization issues. The key was collaboration between laboratory divisions such as Laboratory Genetics, Hematopathology and Anatomic Pathology and with a diverse group of clinicians with expertise, experience in the subject matter. The group used the following approach:
- Identify opportunities
- Review practice data and literature
- Derive recommendations
- Achieve consensus
- Final guidelines approved
- Design process
- Adjust algorithms
Dr. Hanson spent the bulk of his time outlining a recent Mayo Clinic project to develop a comprehensive approach for bone marrow cytogenetic evaluation for lymphoma staging.
Posted at 2:15 p.m.
"Value of Genetic Counselors in Utilization Management" by Mike Astion, M.D., Ph.D.
Dr. Astion’s talk described the value equation for patients as it applies to genetic testing and how utilization management can increase value to patients. He then went on to discuss the laboratory genetic counselor as a utilization management gatekeeper and collaborator.
Genetic counselor utilization management strategies:
- Be organized: promote efficiency and productivity, project professionalism, support best patient care
- Be realistic: avoid burnout, set yourself up for success
- Be respectful: build positive relationships, win hearts and minds
- Be knowledgeable: promote efficiency, project professionalism, educate providers
Dr. Astion also highlighted the work of the Seattle Children’s Hospital Utilization Management Committee, which implemented policies that resulted in a 25% order modification rate in genetic testing and a ~$437 savings per test request!
From that success, the Pediatric Laboratory Utilization Guidance Services (PLUGS) was established to create a collaboration that exchanges vital utilization management information and services regarding pediatric lab testing.
Posted at 12:25 p.m.
"Blood Management" by James Stubbs, M.D.
Dr. James Stubbs discussed a wide range of blood management subjects, including details about Mayo Clinic's successful blood management, which generated a $28M savings, an 8-fold return on investment.
According to Dr. Stubbs, the bottom-line points attendees should know about blood management are:
- Blood management at Mayo Clinic and elsewhere must be multidisciplinary and have a high level of professional involvement
- Best programs for blood management grow from within disciplines.
- Need “internal” champions
- Achieve consensus on transfusion practices from the entire practice through the development of guidelines followed most importantly by communication and education of all involved
- Develop processes to make it easy to do the right thing. Tools range from prompts at order entry to dashboards
- Develop rapid feedback mechanisms
- Develop peer-group comparison data and share the data among peers
- Transfusion medicine and clinical colleagues should partner with the same goal in mind and develop best practices for the right component, right dose, right patient, right time and right reason.
Posted at 11:20 a.m.
"Algorithms and Cascade Tests in the Clinical Laboratory" by Bobbi Pritt, M.D.
Because providers are faced with an increasingly complex menu of testing options, too commonly, a gap exists between what the ordering provider knows and the information needed to appropriately use lab assays. Dr. Pritt discussed the use of laboratory expertise, like algorithms, to guide appropriate test ordering.
The goal of laboratory algorithms are to provide step-by-step procedures to the provider for ordering the correct sequence of tests and/or interpreting test results
Ideal characteristics of laboratory test algorithms:
- Based on widely accepted guidelines; data driven
- Formulated with provider input
Why cascades (laboratory-driven algorithms) work:
- The clinician only places 1 order
- The patient only undergoes a single blood draw
- Initial limited laboratory testing drives additional testing
Posted at 10:25 a.m.
"Getting to the Right Discharge Number" by Brad Karon, M.D., Ph.D.
The cost for “routine” inpatient lab testing adds up! This was a key takeaway from Dr. Karon’s presentation, which also addressed inpatient test utilization metrics, inpatient utilization of top performers, and inpatient utilization strategies.
Inpatient utilization strategies of top performers:
- Review order sets and order short-cuts
- Curtail standing orders
- Implement order entry decision support rules
- Provide cost information to ordering providers
Other inpatient utilization strategies include:
- Algorithms/reflex pathways
- Report cards
- Consultative services
- Review nonstandard (CMS) panels and profiles
Posted on Oct. 8 at 9:02 a.m.
"The Role of Pathology in Utilization Management" by James Hernandez, M.D.
The presentation from Dr. Hernandez focused on helping attendees understand why pathologists are key to the success of the lab test utilization efforts and how your pathologists can help your lab adjust to the coming changes by leading your lab test utilization efforts.
Key points included:
- Laboratories must be at the table discussing how their organization will adapt to the rapidly changing health care environment. If labs are not at the table, they will be "on the table."
- Only pathologists can lead effectiveness and make sure the organization is doing the right thing from laboratory and pathology perspective.
- Pathologists need to understand their role in increasing value for the system.
- Mayo Value Equation and Laboratory Utilization: Value = Outcomes + Service + Safety / Cost over time
- There are three key characteristics that pathology leaders should focus on to ensure success:
- A respected, knowledgeable and engaged pathologist (the Subject Matter Expert)
- Good working relationships with the medical staff
- Data mining and data analysis to monitor the changes in practice patterns, at the individual and department level
- Areas that all pathologists will need additional training and mentoring include:
- Leadership and management training
- Informatics, especially system data mining and data analysis
- Persuasive presentation skills to convince clinicians that it is in their best interests
- Hints from Dr. Hernandez to improve test utilization include:
- Successful lab utilization assumes some degree of integration of the practice
- Get to know your medical staff beforehand, especially the informal leaders and recognized experts
- You don’t have to convince every provider, only the key users of the particular test
- Generate data, be available to answer questions, and continuously give feedback to the medical staff
Data persuades, emotions motivate
Scrutinize your standing orders
Scrutinize your send-out reference tests for tests that may not add value
Posted on Oct. 8 at 7:25 a.m.
About the conference faculty
This year's conference faculty will be presenting on a wide range of subjects. We will post highlights from each presentation throughout the day:
- Introduction/Overview – Don Flott
- The Role of Pathology in Utilization Management — Getting to the Table – James Hernandez, M.D.
- Getting to the Right Test (formulary) – Curt Hanson, M.D.
- Getting to the Right Discharge Number – Brad Karon, M.D., Ph.D.
- Algorithms and Cascade Tests in the Clinical Laboratory – Bobbi Pritt, M.D.
- Blood Management – James Stubbs, M.D.
- Value of Genetic Counselors in Utilization Management – Mike Astion, M.D., Ph.D.
- Pathologist-Driven Algorithms and Guidelines – Curt Hanson, M.D.
- Value of Utilization Management to Payors – Mike Snyder
Posted on Oct. 8 at 7:13 a.m.
Welcome to MML's Utilization Management 2013 Conference
About the conference attendees:
- 29 states represented
- 85 attendees
- 53 physicians
- 32 executives