Test utilization is becoming the driving force for change within the laboratory and health care industries. Attendees of Mayo Clinic's Utilization Management 2014 Conference had the opportunity to learn the perspectives of and lessons from our amazing speakers. Read this post for a comprehensive summary of the conference.
Sept. 22 | 5:20 p.m.
Welcoming Dr. Newcomer
Mayo Clinic Chair of Laboratory Medicine and Pathology Frank Cockerill, M.D., welcomed the conference's keynote speaker, Lee N. Newcomer, MD, MHA. Dr. Newcomer is a senior vice president at UnitedHealthcare with strategic responsibility for Oncology, Genetics and Women’s Health.
Sept. 22 | 5:47 p.m.
Keynote Address: Dr. Newcomer Outlines the State of the Laboratory Test Utilization
Tonight's keynote address was delivered by Lee N. Newcomer, M.D., the senior vice president at UnitedHealthcare with strategic responsibility for Oncology, Genetics and Women’s Health. His hour-long presentation provided this year's attendees a high-level view of the critical importance of test utilization in the future of health care.
In a focused presentation, Dr. Newcomer shared UnitedHealthcare's four utilization strategies, outlined his "Do-Wants" or top solutions to improve utilization, identified how laboratories can create value, and pointed-out key obstacles we face together.
Check back for a more detailed summary of Dr. Newcomer's remarks and perspective.
Sept. 23 | 8:24 a.m.
A Snapshot of 2014 Utilize
We are in a packed ballroom in Rochester, Minnesota with friends from throughout the laboratory industry. Some interesting facts about Utilization Management 2014 include:
- 115 − Attendees
- 26 − States represented
- 32 − Physicians in attendance
- 41 − Health care executives
Sept. 23 | 8:52 a.m.
Setting the Stage
Curt Hanson, M.D., and Don Flott kicked off today's session with a presentation that set the stage for an open dialogue about test utilization. Dr. Hanson and Flott defined test utilization, articulated why proper utilization is critical to patient care, surveyed the current health care environment and where it is going, and offered tangible examples of test utization at its best.
According to Dr. Hanson, the definition of test utilization is, "A strategy for performing appropriate laboratory and pathology testing with the goal of providing high-quality, cost-effective patient care." He added that if the focus is solely on money, then any test utilization effort will at best have mediocre success. However, if good medical practice is the focus, then test utilization will have longevity and will adapt to healthcare changes.
Opportunities for test utilization nationwide include:
- Nationwide, laboratory costs are ~4% of health care costs; but are increasing at a rapid annual rate
- Molecular/Genetics is 15% to 25% of total – fastest growth area
- Conventional wisdom is that 20 to 40% of laboratory testing is unnecessary
Dr. Hanson ended the presentation by outlining several tangible next steps to get started ranging from identifying tests to target, studying how your organization is best positioned to move forward, and implementing utilization tools such as electronic medical record prompts and physician education.
Sept. 23 | 9:17 a.m.
Kicking off the Discussion
Sept. 23 | 9:45 a.m.
Dr. Pritt Outlines Actionable Test Utilization Interventions
In her 45-minute presentation, Bobbi Pritt, M.D., outlined several tangible actions laboratorians can apply to improve test utilization within their health care organization.
The interventions were categorized in three levels of complexity:
- Low − Rename tests to ensure clarity, remove tests that are not clinically meaningful, adjust standard test orders for morning rounds, and promote a preferred ordering pattern.
- Moderate − Use check boxes in the ordering system to engage the ordering physician and implement laboratory cascades to guide test.
- High − Set up IT rules to control utilization, add order entry decision rules, implement a test formulary, and apply a "stop light" approach to tests, prompting different protocols to differently types of tests.
Sept. 23 | 11:08 a.m.
Test Utilization and Anatomic Pathology
Amy Clayton, M.D., Anatomic Pathologist at Mayo Clinic, detailed to the conference attendees many of the utilization strategies in place in the Division of Anatomic Pathology as well as many of the efforts to bring clinicians across disciplines together to have an open dialogue on the testing needs of the practice.
Key points of Dr. Clayton's remarks include:
- Anatomic pathology practices must apply test utilization strategies to contain costs and expense in order to be ready to meet requirements of looming changes to reimbursement models.
- Focus on adopting a best-practices approach by applying algorithms, test send-outs, and companion diagnostic.
- Benchmarking may be an effective tracking tool to study and monitor test utilization efforts.
- All members of the patient care team—anatomic and clinical pathologists in collaboration with practicing clinicians—have a role in utilization strategy formulation, implementation, and adjustment.
- Work to make sure your organization has the appropriate knowledge dissemination mechanisms.
Sept. 23 | 12:02 p.m.
A Panel Discussion
For more than an hour, panel members from Mayo Clinic's test utilization team took questions from the audience and discussed lessons learned from test utilization projects over the last several years.
Sept. 23 | 3:02 p.m.
Leveraging Genetic Counselors
As the demands on laboratories mount, the role of genetic counselors will grow in scope and importance. This evolving role was the subject of the first afternoon session. The sessions speakers were:
- Mike Astion, M.D., Ph.D.—Division Chief, Laboratory Medicine, Seattle Children’s Hospital, Seattle, Wash.
- Jessie Conta, M.S., L.G.C.—Laboratory Genetic Counselor Lead, Department of Laboratories and Pediatric Laboratory Utilization Guidance Services, Seattle Children’s Hospital
- Lindsay Zetzsche—Genetic Counselor, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn.
According to the presenters, genetic testing presents unique challenges to the value equation because the tests are expensive, insurance coverage is inconsistent, and provider knowledge of testing options is inconsistent across specialties. The hour-long presentation discussed how genetic counselors and doctoral-level laboratory staff can create a successful utilization management system to provide significant cost savings to the hospital and increase value to patients.
Sept. 23 | 3:42 p.m.
Create a Successful Utilization Management Program in the Community Hospital Setting
Offering a different perspective than earlier presenters, Jeff Pearson, M.D., Medical Director at Bronson Methodist Hospital Hospital, offered his perspective on implementing utilization management efforts in smaller institutions. According to Pearson, community-based hospitals face many of the same challenges as large hospital systems in controlling the costs of blood products and laboratory testing, but may have limited resources and personnel to tackle these issues. Pearson's talk focused on how his pathologists and their colleagues at Bronson Methodist Hospital decreased red blood cell transfusions by 25%, controlled point of care testing, and put the brakes on expensive boutique laboratories and genetics testing.
Sept. 23 | 4:38 p.m.
Lessons Learned from a Large Health System
The final presentation of the conference was from Jim Crawford, M.D., Ph.D., who is the Chair of the Department of Pathology and Laboratory Medicine, North Shore-Long Island Jewish Health System. His multifaceted presentation included specific examples of how his institution applied utilization management strategies including a case study of the 2009 novel H1N1 outbreak in New York.
Dr. Crawford's presentation emphasized that utilization management occurs throughout a integrated laboratory service line and must be present throughout every aspect of the laboratory's services. Additionally, the possibilities of applying test utilization strategies is endless, but can only be successful with partnerships throughout a health system.
Sept. 23 | 4:51 p.m.
A special thank you to our attendees, faculty, and staff for an amazing Utilization Management 2014 Conference! Please read the posts below to see the great wealth of information presented over the last two days. Also, check back to our blog for full summaries, which will posted over the next couple months.