Ordering the wrong laboratory tests leads to patients and laboratories incurring unnecessary costs. Healthcare organizations across the country have found that focusing utilization interventions on the ordering provider is one of the most effective ways to curb overutilization. One type of intervention that has proven to be quite impactful is the use of utilization report cards that provide feedback to physicians on their behavior relative to a desired norm.
“If you’re trying to influence physician behavior, there’s a variety of IT interventions that can help, and they don’t produce the same level of happiness in physicians,” said Dr. Michael Astion, medical director at the department of laboratories at Seattle Children’s Hospital, in a recent webinar with Viewics.
Seattle Children’s Hospital backs an initiative called the Pediatric Laboratory Utilization Guidance Service (PLUGS), designed to help hospital laboratories and practitioners decrease costs and errors associated with unnecessary laboratory testing. “In general, things like report cards can make them happy if they’re done in a positive way,” said Astion.
Dr. Brian Jackson, vice president and chief medical informatics officer at ARUP Laboratories and associate professor of clinical pathology at the University of Utah in Salt Lake City, calls this concept “nudging”. He writes:
“…To become a great healthcare system, it’s…necessary to identify the factors that should remain flexible in order to support the work of of our best doctors. What we need, in other words, is a theory of active, engaged management that respects the professional role of physicians and takes full advantage of their education, skills, and ingenuity.
One useful tactic under this approach is nudging, i.e. steering physicians in the direction that we know is usually right, while still giving them freedom to deviate where appropriate. This requires engineering the information environment in which they act, such that usually correct actions become the default, and deviation requires a conscious choice. In more formal terms, nudging is an application of behavioral economics, which blends economics and psychology.”
Astion suggests putting the nudging concept into practice by analyzing the data from ordering physicians. Instead of criticizing a physician for over-ordering tests, the data from physicians who are ordering tests correctly is held up as an example of what to strive for. “People want to be like the person who’s behaving best,” Astion said. “So, we influence physician behavior using positive feedback with nudging. That’s what works the best.”
Together, Viewics and PLUGS are developing a system for providing sophisticated test utilization management analytics and dashboards. “It’s relatively easy to put together a provider report card or modified report card with Viewics,” said Astion. “Report carding is particularly useful. And, you can actually get down to the physician accountability level in Viewics.”
PLUGS has many examples from around the country of influencing physician behavior through report cards and nudging. “Physicians will often need to see their behavior relative to their peers to adjust their behavior, and those are the kinds of things you can pull out of Viewics,” said Astion.
Hear more from Dr. Astion. Download our on-demand webinar, Best Practices for a Data-Driven Approach to Test Utilization Management.