The success of any utilization management initiative depends on having reliable data, along with the ability to identify outliers, compare providers, and share insights meaningfully. The best analytics solutions provide comprehensive and detailed insight into where opportunities exist with regards to utilization. Forward-thinking laboratories are looking to curb healthcare costs by focusing on instances of overutilization. For example, the physician utilization management analysis to the left leverages ICD codes to look at what different physicians order for patients of the same diagnosis.
Now, leaders can compare ordering habits and establish customary and standardized care for complex disease states, such as coronary disease. The end result for the patient is a service that takes into account the expertise of multiple providers. This in-depth comparison simultaneously exposes unnecessary and expensive tests that are disadvantageous for both the patient and the organization.
Unnecessary lab testing is an issue that has been probed and scrutinized for years. The most obvious concern is that these unnecessary tests waste money. However, it may be difficult to distinguish which tests are necessary or excessive without concrete metrics. Organizations are learning that their data already holds powerful insights for avoiding unwarranted lab tests. For example, costly tests with low abnormal rates potentially uncover unnecessary test ordering. The view to the left visualizes the average abnormal rate per test compared to a physician’s abnormal rate to identify potential areas of opportunity.
In an environment where clinicians are susceptible to choosing the wrong test due to similar test names, lab leaders can provide evidence-based guidelines and testing protocols to define and standardize quality medical processes. Common tactics include the utilization of test formularies and test dictionaries. Test dictionaries, like this one, present several options, which are often similar in appearance, to ordering physicians.
Analyses on commonly ordered tests and their associated results allow for determination of ideal procedure when presented with a patient with particular symptoms. Unnecessary ordering of laboratory tests is clearly a poor use of limited resources. Furthermore, these instances also expose patients to risks of not only unnecessary test conditions (e.g. radiation, phlebotomy, chemicals, etc.), but also to potential dangerous clinical interventions based upon incorrect results.
Escalating costs — both in terms of missed revenue opportunities and actual monetary savings — have driven organizations to refocus their attention to send-out tests. An example analysis is shown to the left, depicting send-out ordering patterns that help leaders identify and predict potential revenue.
Tests that were once esoteric or too expensive to justify as an in-house service may increase in frequency and quantity for reconsideration. Organizations that can easily track volume analyses like this are able to more quickly decide when to bring a send-out test back in house to reap the full benefits. Additionally, quality lapses are common with send-out tests, and patient care can be seriously impacted. By understanding which tests are currently being sent out, leaders may identify alternative existing in-house or less expensive tests that answer the same clinical questions for their patients without the additional wait time and quality issues. Leaders are able to consolidate, combine, and standardize tests to offer patients the best quality of care.
Providers and leaders need to sufficiently address patients’ current needs, but by using analytics, they are also able to delineate what care is necessary and what is excessive.
To learn how Viewics customers are using concrete metrics to continually assess and avoid overutilization of costly lab tests, watch our on-demand webinar: “How Lab Test Utilization Strategies can Increase Revenue and Improve Patient Outcomes.”