Efforts to reduce inappropriate utilization of laboratory testing have tended to focus on overutilization, but underutilization can have significant consequences, including costly hospitalizations, readmissions, and avoidable complications from care gaps.
Duplicative, unnecessary, or excessively expensive tests are the focus of many recent studies and initiatives, including the “Choosing Wisely” campaign being undertaken by the American Board of Internal Medicine (ABIM). Success stories about stamping out waste often credit that success in large part to eliminating the needless ordering of costly laboratory tests. An example of the latter comes from the University of California San Francisco Medical Center, where neurosurgery residents targeted overutilization in the laboratory and reported a $2 million savings after cutting the use of five laboratory tests in half, without affecting patient outcomes. Further, in the wake of compelling academic analyses of waste such as “Eliminating Waste in US Health Care,” by Donald M. Berwick and Andrew D. Hackbarth in 2012, surveys indicate that the majority of physicians perceive unnecessary medical testing to be a persistent problem.