An analysis from Change Healthcare has found that approximately 7.7 percent of all lab orders are clinically inappropriate. The data, taken from Change’s CareSelect Lab point-of-order decision support solution, suggests that approximately 12 percent of total laboratory spending is unnecessary.
In a recent interview, Caroline Liebscher, product manager for CareSelect Lab at Change Healthcare, discussed the significance of the findings.
First, she noted that the Change Healthcare 2021 Laboratory Ordering Utilization Index is based on an internal analysis of approximately 3.4 million provider ordering transactions processed between September and November 2021. Ordering transactions were sourced from 84 geographically dispersed hospitals with a broad range of laboratory volumes, including multiple academic medical centers.
The analysis leverages clinical appropriateness criteria authored and maintained by experts at Mayo Clinic. All the ordering transactions in the Lab Ordering Index were measured against these criteria.
The highest rates of inappropriate ordering were for specialized and rapidly evolving tests, like inherited genetics. Change noted that some of the Mayo protocols are about care setting and when you should or should not be ordering. Perhaps the genetic tests are not being ordered by an oncologist and/or genetic counselor, and the health system wants to restrict who orders those tests. As new tests are brought to market and best-practice recommendations are updated the ordering of genetic testing is only becoming more complicated, the report noted.
In addition, there are many routine labs that are being ordered too often and are not deemed clinically necessary, according to the Index.
The report notes that certain tests may only be appropriate to order once a day, once every three days, once a year, or even once in a lifetime The Change analysis examines 130 clinical indications that can be measured against frequency criteria.
I asked Liebscher if that level of inappropriate ordering of routine lab tests would be easy for hospitals to change.
“As long as you have leadership and governance support, absolutely, those are the tests that a lot of our sites start looking at initially, because they are widely ordered,” she said. “The really nice thing about our integration is that if they find in the data that there's one particular department that's ordering those routine labs more often than others inappropriately, they can do education or add some decision support for the providers in that department specifically. It is a way to take a data-centric approach to your lab stewardship and your lab guidance.”
She said health systems are all at different points along the journey of reducing unnecessary lab ordering. “There is often at least a starting point in creating a group,” Liebscher said, “but how mature that group is in efforts varies quite a bit. Some people are starting to focus on it now, while others have been focusing on it for five years and are looking for ways to advance what they've been working on. There is typically someone at each organization who is ready to do this, whether or not they have that whole group formed. We hope that this index gives them an idea of what they can do and makes some people want to look at their data a little bit more.”