Preventing Genetic Testing Order Errors With a Laboratory Utilization Management Program

Mathias, Patrick C.; Conta, Jessie H.; Konnick, Eric Q.; Sternen, Darci L; Stasi, Shannon; Cole, Bonnie; Astion, Michael L.; Dickerson, Jane A.

doi:10.1093/ajcp/aqw105

Cited by 23 publications

(23 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that tests were ordered by both obstetrician gynecologists and certified midwives functioning as perinatal providers, infertility sub‐specialists, and primary care providers such as family practice physicians. Previous studies have identified higher errors for genetic tests ordered by providers without specialty training in genetics (Mathias et al., 2016). We also found cases where a screening test was initially ordered with a family history of cancer, followed by the addition of targeted testing based on genetic studies of the affected individual.…”

Section: Discussionmentioning

confidence: 99%

“…The strengths of this study are the thorough review of ordered genetic tests and the chart review to determine the appropriateness of testing. (Mathias et al, 2016), and other techniques including order restriction and guidance (Dickerson et al, 2014…”

Section: Study Limitationsmentioning

confidence: 99%

“…Similarly, recent studies have also shown the benefit of utilization management in terms of optimizing test ordering and decreasing costs (Dickerson et al, 2014, Londre, Zaleski, & Conta, 2017, Mathias et al, 2016, Miller et al, 2014, Riley, Procop, Kottke-Marchant, Wyllie, & Lacbawan, 2015. The goal of our study was to determine the cost of completing a number of directly orderable genetic tests at our institution.…”

Section: Introductionmentioning

confidence: 98%

See 2 more Smart Citations

Genetic testing costs and compliance with clinical best practices

Montanez

Berninger

Willis

et al. 2020

Journal of Genetic Counseling

View full text Add to dashboard Cite

We sought to determine the costs of genetic testing and compliance with published guidelines and clinical best practices at our institution. A cost analysis was performed comparing the costs of ordered tests to the cost of the recommended testing. This was an approved quality improvement project at a tertiary teaching hospital in California. We identified charts associated with the genetic testing billing codes for common genetic tests through our contracted laboratory (cystic fibrosis genotyping, Breast cancer susceptibility gene (BRCA 1&2), Methylenetetrahydrofolate reductase (MTHFR), factor V Leiden (FVL), prothrombin gene pathogenic variant, alpha-thalassemia, hemochromatosis, and cell-free fetal DNA). Charts were reviewed retrospectively by a licensed, certified genetic counselor to assess the compliance with published clinical practice guidelines identified on GeneReviews and the American College of Obstetricians and Gynecologists (ACOG). Tests were classified as: appropriate, misordered/not indicated, misordered/false reassurance, and misordered/inadequate. We performed a cost analysis for the recommended test changes. We reviewed 114 charts over a three-month period. Forty-four (38.6%) of the tests were misordered based on published clinical practice guidelines: 24 (21%) were misordered/not indicated, 8 (7%) were misordered/false reassurance, and 12 (10.5%) were misordered/inadequate. Costs of ordered testing ($75,177) were compared to recommended testing after review ($54,265), with a total cost savings of $20,912. In clinical practice, over one-third of genetic tests reviewed were misordered. As these tests are a small fraction of all genetic tests at our institution, future studies should broaden the scope of testing evaluated to understand the magnitude of this problem and potential cost savings. Genetic counselor review and involvement in genetic test ordering can decrease inappropriate healthcare expenditures and improve patient care.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Genetic testing costs and compliance with clinical best practices

Montanez

Berninger

Willis

et al. 2020

Journal of Genetic Counseling

View full text Add to dashboard Cite

show abstract

“…Misutilization—the ordering of laboratory tests that are inappropriate for the clinical questions being asked—is fostered by the ever-increasing number of available laboratory tests and the inability of busy physicians to stay abreast of their utility. 56,70 -72 Indeed, a resolution was recently passed by the House of Delegates of the American Medical Association to close potential gaps in the training of physicians in use and interpretation of laboratory tests. 73 The following case illustrates the seriousness of this issue.…”

Section: Reducing Diagnostic Errorsmentioning

confidence: 99%

The Value Proposition for Pathologists: A Population Health Approach

Ducatman

Crawford

et al. 2020

Academic Pathology

View full text Add to dashboard Cite

The transition to a value-based payment system offers pathologists the opportunity to play an increased role in population health by improving outcomes and safety as well as reducing costs. Although laboratory testing itself accounts for a small portion of health-care spending, laboratory data have significant downstream effects in patient management as well as diagnosis. Pathologists currently are heavily engaged in precision medicine, use of laboratory and pathology test results (including autopsy data) to reduce diagnostic errors, and play leading roles in diagnostic management teams. Additionally, pathologists can use aggregate laboratory data to monitor the health of populations and improve health-care outcomes for both individual patients and populations. For the profession to thrive, pathologists will need to focus on extending their roles outside the laboratory beyond the traditional role in the analytic phase of testing. This should include leadership in ensuring correct ordering and interpretation of laboratory testing and leadership in population health programs. Pathologists in training will need to learn key concepts in informatics and data analytics, health-care economics, public health, implementation science, and health systems science. While these changes may reduce reimbursement for the traditional activities of pathologists, new opportunities arise for value creation and new compensation models. This report reviews these opportunities for pathologist leadership in utilization management, precision medicine, reducing diagnostic errors, and improving health-care outcomes.

show abstract

“…A specific intervention that enhances teamwork is the implementation of diagnostic management teams in any of the areas where they have shown to be effective including coagulopathy and hematologic malignancy (5). Another teamwork intervention is the review of complex genetic test orders by a genetic counselor, especially if ordered by a physician who is not a geneticist (6)(7)(8). This addresses the nearly one-third of genetic tests orders that contain errors.…”

mentioning

confidence: 99%