Abstract 211: Reduction in Laboratory Associated Cost Through Education Based Gatekeeping

Abstract

Background: Laboratory testing is one the factors contributing to rising health care expenditures. Recent estimates show that laboratory and pathology testing accounts for 4% of all yearly healthcare costs. Depending on the country, clinical setting, method, and specific tests evaluated, studies have shown that a relatively large percentage (up to 42%) of laboratory testing may be wasteful. We proposed a study to evaluate the lab related costs in our institution. Objectives: To evaluate the effects of behavioral interventions that may result in lab-associated cost reduction. Methods: We identified the top 10 Diagnosis-related Groups (DRG) for our institution, along with most common requested laboratory investigations for the patients hospitalized during three fiscal years 2015-2017. Extensive review of data from fiscal year 2015 (identification period) was performed by a review committee comprising of physicians, lab leadership, billing & coding team and Internal Medicine operations director. Two interventions were selected based on the institutional work flow design, and included removal of default duration from complete blood count and basic metabolic panel orders, and behavioral modification with structured education to create awareness for the cost associated with unnecessary lab tests. Interventions were implemented by the end of fiscal year 2016 and start of 2017. Comparison of each fiscal year cost data was performed. Results: A total of 1612 patients with selected DRGs were identified in pre-intervention fiscal year 2016 with total lab cost of $1,603,724 and average cost of $995/patient. During post-intervention fiscal year 2017, 1530 patients were identified with total lab cost of $1,174,557 with average cost of $768/patient. Post-intervention overall cost reduction was noted to be $429,167 which is 26.7% lower than pre-intervention fiscal year. Per patient cost was lowered by an amount of $227; a 22.8% decrease. Conclusion: In this single center study, implementing modification of default lab orders along with structured educational program showed a significant reduction in lab related cost without interfering with the clinical decision-making process of the providers.