Laboratory Test Utilization in an Expanding Regional Laboratory Network: Past Successes and Future Opportunities

Abstract

Abstract Introduction The University of Rochester Medical Center developed a reference test utilization program implemented in 2011 to tackle increasing test volumes and costs. There was an initial >7,000 decrease in test volumes, which equated to >$1,000,000.00 in savings by year end 2012. Despite this, by the end of 2018, testing volumes had increased 34% and the cost had climbed 36%. Here we would like to discuss the methods implemented for initial success, potential reasons for continued increases in volumes and costs, and ideas to mitigate this trend in the future. Methods In 2010, the University of Rochester formed a laboratory diagnostics committee, which successfully decreased reference testing volumes and costs in both the inpatient and outpatient settings. They did this by developing a formulary for reference tests, which was divided into three tiers based on clinical utility and cost: tier 1 tests, unrestricted and available to all providers to order; tier 2 tests, restricted with only board-certified, subspecialty-trained physicians able to order; and tier 3 tests, off formulary and not available to order. The resident physician staff was also no longer allowed to order any reference testing on inpatients. Despite initial gains costs and volumes have climbed >36% and 34%, respectively, since implementation. Possible explanations for this include the addition of regional affiliate hospitals and reference clients that are not following these protocols, increased testing volumes, and increasing use of molecular testing. Conclusion Despite successful implementation of a reference test utilization program, close monitoring and adaptations are necessary in our continuously changing health care environment to remain effective. Implementation of the program at the regional affiliate hospitals and a more robust molecular testing menu in-house are potential options to control rising costs while providing high-quality patient care.