In this course, we have outlined the need for laboratory utilization management (UM) and a UM team. We have outlined what an UM team would look like, how it would operate, and the kinds of projects it should undertake. As reimbursement rates decline, high-deductible insurance plans become more popular, and laboratory testing becomes more esoteric and available, UM becomes essential for any health care organization. We must also not forget about the patient. A 2016 Forbes survey showed that half of Americans do not have $500 in savings to cover an emergency. For these patients a large bill for unneeded or redundant lab testing is a huge burden.
We've outlined some initiatives that UM teams could undertake, such as creating a formulary for approved send-out tests. We also discussed the need to develop policies and guidelines around over-used tests or tests of limited value and discontinuing obsolete tests. Other efforts, such as defining or limiting stat tests and monitoring the frequency of tests can also be very useful.
The UM team has a versatile and powerful tool in the electronic medical record (EMR). The EMR can be used to facilitate changes in practice by canceling duplicate tests, redirecting clinicians to better test alternatives, alerting clinicians that a similar test was ordered recently, and even showing clinicians how many lab tests they order compared to their peers.
Finally, we discussed the growing issue of genetic testing and some of the implications that these high-cost, low-volume tests present.
In the end, we must remind ourselves that good UM is about using the right test at the right time, on the right patient. It is not solely concerned with reducing costs. The mission of UM is to maintain or improve patient care while eliminating unneeded or wasteful testing. All laboratory testing has the potential to drive unneeded and anxiety-producing follow-up downstream. As laboratory professionals, we need to stay cognizant of the fact that a simple laboratory test, when used out of context, may end up driving further testing that negatively affects patients. Yet we all know that the right lab tests can save lives and provide essential data for patient management. Riding the line between these two extremes can be difficult but it is also stimulating and rewarding. Being involved in UM is a great opportunity for laboratory professionals to raise their scope of practice and network with clinicians in new ways. The time for leadership in laboratory medicine is here; let's take up the challenge and bring the clinical laboratory to the center of these efforts.
