using our BEST judgment when ordering tests

  Using our B.E.S.T. judgment when ordering tests

Mira Irons, MD, associate chief, Division of Genetics, and Mary Ellen Cortizas, JD, administrative director, Department of Laboratory Medicine, are leading a two-year project to help providers determine the most medically appropriate type and amounts of laboratory tests for our patients. The B.E.S.T. (Bringing Expertise to Selecting Tests) project, endorsed by Provider-Payer Quality Initiative (PPQI), is a collaborative endeavor including members of Laboratory Medicine, Genetics, Cardiology, Gastroenterology, and Neurology.

The ordering of standard lab tests such as complete blood counts, is well understood by the provider community. However, the explosion of molecular testing over the last ten years has resulted in a whole new generation of testing that is expensive and complex, with few guidelines for use. The B.E.S.T. team will assess current and projected test usage, and develop new policies and practices for optimal use that will be communicated to those doing the ordering.

The primary goal is to safely deliver useful information to the people determining which tests are most clinically and technically valid for our patients, while avoiding excess waste and improving cost efficiency. A variety of systemic IT interventions will be established for monitoring compliance with new guidelines and the outcomes of testing using payer and charge data. Future expansion includes the design and implementation of order sets, and the creation of an alert system for the monitoring of more than 500 types of tests. Irons and Cortizas expect to see a reduction in unnecessary testing and an increase in internal controls and systems checks to assure that necessary tests are not missed. For the first two years, the estimated charge avoidance is projected to be approximately $1 million with a return of investment to be roughly $400,000 for the same time frame.