Education, outreach reduce unnecessary lab tests

Providers who better understand the specific uses of different kinds of laboratory tests order fewer unnecessary tests and provide better patient care, Medscape Medical News reported from the American Society for Clinical Pathology conference.

In one study presented at the conference, the Western Connecticut Health Network slashed orders for a vitamin D test by 75 percent by educating doctors about a test more appropriate for assessing vitamin D deficiencies. Education and other follow-up efforts saved the lab $3,700, according to the article.

A similar effort involving serum methylmalonic acid (MMA) tests cut the number of tests ordered by 56 percent and saved more than $10,000 in a year, according to Medscape. In that case, the lab conducted tests only if the provider previously tested the patient's vitamin B12 levels and they fell into a particular range that warranted confirmation with the MMA test.

A separate study reported earlier this month in the Annals of Internal Medicine found that more than a third of cardiac stress tests conducted with imaging were "probably inappropriate," racking up $500 million annually in unnecessary costs and potentially causing 491 future cases of cancer.

"Nuclear imaging stress tests command higher reimbursement," Joseph A. Ladapo, M.D., Ph.D., told MedPage Today, which reported on the findings. "No one likes to talk about this but there is plenty of evidence that physicians respond to financial incentives."

Other studies have found that computerized physician order entry with decision-support alerts can reduce duplicative CT scans, as well as medically unnecessary B-Type Natriuretic Peptide (BNP) tests on heart failure patients--to list just two examples.

Those two programs focused on clinical decision support, but another study showed that alerting doctors to the cost of a test before it's ordered cut the number of tests ordered by 9 percent at Johns Hopkins Hospital.

"Whether broadening this intervention and coupling it with educational interventions related to cost consciousness and stewardship of resources will increase its effect on clinical practice deserves further study, provided that providers are not inappropriately incentivized to limit needed care," said the study authors.

For more information:
- here's the Medscape article
- check out the MedPage Today article
- here's the Annals of Internal Medicine study 
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