Clinical Lab Testing

One Way for Hospitals to Cut the Cost of Lab Tests

Making physicians aware of the costs of blood tests can lower a hospital’s daily bill for those tests by as much 27%, a new study suggests.

It is common practice at hospitals to test patients’ blood every day and it is wasting money and time, according to the study’s authors from the University of Miami and Brown University.

The researchers started by monitoring the baseline daily per-patient cost for two common lab tests, complete blood count and total chemistry panel, among surgical patients at Rhode Island Hospital in Providence. Then they started a program of scripted weekly announcements to surgical house staff—the doctors-in-training who order the bulk of the tests—and their attending physicians, about the cost of the tests.

At the beginning of the program, the daily cost per non-intensive care patient was $147.73. Over the 11 weeks of the study, that dipped as low as $108.11, in the eighth week. There were a couple of weeks where the cost of tests went up from the previous week, but those corresponded with a new influx of intern physicians, the authors write.

“There was no telling anyone when, or when not, to order a particular test,” says Elizabeth Stuebing, a study co-author and a fellow in trauma and critical care at the University of Miami’s Miller School of Medicine. Over 11 weeks, the total saved was $54,967, though that figure, and the per-patient savings are based on the sticker price of the tests, not the amounts paid by Medicare or negotiated with third-party insurers. That means the true savings was lower, Dr. Stuebing says.

But she says it shows what can happen merely by giving physicians information they don’t usually have. “We never see the dollar amount of anything,” Dr. Stuebing says. “The first week I stood up and said that in the previous week we’d charged $30,000 on routine blood work and I could hear gasps from the audience.”

The study didn’t continue beyond 11 weeks. It’s not possible to know if the behavior changes would continue. The research appears in the May issue of Archives of Surgery.

In an accompanying commentary, A. Benedict Cosimi, a professor of surgery at Harvard Medical School, compares the daily volume of unnecessary blood work to the bloodletting of centuries past. He attributes redundant and unnecessary tests in part to defensive medicine—physicians scared of being sued. He also notes that physicians and patients rarely know what routine tests and treatments cost.

Dr. Cosimi says the study represents “a good first step, just to show that there’s a problem, and a potential solution.” The goal would be to establish guidelines for proper testing. It’s not just blood work that could benefit from this kind of approach.

At his own transplant unit, Dr. Cosimi says he noticed changes in prescribing behavior simply by posting the different costs of two similar antibiotics.

“We know medical care is costing more than it has to,” says Dr. Cosimi. “There are some simple solutions.”

Multiplexed testing using biochips can also provide increased efficiencies and improved clinical performance. .  Traditional diagnosis takes the form of single analyte assays, even though several are usually required, thus increasing sample volumes, possibly requiring multiple patient attendance and increasing the time before diagnosis. A multi-analyte assay will reduce patient discomfort, as many related tests can be run at once, negating the need for multiple patient sampling. Multiple markers also give a more comprehensive picture of the patient’s condition, so providing an accurate and rapid diagnosis. This in turn will lead to better patient care.

The surface chemistry of the biochip and the analysis platforms allow BAT to be used with a range of patient samples, from whole blood, serum, saliva, urine and tissue biopsy, depending on the biochip assay under study

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