Many years ago I worked for a large, national laboratory.  Not as a Medical Technologist, but as a Physicians’ Office sales and service representative.  One of my main job responsibilities was to market new laboratory tests.  I was paid salary plus bonus/commission for new sales generated.  I would use my knowledge of laboratory science to educate the physicians on these new tests in order to increase their use, and in essence, my income.  And I think I was pretty good at it.

Now instead of selling new tests to physicians, I work for the physicians. As the Laboratory Manager for a Physicians’ Office Laboratory, many of my former “customers” are now the same physicians who employ me.  I still get to use my knowledge of laboratory science when working with physicians, but I no longer do that to promote the use of the latest and greatest (and more expensive) testing.  There are new motivations to guiding better test selection – Quality, Cost-effectiveness, and Relevance.

Healthcare has changed. The increased out-of-pocket costs many patients’ face has forced them to become more informed consumers and take a more active role in managing their healthcare. Patients have choices, and they are not shy about exercising their right to choose a healthcare provider who can deliver the best care, for the best cost.

So how does all this tie together?  That’s a very good question.

When a sales and marketing representative presents new testing to physicians, the information provided is designed to promote that test in the best light. A good representative, knowing that today’s physicians are under pressure to see more patients and do more with each visit, will present the test with that in mind. But that information is biased for the company doing the presenting.

My goal is to remain neutral to vendors and for the most part and as a laboratory scientist, I am able assist my physicians by performing the comparative and supporting research.  I pull research and data from multiple sources such as journals, competitor literature, reference laboratory literature and clinical trials.  I read everything I can find about a test, summarize it, and present it to the physicians.

When researching, Here are a few elements of my focus:

TEST INDICATIONS:  Is this test designed as a screening tool or a diagnostic tool?  Should it be performed before or after symptoms appear?  Should it be part of a routine examination or a problem-focused exam? Tests designed as diagnostic tools, are often not covered by insurance for screening.

SPECIMEN REQUIRED:  Is this an invasive test?  Does it require collection during an examination?  Can the patient have it collected at an outside location such as an outpatient laboratory or reference laboratory Patient Service Center. Patient compliance is much greater when the specimen is collected on the date of service of the office visit.

INSURANCE COVERAGE: Is the test routinely covered by major insurance carriers?  Is it investigational?  Does Medicare have limited coverage determination for frequency or diagnosis code?

All of the above can indicate the patient responsibility for the cost of the test.

SENSITIVITY AND SPECIFICITY:  Most marketing literature provided by a vendor will include some of this data, quoting trials and commentary that show their product is superior to any competitors.  Were other trials performed?  Were comparatives made against a reasonable standard?  Does the competitor have trials showing the opposite?

You have to be careful when relying on one view of statistics. The presenter has the ability to choose which statistics they present, and which to leave out. And many statistics can be viewed and explained differently.  It’s all about the viewpoint.

Once my research is complete, and I have reviewed it with my Laboratory Director, I draft a memo to the physicians, outlining the information obtained.  I am respectful of the physicians’ time and am very careful to keep this document to 2 pages or less.  I include facts and figures from a non-biased perspective.  I am also sure to include a link to my primary source documents for any physicians’ who wish to review the data themselves. Then I end with a summary and recommendation.

This memo is then presented to our Chief Medical Officer for review.  When approved by both the Laboratory Director and Chief Medical Officer, the memo and recommendations will be distributed to all physician and non-physician providers as well as clinical staff. And if necessary, templates and order sets in our EMR will be updated to reflect the better test selection.

Since beginning to look at this new approach to guiding better test selection, our organization has made 3 major changes to benefit the patients:

Group B strep susceptibility – Providers are now more aware of patients Penicillin Allergy status and are ordering susceptibilities when necessary, not routinely. Although the outcome is not visible to the patient, reduced insurance costs are beneficial, and patient care is not sacrificed.

HPV mRNA – Standardized test ordering for HPV by messenger RNA instead of DNA yields the same sensitivity, but higher specificity.  This leads to fewer patients receiving invasive confirmation testing.  It also detects more HPV at a later stage, where it is more likely to lead to pre-cancer or cancer. The end result is Increased patient satisfaction with reduced cost, improving patient care.

Screening tests for vaginitis/vaginosis – Patients’ medical history is reviewed to determine if screening tests or diagnostic tests are indicated.  Screening test are routinely less expensive, provide a faster time to resulting, and are appropriate for the majority of patients with acute onset of symptoms, who do have recurring infections.

Better test selection has a direct impact on both the quality and cost of the care available to the patient. There are many opportunities for you, as a laboratory scientists, to guide better test selection.  The benefits to both the patient and the physician depend on your desire and determination.

So where will you start?  What test selection can you guide?

About The Author

Margaret Blaetz began her career as a Medical Laboratory Technician specializing in Microbiology and obtained her Bachelor of Science Degree at Glassboro State College (Rowan University). While employed as an EMR trainer at Regional Women’s Health Management, LLC Margaret’s expertise in medical technology and project management were called into play with the planning, credentialing and opening of the Regional Women’s Laboratory. In 2012, Margaret expanded her credentials to include Certified CLIA Compliance Professional (AAPOL). Margaret serves as a CLIA regulatory resource for more than 30 Physicians Office Laboratories. Margaret’s passions include Community Theater and hound dog rescue groups; SOS Beagles NJ and Tri-State Basset Rescue. In her spare time, Margaret and her husband enjoy camping and working as Highway Hero Rescue Transporters.

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