Residents Save $2M By Eliminating Needless Lab Tests

John Commins, for HealthLeaders Media , October 21, 2013

Having noticed that "the majority of tests we were ordering… really didn't impact the day-to-day care," a group of neurosurgery residents identified five lab tests that could be eliminated without affecting patient safety. They generated nearly $2 million in savings, including $75,000 in direct costs for their medical center.

Seunggu J. Han

Seunggu J. Han, MD, is a neurosurgeon

Neurosurgery residents at the University of California San Francisco Medical Center have demonstrated that a reduction by nearly 50% in the use of five common lab tests has no effect on patient care. The reductions generated $1.7 million in savings for payers in fiscal 2011–12, and another $75,000 in decreased direct costs for the medical center, according to a study in Journal of Neurosurgery.

In the one year before the project, the residents identified 45,023 of tests for serum levels of total calcium, ionized calcium, chloride, magnesium, and phosphorus in the neurosurgical service. In fiscal year 2011–2012, this number was reduced 47% to 23,660. The residents' findings were part of an in-house initiative at UCSF that encourages clinicians to identify department-specific cost savings and quality improvements in care delivery.

Seunggu J. Han, MD, a lead researcher among the 18 residents in the project and a neurological surgeon with UCSF, says it makes sense that residents would lead cost savings and quality initiatives because they're often the front-line clinicians with the most contact with patients.

"As a group of residents, we picked up that the majority of tests we were ordering on the neurosurgery service really didn't impact the day-to-day care," Han says. "No clinical decisions were made based on those lab results, whether they were normal or not. The patient's care would not have changed at all whether we had done that test or not. That was the case particularly with those lab tests that we identified."

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4 comments on "Residents Save $2M By Eliminating Needless Lab Tests"

Real savings (10/27/2013 at 9:25 AM)
Honest accounting is right. The majority of the tests are chemistry tests.The real savings are the cost of reagents and controls. Thus $75,000 are the real savings. As my CFO would say the $2 million is" funny money".

Honest Accounting (10/23/2013 at 2:05 PM)
Good story and good effort, but please some truth in accounting! The project reduced CHARGES by $1.7 million, which probably did not mean much (if any) in real costs differences to the insurers, who probably paid per case or per day reimbursements that were not changed by reduced testing. It is good to reduce utilization that does not benefit patients, but care should be taken to report that correctly.

DonaldStumpp (10/23/2013 at 1:08 PM)
In other news.... the Lab Director was fired for not achieving revenue goals. Oh what a tangled web we weave. If the hospital revenues are on a DRG or case basis, then there truly is savings to the hospital, otherwise, this savings cost them. I'm not arguing it should not be done, but shows how incentives can be misplaced. If there is not value in the procedure or test or service, it needs to be eliminated.




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