Hepatitis C Antibody Testing: Saving Costs by Preventing Multiple Unnecessary Tests

Background:

Healthcare costs continue to represent a growing burden on the American economy.  Current research has focused on methods to eliminate unnecessary tests or procedures to save costs and prevent waste.  Hepatitis C antibody testing represents one example of a test that, when positive, almost never needs to be repeated in a patient’s lifetime. Once positive for HCV antibodies, a patient will usually remain positive indefinitely (unless they have undergone a bone marrow transplant or other immunomodulatory therapy).

Purpose:

Identify and quantify the amount of healthcare waste in the form of unnecessary repeat testing by using hepatitis C antibody testing as a test case. Followed by the design of methods to prevent unnecessary repeat hepatitis C testing.

Description:

All adult patients admitted to the UCSD healthcare system during a 9 month period were analyzed for whether they had been tested for hepatitis C antibody. There were 1356 admitted patients tested during this period, of which 407 patients (30%) were tested twice in the same admission and 66 patients had multiple positive tests . As of May 2013, the Medicare reimbursement cost for this CPT code was $20.22 per test. All 407 people had congruence of test results, suggesting that $8229.54 in health care dollars could have been saved by preventing repeat testing. As a result of this study, the Epic EMR was changed to warn providers ordering a hepatitis C test of a previous positive result. In the 6 months after implementation of this change there were 1319 patients tested, of which 125 (9.5%) were tested twice in the same admission and of which only 19 patients had multiple positive tests.

Conclusions:

Hepatitis C antibody testing represents a feasible test case for eliminating health care waste that takes the form of multiple or redundant tests.  Despite only intervening on prevention of multiple positive tests, fewer tests were ordered as well perhaps due to heightened awareness of waste related to hepatitis C testing.  By implementing small changes to the EMR, real dollars in health care savings can be made.  This test case scenario could be applied to testing for hepatitis B antibodies, TSH, ANA, HIV, and other tests where repeat testing at short intervals or multiple positive tests represent wasted healthcare dollars.