Background: Laboratory testing is an integral part of modern medicine with an estimated 4-5 billion tests performed in the United States each year, and accounts for 3-5% of healthcare spending. At our resident-run clinic in an underserved community, the cost of laboratory tests in 2013 was over $400,000, exceeding the government subsidy. In this study, we evaluated the effect of an educational intervention program on reducing laboratory testing costs in our clinic.
Methods: In this educational intervention program provided between November 2014 and January 2015, internal medicine residents were given lectures on appropriate utilization of laboratory testing, which focused on the reinforcement of standard practice guidelines and analyses of scenarios where unnecessary laboratory tests were ordered. Costs of commonly used laboratory tests were posted in the clinic. We compared the laboratory tests ordered in a 10-week period after the intervention and that in the same period of the previous year (control period). Multivariate nonparametric statistical methods, (i.e. ordinary logistic regression) and subgroup analysis were used to evaluate the effect of this program on laboratory cost reduction.
Results: After the intervention was implemented, there were a total of 453 clinic visits between November 2014 and January 2015. There were 471 clinic visits during the control period between November 2013 and January 2014. Seventy different types of laboratory tests were ordered in these periods. The educational intervention was independently associated with a significant laboratory cost reduction (OR=1.53, 95%; CI: 1.12-2.11). The median lab cost per visit decreased from $106.00 to $74.00 (p <0.01). The total cost in the 10-week study periods decreased from $79,403 to $51,463. This represents an extrapolated annual cost reduction of $145,288. Our intervention was associated with similar reductions of laboratory costs in the following two subgroups: age groups of <50 years (OR=1.53, 95%; CI: 1.12-2.11) and ≥ 50 years (OR=1.58, 95%; CI: 1.14-2.21), new clinical encounters (OR=3.63, 95%; CI: 1.89-7.13) and follow-up visits (OR=1.53, 95%; CI: 1.20-1.96). In the analysis of individual laboratory tests, the cost of TSH and Vitamin D tests had the greatest reduction ($8,176 and $5,088 respectively). Other tests, including CBC, CMP, HbA1c, and lipid profile, were not affected by our education program.
Conclusions: An appropriately designed physician educational intervention program is effective in reducing unnecessary laboratory tests and the associated costs. Screening tests with inadequate evidence support were reduced most, whereas those with benefits did not decrease significantly.