Reduction of Health Care Costs and Improved Appropriateness of Incoming Test Orders: the Impact of Genetic Counselor Review in an Academic Genetic Testing Laboratory

Abstract

The goal of this study was to evaluate the impact of genetic counselor (GC) review of incoming test orders received in an academic diagnostic molecular genetics laboratory. The GC team measured the proportion of orders that could be modified to improve efficiency or sensitivity, tracked provider uptake of GC proposed testing changes, and calculated the health care dollar savings resulting from GC intervention. During this 6-month study, the GC team reviewed 2367 incoming test orders. Of these, 109 orders (4.6%) were flagged for review for potentially inefficient or inappropriate test ordering. These flagged orders corresponded to a total of 51 cases (1-5 orders for each patient), representing 54 individuals and including 3 sibling pairs. The GC team proposed a modification for each flagged case and the ordering providers approved the proposed change for 49 of 51 cases (96.08%). For the 49 modifications, the cost savings totaled $98,750.64, for an average of $2015.32 saved per modification. This study provides evidence of the significant contribution of genetic counselors in a laboratory setting and demonstrates the benefit of laboratories working with ordering providers to identify the best test for their patients. The review of test orders by a genetic counselor both improves genetic test ordering strategies and decreases the amount of health care dollars spent on genetic testing.

The composition and capacity of the clinical genetics workforce in high-income countries: a scoping review

“…[71][72][73] Several studies described the involvement of GCs in test triage as part of laboratory utilization management. [74][75][76][77] Also in the laboratory, CLGs can be the responsible head of a laboratory performing human genetics tests in 73% of the countries that recognize this title, according to a survey of more than 50 European and non-European countries. 48 Responsibilities of the CLG vary by region, and can include writing and signing laboratory reports, results interpretation, teaching, and (less commonly) counseling patients.…”

“…68 Quality improvement through utilization management was also reported as a way to increase appropriate use of genetic services. GCs have been shown to play an important role in utilization management through patient identification and triage 156,173 and through reviewing genetic test requests in a laboratory setting, [74][75][76][77] resulting in a reduction in inappropriate testing. 75,77…”

“…GCs have been shown to play an important role in utilization management through patient identification and triage 156,173 and through reviewing genetic test requests in a laboratory setting, [74][75][76][77] resulting in a reduction in inappropriate testing. 75,77…”

Genetic counselors and legal recognition: A made‐for‐Canada approach

“…Genetic tests ordered by primary health care providers unfamiliar with genetic testing can result in incorrect or unnecessary testing being ordered, increasing cost expenditures (Brierley et al., 2012). Genetic counselors, through their specialized knowledge and training, have been shown to decrease expenditures to the health care system and increase cost efficiencies, especially as the health care system moves toward genomic medicine (Branda, 2017; Dragojlovic et al., 2020; Suarez et al., 2017; Wakefield et al., 2018).…”

U.S. Genetic counselors’ perceptions of inpatient genetic counseling: A valuable model for medically complex patients

“…Insurance coverage for genetic testing is a perceived benefit of inpatient genetic counseling, though the billing methods used (bundled hospital stay billing or institutional billing) are costly for hospitals if many tests are ordered unnecessarily (Conway et al, 2020;Miller et al, 2014;Wakefield et al, 2018). Since GCs are trained to select the appropriate test (American Board of Genetic Counseling, 2019), having access to a GC who can assist in appropriate genetic test selection can save their institution a significant amount of money (Conway et al, 2020;Miller et al, 2014;Wakefield et al, 2018).…”