title: Genetic counselor review of genetic test orders in a reference laboratory reduces unnecessary testing.
abstract: Genetic tests are routinely ordered by health care providers (HCPs) within a wide range of medical specialties. Many providers have limited knowledge or experience with ordering and interpreting genetic tests; thus, test order errors are common. Rigorous review of genetic test orders by genetic counselors (GCs) can provide a direct financial benefit to medical institutions, patients and insurers. GCs at ARUP (Associated Regional University Pathologists) Laboratories routinely perform a preanalytic assessment of complex molecular genetic test orders that includes reviewing clinical and family history information and considering the clinical utility and cost-effectiveness of ordered tests. GCs contact the ordering institution and/or HCP as needed to collect additional clinical information and confirm the test order or suggest alternative testing based on the provided information. A retrospective review of the GC-facilitated test changes over a 21-month period at ARUP laboratories was performed. Approximately 26% of all requests for complex genetic tests assessing germ line mutations were changed following GC review. Testing fees associated with canceled tests were summed to estimate the cost-savings resulting from GC-facilitated test reviews. The test review process resulted in an average reduction in charges to the referring institutions of $48,000.00 per month. GC review of genetic test orders for appropriateness and clinical utility reduces healthcare costs to hospitals, insurers, and patients.
authors.affiliation: Genetics Division, ARUP Laboratories, Salt Lake City, Utah.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Miller
authors.forename: Patti
authors.initials: P
authors.lastname: Krautscheid
authors.forename: Erin E
authors.initials: EE
authors.lastname: Baldwin
authors.forename: Tatiana
authors.initials: T
authors.lastname: Tvrdik
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Openshaw
authors.forename: Kim
authors.initials: K
authors.lastname: Hart
authors.forename: Danielle
authors.initials: D
authors.lastname: Lagrave
mesh_terms: D003376:Counseling; D005817:Genetic Counseling; D005820:Genetic Testing / Q000191:economics / Q000592:standards; D017048:Health Care Costs; D006801:Humans; D007753:Laboratories / Q000592:standards; D011785:Quality Assurance, Health Care; D057188:Workflow
keywords: genetic counselors; health care costs; misordered tests; molecular genetic testing; test order review