title: Audit of Use and Overuse of Serum Protein Immunofixation Electrophoresis and Serum Free Light Chain Assay in Tertiary Health Care: A Case for Algorithmic Testing to Optimize Laboratory Utilization.
abstract: OBJECTIVE
  Overuse of laboratory tests is a persistent issue. We examined the use and overuse of serum immunofixation electrophoresis and serum free light chain assays to develop an algorithm for optimizing utilization.
  
  
  METHODS
  A retrospective review of all tests, for investigation of monoclonal gammopathies, for all patients who had any of these tests done from April 24, 2014, through July 25, 2014, was carried out. The test orders were categorized as warranted or not warranted according to criteria presented in the article.
  
  
  RESULTS
  A total of 237 patients were tested, and their historical records included 1,503 episodes of testing for one or more of serum protein electrophoresis, serum immunofixation electrophoresis, and serum free light chain assays. Only 46% of the serum immunofixation and 42% serum free light chain assays were warranted. Proper utilization, at our institution alone, would have obviated $64,182.95/year in health care costs, reduced laboratory cost of reagent alone by $26,436.04/year, and put $21,904.92/year of part B reimbursement at risk.
  
  
  CONCLUSIONS
  Fewer than half of the serum immunofixation and serum free light chain assays added value. The proposed algorithm for testing should improve utilization. Risk to part B billing may be a disincentive to reducing test utilization.
authors.affiliation: From the Department of Pathology, Division of Clinical Pathology, Georgia Regents University, Medical College of Georgia, Augusta.
authors.forename: Christopher
authors.initials: C
authors.lastname: Heaton
authors.affiliation: From the Department of Pathology, Division of Clinical Pathology, Georgia Regents University, Medical College of Georgia, Augusta.
authors.forename: Shikhar G
authors.initials: SG
authors.lastname: Vyas
authors.affiliation: From the Department of Pathology, Division of Clinical Pathology, Georgia Regents University, Medical College of Georgia, Augusta. gurmukhsinghmdphd@yahoo.com.
authors.forename: Gurmukh
authors.initials: G
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004586:Electrophoresis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood*; D008297:Male; D000069342:Medical Overuse / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D010265:Paraproteinemias / Q000175:diagnosis*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D007147:Immunoglobulin Light Chains
keywords: Algorithmic testing; Appropriateness of laboratory utilization; Laboratory cost of health care; Serum free light chain assay; Serum protein electrophoresis; Serum protein immunofixation electrophoresis