Advancing the Science

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January 8, 2020

Dropping ‘rarely abnormal’ blood tests could save $9 million per year, Mayo research finds

By Adam Harringa
A lab technician adds a vile of blood to a container.

Americans spent $3.6 trillion on health care in 2018 – that’s nearly 18 percent of the country’s gross domestic product, according to the Centers for Medicare and Medicaid Services (CMS). As legislators, insurers and health care institutions look for ways to curb costs, blood tests are often scrutinized to weed out the unneeded.

So cutting tests that potentially cost the U.S. $9 million annually and require no action 99% of the time is likely a good start.

Routine blood tests that are given the day after colon or rectal surgery turned up abnormal results 4% of the time. Furthermore, of those patients with abnormal results, only 1% warranted follow-up action, new research from Mayo Clinic has discovered. Based on these findings, Mayo has changed the way it orders the blood tests for its patients: Instead of it being automatic, now they’re only used in at-risk patients. The study published recently in the Annals of Surgery.

“The data confirmed our clinical experience that these labs are rarely abnormal,” says lead author Nicholas McKenna, M.D., a general surgery resident in the Mayo Clinic Department of Surgery. “Discontinuing these tests would save money that would otherwise be billed to the patient or insurance. It also saves the patient the pain and inconvenience of another blood test, often drawn during the night for inpatients.”

The research team studied 8,205 lab tests performed in 2015, 2016 and 2017 on the Rochester campus of Mayo Clinic the day after colorectal surgery. Of those, 308 tests (3.8%) were abnormal, and 58 (1%) warranted additional treatment based on the results. Based on CMS reimbursement, the total cost for those labs in the outpatient setting is about $64,000, according to the study. However, costs vary significantly for inpatient and outpatient services and based on the type of medical insurance, Dr. McKenna adds.

Extrapolating that figure based on the roughly 300,000 colorectal surgeries performed annually in the U.S. adds up to more than $9 million, the study finds. If medical institutions repeat the test daily or every other day, as is common, stopping or reducing the test could double or triple the savings, the researchers point out.

Traditionally, health care providers automatically order next day blood tests after colorectal surgery to monitor patient recovery. But new techniques have led to faster recovery over the last two decades, the researchers say, so it may be time to rethink some routine processes.

As a result of the team’s research, the Mayo Clinic Division of Colon and Rectal Surgery no longer orders these tests automatically. Rather, the health care team orders tests based on individual patient need, such as symptoms, medical history, or abnormal vital signs.

“Requiring providers to order labs specifically for patients as an ‘opt-in’ process will decrease the overall number of tests and increase the value of tests chosen for the particular patient,” Dr. McKenna says.

The research team is now developing tools to predict which patients could have abnormal lab results. They’re also studying standard blood tests ordered the day after other surgeries.

Dr. McKenna is a surgical outcomes research fellow in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

The study’s senior author is Robert Cima, M.D., a Mayo Clinic colon and rectal surgeon. Study co-authors are Elizabeth Habermann, Ph.D., Robert D. and Patricia E. Kern Scientific Director for Surgical Outcomes, and Amy Glasgow, who also is part of the Mayo Clinic Kern Center for the Science of Health Care Delivery. The center seeks to discover new ways to improve health; translate those discoveries into evidence-based, actionable treatments, processes and procedures; and apply this new knowledge to improve care for patients everywhere.

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Tags: blood test, Center for the Science of Health Care Delivery, Elizabeth Habermann, health care value, health sciences research, medical research, News, Nicholas McKenna, Robert Cima, surgery, surgical outcomes, value

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