Genetic Lab Stewardship Committee

The Intermountain Genetic Laboratory Stewardship Committee operates under the Intermountain Hospital Laboratory Stewardship Committee and is composed of individuals from across the healthcare system including send-outs laboratory, genetic counseling, pathology, physicians, and billing. This committee meets monthly to address issues related to genetic testing across the Intermountain system. If you have a topic to propose to the committee, please submit an email to LabGC@imail.org.

Send-Out Test Review

Studies have shown that a significant proportion of genetic tests are misordered and that review by a genetics expert (such as a genetic counselor) can correct many of these misorders. Active genetic laboratory stewardship is important to reduce risks to patients, providers, and the hospital system from inappropriate send-out test orders. Genetic testing processed through Intermountain hospital send-out labs undergoes a review by the Intermountain laboratory genetic counselors in accordance with Intermountain Genetic Testing Guidelines.

This process, first initiated in 2015 at Primary Children’s Medical Center, is currently being introduced and implemented within hospital send out departments across the system. The laboratory genetic counselors work closely with the send-outs laboratory staff to review orders for genetic testing prior to shipment of the sample to a reference lab. If the team has any questions after reviewing the order and the patient’s chart, they will contact the ordering provider via email or phone to discuss the case. If you have questions about ordering genetic testing, please contact LabGC@imail.org.

Genetic Laboratory Stewardship Literature

Wakefield E, Keller H, Mianzo H, Nagaraj CB, Tawde S, Ulm E. Reduction of Health Care Costs and Improved Appropriateness of Incoming Test Orders: the Impact of Genetic Counselor Review in an Academic Genetic Testing Laboratory. J Genet Couns. 2018;27(5):1067-1073. https://pubmed.ncbi.nlm.nih.gov/29427196/

  • Genetic counselors reviewed orders for molecular diagnostic laboratory for 6 months. 109/2367 (4.6%) orders flagged for review and 96% of those reviewed were modified resulting in a cost savings of $98,750.64.
  • "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."

Miller CE, Krautscheid P, Baldwin EE, et al. Genetic counselor review of genetic test orders in a reference laboratory reduces unnecessary testing. Am J Med Genet A. 2014;164A(5):1094-1101. https://pubmed.ncbi.nlm.nih.gov/24665052/

  • Genetic counselor review of test orders at an academic laboratory over 21 month period; resulted in 26% of germline cases being modified; $48,000 overall client savings per month.
  • "GC review of genetic test orders for appropriateness and clinical utility reduces healthcare costs to hospitals, insurers, and patients."

Montanez, K., et al. Genetic testing costs and compliance with clinical best practices. J Genet Couns. 2020;00:1-6. https://pubmed.ncbi.nlm.nih.gov/32356909/

  • Retrospective chart review of genetic test orders with comparison to published ACOG recommendations; review performed by a genetic counselor
  • 38.6% (44/114) of tests misordered in 3 months, resulting in $20,912 excess cost
    • 21% not indicated; 7% false reassurance; 10.5% inadequate

Haidle JL, Sternen DL, Dickerson JA, et al. Genetic counselors save costs across the genetic testing spectrum. Am J Manag Care. 2017;23(10 Spec No.):SP428-SP430. https://www.ajmc.com/view/genetic-counselors-save-costs-across-the-genetic-testing-spectrum

  • Data from NSGC Test Utilization Subcommittee
  • 6/8 inappropriate BRCA orders in one clinic
  • 57 months of send-outs review at Seattle Children's Hospital resulted in 32% test modification rate and $972,000 total cost savings
  • 1 year of send-out review at Regions Hospital/HealthPartners resulted in 13.5% test modification/cancellation rate and $236,000 in cost savings
  • 14 month review of BRCA1/2 orders by non-GCs at LabCorp resulted in 54% test modification rate and $148,000 in client cost savings
  • Review of BRCA1/2 testing requests by insurance group eviCore identified that 14.6% of cases did not meet NCCN/USPSTF criteria; overall 22.1% of all genetic tests were inappropriate

Mathias PC, Conta JH, Konnick EQ, et al. Preventing Genetic Testing Order Errors With a Laboratory Utilization Management Program. Am J Clin Pathol. 2016;146(2):221-226. https://pubmed.ncbi.nlm.nih.gov/27473740/

  • 2.5 years review of genetic test orders at pediatric tertiary care medical center; 33% modified/cancelled
  • Orders from non-genetics providers had a significantly higher error rate than orders from genetics providers
  • Inpatient orders significantly more likely to have errors than outpatient orders (modification for inpt orders was almost double the rate for outpt)

Suarez CJ, Yu L, Downs N, Costa HA, Stevenson DA. Promoting appropriate genetic testing: the impact of a combined test review and consultative service. Genet Med. 2017;19(9):1049-1054. https://pubmed.ncbi.nlm.nih.gov/28125079/

  • Genetic testing misorders (clerical errors, redundant testing, better alternatives, controversial, other) reduced from 22% to 3% with UM program combined with consultative service.
  • GC performed initial review, questions directed to molecular pathologist and/or medical geneticist.

Riley JD, Procop GW, Kottke-Marchant K, Wyllie R, Lacbawan FL. Improving Molecular Genetic Test Utilization through Order Restriction, Test Review, and Guidance. J Mol Diagn. 2015;17(3):225-229. https://pubmed.ncbi.nlm.nih.gov/25732008/

  • Combination approach of restricting the ordering of 273 genetic tests (inpatient and outpatient) combined with GC review of genetic test orders (GC questions sent to molecular genetic pathologist)
  • Saved $1.5 mill in 27 months (average savings of $2,243 per case); Sept 2011 through Dec 2013
  • "Most important, these UM initiatives provided evidence of improved utilization of genetic and genomic testing, in support of good patient care."

Dickerson JA, Cole B, Conta JH, et al. Improving the value of costly genetic reference laboratory testing with active utilization management. Arch Pathol Lab Med. 2014;138(1):110-113. https://pubmed.ncbi.nlm.nih.gov/24377818/

  • Risks of send out testing: increased number of handoffs, ordering wrong or unnecessary test, specimen delays, data entry errors, preventable delays in reporting and acknowledging results, excess financial liability
  • Test orders reviewed by rotating team of doctoral-level consultants and genetic counselor
  • $118,952 saved ($463 per case) in an eight-month period; Almost 1/4 of tests modified; savings passed on mostly to patients