Formularies Might be Coming to a Lab Near You
We are all familiar with the concept of generic versus brand name for medication. Once a pharmaceutical manufacturer loses its patent exclusivity to make and sell a drug (at an inflated price, usually), other manufacturers can make the same drug. Competition drives down the price and consumers benefit from getting a certain medication of the same efficacy at a price less than the brand name drug.
Many hospitals, physicians, HMOs and insurance company strongly advocate the use of generics over brand name wherever available. The cost savings for a payer can be significant. Another cost-saving measure adopted by many hospitals is the development of a formulary- a set of drugs carried by the pharmacy and available for use. Carrying only a finite inventory saves money. But there is a more convincing reason for the use of formularies: best practices often dictate the use of certain medications for certain conditions.
Physicians who want to prescribe medications not included on the hospital formulary have to provide justification (usually to pharmacy or a medical staff committee). Sometimes that application is approved and sometimes it is not. It is very difficult to imagine a cogent argument against such restrictions; especially if related to best practices for treating certain diseases.
Well, if you think about it a laboratory's menu is sort of a formulary as well. As laboratory utilization becomes more of an issue with payers like Medicare, laboratorians will be forced to look more at the tests which are offered on their menu and even whether physicians have carte blanche in getting every single test they order.
Labs have largely sidestepped the issue of limiting test availability by continuing to order archaic tests based on physician preference, or sending a test off to a reference lab when an in-house test would have provided the same (or superior) information.
In the same way that pharmacists have worked with physicians and formulated P&T (pharmacy and therapeutic) committees, laboratorians need to go down that road as well. Physicians realize that pharmacists are the experts on medication use. Laboratorians need to step up to the plate and educate physicians about removing archaic tests, limiting certain tests to once per hospital stay and limiting the frequency of even simple tests like BMP. Physicians should be encouraged to order the single tests they need rather than a model. For example, maybe a physician is only interested in a creatinine or potassium, but he has been "spoiled" in being allowed to order a BMP daily, or even twice a day.
Utilization management is not only about costs, it is also about best practices and better patient care. What steps have your laboratory taken regarding laboratory utilization management?