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ASCP Mantra for the Choosing Wisely Campaign: Right Test, Right Patient, Right Time, Right Cost

Wednesday, February 13, 2013

Great medical societies think alike. That was the conclusion of Lee H. Hilborne, MD, MPH, FASCP, DLM(ASCP)CM, when he realized that ASCP and the American Academy of Ophthalmology both came up with similar recommendations that healthy patients should avoid preoperative testing for low-risk surgeries without a clinical indication.

“Whether healthy patients are having minor surgery for a bunion or laser surgery to correct their vision, they do not generally need a set of blood chemistries ordered before the surgery,” says Dr. Hilborne, 2011–2012 Chair of the ASCP Institute Advisory Committee and former ASCP President. “These tests are not necessary for healthy patients and waste the finite resources of the U.S. health system.”

ASCP and the American Academy of Ophthalmology are two of the 17 medical societies that today each announced five tests and procedures that physicians and patients should question as part of the ABIM Foundation’s Choosing Wisely campaign, which aims to spark conversations between patients and physicians about what care is really necessary. The ASCP Institute Advisory Committee spearheaded the review panel of ASCP experts in pathology and laboratory medicine who evaluated hundreds of options based on both the practice of pathology and evidence available through an extensive review of the literature.

For example, magnify the cost of patients’ preoperative testing by 34.7 million ambulatory surgery visits annually in the United States, according to the latest National Health Statistics Report. If 25 percent of these surgeries are low risk and 50 percent of the patients undergoing these surgeries are healthy, the reduction in cost would still be enormous. Just as important, pathologists and laboratory professionals know that some healthy people will have abnormal laboratory values purely because of the statistical way for how reference intervals are defined. An abnormal value may result in unwarranted procedural delays or unnecessary further clinical investigation.

Currently, U.S. healthcare delivery contains practices that may provide little, if any, benefits to patients. According to a recent report from the Institute of Medicine, as much as 30 percent of U.S. health care is duplicative or inappropriate. When healthcare resources are wasted, it threatens the nation’s ability to deliver the highest quality of care possible to all patients.

“Measuring outcomes is essential in the fast-approaching evolution of health care that is underscored by the axiom ‘right test, right patient, right time at the right cost,’ ” says Dr. E. Blair Holladay, ASCP Executive Vice President.

ASCP’s list identified the following four other recommendations:

  • Do not perform population-based screening for 25-OH-Vitamin D deficiency.

  • Do not perform low-risk human papillomavirus (HPV) testing.

  • Only order Methylated Septin 9 (SEPT9) on patients for whom conventional diagnostics are not possible.

  • Do not use bleeding time tests to guide patient care.

To read articles about ASCP’s five tests in the American Journal of Clinical Pathology and Critical Valuesclick here.