Elsevier

Clinica Chimica Acta

Volume 427, 1 January 2014, Pages 127-130
Clinica Chimica Acta

Establishing benchmarks and metrics for utilization management

https://doi.org/10.1016/j.cca.2013.09.037Get rights and content

Abstract

The changing environment of healthcare reimbursement is rapidly leading to a renewed appreciation of the importance of utilization management in the clinical laboratory. The process of benchmarking of laboratory operations is well established for comparing organizational performance to other hospitals (peers) and for trending data over time through internal benchmarks. However, there are relatively few resources available to assist organizations in benchmarking for laboratory utilization management. This article will review the topic of laboratory benchmarking with a focus on the available literature and services to assist in managing physician requests for laboratory testing.

Introduction

As a result of the changing healthcare environment, many clinical laboratories are designing quality improvement initiatives and identifying cost reduction strategies. One common target which not only reduces healthcare costs but also improves laboratory processes and patient care is utilization management of laboratory testing. Strategies for utilization management are discussed in detail in other chapters (e.g. redesign of requisitions, changing standing orders, provider order entry and clinical decision support, physician profiling, educational initiatives, implementing admission templates, eliminating obsolete tests and instituting testing algorithms) [1], [2], [3], [4], [5], [6], [7].

Benchmarking is one tool that is frequently utilized to assess clinical laboratory performance and to inform quality improvement initiatives such as utilization management [8], [9]. In the clinical laboratory benchmarking has historically been utilized for performance indicators such as productivity, assessing testing costs and determining the appropriate staffing mix. Benchmarking for financial and operational targets such as utilization management also exists [10]. Benchmarking data can drive process improvement and assist laboratories to compare their performance to an explicit standard, either locally or nationally [11], [12], [13]. As laboratories strive to identify best practices and set appropriate targets for utilization management, benchmarking data can be invaluable. It can also be an impetus to engage colleagues in decision-making surrounding utilization management and to demonstrate the value of the laboratory [6], [9], [11], [12], [13]. In conjunction with utilizing benchmarking tools, laboratories need to define appropriate internal metrics to assess the success of utilization management strategies and to identify future opportunities [14].

A survey by Chi Solutions in 2006 showed that 56.5% of hospital clinical laboratories utilize benchmarking to some extent [9]. Of the 56.5%, 11.8% utilize internal benchmarking and 32.9% use subscription services such as Chi Solutions. The remaining 55.3% submit and receive data as a part of their internal hospital-wide benchmarking program. This chapter will discuss available external and internal benchmarking tools for utilization management as well as their advantages and disadvantages. The development of metrics to measure success will also be reviewed.

Section snippets

External benchmarking

Many clinical laboratories choose to use external sources including subscription services, laboratory professional organizations and/or shared peer data for establishing benchmarks for utilization management. External benchmarking can be a valuable resource, but potential limitations of the data should be understood. Before participating in external benchmarking and determining which source to utilize, laboratories should determine what they hope to gain and how they will utilize the results

Internal benchmarking

Internal benchmarking for utilization management involves comparing a clinical laboratories utilization patterns to its own past or present performance. There are several different approaches. Utilization across the entire institution can be determined, which may be helpful for monitoring global utilization patterns such as the use of reference laboratories. However, more specific and detailed comparisons are usually more informative. For example, test utilization between or within departments

Metrics

The metrics utilized to monitor test utilization should be determined prior to analysis, be consistent with national standards and be examined over time. Before choosing a metric, laboratories should consider the potential difficulty of the data collection process. If metrics are too complex or time-consuming to gather, they will not be consistently measured and the laboratory will not reap the benefits of benchmarking [8]. It is ideal if data can be gathered electronically to simplify the data

Conclusions

The utility of laboratory tests for the diagnosis and management of disease is constantly changing. Clinical laboratories should take an active role in controlling test utilization and in leading a utilization management program [4]. Internal and external benchmarking data can be useful in this endeavor. Each approach has its benefits and limitations and ideally should be used in combination and tailored to individual utilization strategies. Unfortunately, there are not many resources for

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