Daniela Iacoboni

The importance of responsible test ordering practices

Daniela Iacoboni, MS, CGC, Invitae genetic counselor

In the increasingly diverse next-generation sequencing genetic testing marketplace, Test Utilization Management Service (UM) is an important trend that promises to rein in the overuse of tests. This collaborative effort by pathologists, lab directors, and genetic counselors seeks to establish policies and algorithms that ensure the right test—and only the right test—is ordered for each patient.

The UM concept is gaining momentum, particularly at a time when healthcare is shifting from a volume-based to a value-based model to improve care and reduce payer costs. While lab testing overall accounts for less than 10 percent of healthcare expenses, lab results drive two-thirds of major healthcare decisions, including admissions, discharge, and management.1 It’s easy to see why the UM concept has been adopted by major organizations, including the American Board of Internal Medicine and the American College of Physicians.

The concept is simple and the benefits more than pay for implementation costs. As an illustration of the power of a UM program, ARUP Laboratories found more than $1 million worth of genetic tests were mis-ordered over a 21-month period. In addition, approximately 26 percent of all requests for complex genetic tests were changed following expert review.2

It is an oversimplification to blame providers alone for test overuse, as there are multiple factors at play. Malpractice fears, financial incentives, marketing, and patient pressures all work in sync to drive up orders and costs. While UM is a logical and viable solution, it will take a unified effort and the appropriate tools to truly impact our medical system in a meaningful way.

Invitae has made substantial efforts to incorporate the UM philosophies into its core business model by:

Lowering costs and eliminating barriers — We offer all of our multi-gene panels for the same low price of $1500* regardless of the number of genes analyzed. Removing cost as a barrier allows providers to use their clinical judgment to select the most appropriate depth of analysis in any given situation.

Looking deeper with a free re-requisition — If clinicians don’t find the answers they’re looking for in the first genetic test, they can order a broader test panel related to the original indication at no additional charge within 90 days of receiving the first test result.** This gives clinicians the unique opportunity to start with a narrow scope where appropriate and to expand their search if necessary.

Backing you up with a team of genetics experts — Our team of genetic counselors can help guide clinicians, whether it’s by helping decide which tests to order or offering advice on how to communicate results with patients. Genetic counselors also assist in the clinical interpretations presented in the written report accompanying each test result.

To further support the UM movement, Invitae has recently joined Seattle Children’s Hospital’s Pediatric Laboratory Utilization Guidance Service (PLUGS). This group has been a leader in test utilization management, with members including Mayo Clinic, ARUP, and Children’s Hospital of Philadelphia, among more than two dozen others. This collaboration ties in closely with our mission to bring genetic information into routine medical practice, thereby improving the quality of healthcare for billions of people. Universal acceptance of the UM philosophy will make our vision a reality.

1 Forsman, RW, Clinical Chemistry. 1996; 42:813-816.
2 Rothwell, E, et al., American Journal of Medical Genetics Part A. 2012; 9999:1–8.

*U.S. contract pricing only, with appropriate clinical indication. Contact Client Services for more information.
**Re-requisition: Only genes available at the time of original order are eligible.