Inpatient Screening Tests
For the calendar year 1999, all inpatient hospitalizations at Saint Joseph Health Center were reviewed according to diagnostic category across all medical, surgical, pediatric, and obstetric admission categories. All inpatient admissions were reviewed over the 12 month period. In each case, the laboratory testing associated with each admission was reviewed on a case by case and not clinician by clinician basis. It was found that between 5% and 40% of all inpatient admissions, for a variety of diagnoses, were found to contain at least one screening test as a part of the diagnostic evaluation. The fewest number of screening tests were ordered in obstetric admissions (5%) and the largest (40%) in general medical admissions. Tests most commonly ordered included TSH, T3, T4, Free T4, and T3 Resin Uptake, CEA (Carcinoembryonic Antigen), Pap Smear, Lipid studies, Cholesterol testing, and Prostate Specific Antigen levels. In nearly every case, the screening test was ordered, not as a course in the primary evaluation, but rather as a matter of a more complete evaluation of the patient’s complete health status.
In general, these inpatient admissions represented a fixed reimbursement to the hospital and were not reimbursed on an item by item basis. This meant that any screening testing ordered represented a deduction against the fixed reimbursement, which was usually not necessary in the patient evaluation.
Approximately 4,000 screening tests were ordered over the 12 month period. Making the assumption that approximately 80% of these could be eliminated, the proposed savings to the health center was in the range of approximately $100,000.
It is of note that, by far and away, the most common screening tests ordered were the TSH and the subsequent thyroid testing evaluation. It should be noted that, in general, for a thyroid evaluation only a TSH and a T4 are required. This evaluation in general can be undertaken on an outpatient basis and not in the inpatient setting. The second most common category of screening tests ordered was that for lipids and cholesterol testing. Other notable screening tests were that of Pap smears, CEA and PSA. These three potential tumor evaluations are again best left for the outpatient setting.
A program has been undertaken at Saint Joseph Health Center to eliminate the utilization of these screening tests which has shown significant success early on. The goal is to provide the screening testing in the outpatient setting where it is appropriately reimbursed and not in the inpatient setting. Results of this ongoing program are currently being evaluated and reviewed.