[ dxtrending ] The Value of Diagnostics STAKEHOLDERS HIGHLIGHT BENEFITS OF IMPROVED HEALTHCARE AT REDUCED COSTS Roundtable moderated by Steve Halasey T he clinical laboratory community has long recognized the need to provide payors and policymakers with a clear understanding of the value of diagnostic testing. But mov- ing that task from the ‘to do’ to the ‘done’ column has proven to be more difficult than those outside the community could ever imagine, and experts acknowledge that the need to demonstrate the value of diagnostics is as strong today as it ever was. To find out more about how their makers and users view the value of diagnostics—and how changing views are affecting the adoption and use of such tests—CLP recently spoke with a number of experts in the field (see sidebar, page 13). Below is a small portion of the resulting conversation, for which the full-length version can be found on the CLP Web site at http://tinyurl.com/hyc5co6. CLP: How do varied stakeholders related to the clinical laboratory community define the value of diagnostics? Franz Walt: We certainly do have a variety of stakeholders—including patients, physicians, laboratorians all the way up to the C-suite deci- sionmakers, payors, and regulators—and ‘value’ means different things to each group. For patients, value certainly resides in fast tests that provide accurate diagnoses. For phy- sicians, fast turnaround time and accuracy are important, but they also want to have access to an attractive menu of assays that are relevant to their practice area. For the decisionmakers in the central lab, there is high value in being able to provide their custom- ers relevant clinical information in a very cost- efficient manner. In addition, laboratorians all over the world tell us they would like to feel more in control. They would like to have a simplified oper- ation. And they would like to be able to optimize patient outcomes as well as their business. For payors and regulators, key value metrics include a test’s ability to reduce healthcare costs, 12 March 2016 | clpmag.com maximize accountable care, and—especially for regulators—protect public safety. Rob Jenison: Approaching this question more from a point-of-care (POC) perspective, the issues are quite similar. Clinicians and patients are the key stakeholders, and for both groups the accuracy of a test is of vital importance. Another objective of importance to clinicians and patients is to have tests that can drive appro- priate treatment and patient management within an actionable time frame. The laboratorians who serve as POC coordina- tors are not unlike central laboratory staff. They want their tests to be accurate and easy to perform, with very few hands-on steps, and they want to have a good workflow. Turnaround time is also important, as a way to get the test results back to physicians quickly. Payors and purchasing organizations naturally look at the upfront purchase costs of both instru- ments and consumables, but we’re beginning to see them also look at the versatility and cost-benefit profiles of the tests they are planning to adopt. As tests evolve, increased accuracy and reduced turn- around times result in lower hospital costs. Chris Bird: Lab professionals understand the value of diagnostics because they’re right in the thick of it every day. They see the effects that diag- nostics have on managing patients—helping to determine whether a patient can be released from the emergency department or must be sent to the catheterization lab for treatment, or providing a diagnosis that can result in the patient having or not having a drug. However, there may be something of a dis- connect between clinical laboratories and the decisionmaking executives in the C suite, who are charged with looking out for the total continuum of patient care. To get a seat at that table, laboratory medicine needs to have stronger communications on behalf of its interests, including the value of diagnostics and the roles that diagnostics play in clinical deci- sionmaking. It is believed that diagnostic testing represents just 2% to 3% of all healthcare spending, but influences 60% to 70% of medical decisionmak- ing. So the gist of this is that there’s very little spent on diagnostics, but the amount that is spent has significant influence on how decisions are made clinically. CLP: Brian, in your experience are those num- bers about right—a 2% to 3% spend influenc- ing 60% to 70% of medical decisionmaking? Brian Jackson: The spend side is the more reliable number, but I would estimate that the actual figure is closer to 3% to 5%. Nevertheless, I’m personally convinced that the clinical impact of diagnostic testing is disproportionately high in relation to its cost side. I am a firm believer that getting the upstream steps right is critical to optimizing both the quality and efficiency of healthcare. But I don’t know how you would ever set up a study to quantify those relationships. CLP: Peter, how does the equation for defin- ing the value of diagnostics change when the different stakeholders involved with POC diag- nostics are considered? Peter Koerte: The POC environment does have many stakeholders, but I would highlight just four, beginning with the patients themselves. POC test- ing enables patients to get the results of their tests right away, which is a major factor in increasing patient satisfaction. The second group I would highlight is physi- cians—and especially those in emergency depart- ments—who may need to triage patients and make quick decisions about a course of treatment. For this group, the value of POC tests derives from their fast turnaround time, which makes possible