Provider Demographics 2017 (N = 105, 48 % response rate)

Transcription

1 Provider Demographics 2017 (N = 105, 48 % response rate)

2 Provider Attitudes 2016 Provider Attitudes 2017

3 Summary points from provider attitudes The program intent is being met (>90% of provider attitudes are positive). Compared to 2016, 20% more providers feel either neutral or negatively about incorporating cost into test selection process. This response aligns with our approach to stress testing rationale and necessity, and not just cost. There was no change in the feeling toward the information provided for order modifications.

4 Should the result notification process be reinstated? Situation: Given the enhancements to CIS Message Center, Laboratory Medicine has recently removed the Outlook result notification process for the subset of tests which meet our case review criteria for follow-up (e.g. genetic send-out tests). Background: The result notification process was instituted in 2014 due to concern regarding failure to retrieve results, especially those with long turnaround times. Since then, Children s has implemented the standardized use of CIS Message Center for result notification. Meanwhile, the volume of testing sent out has increased beyond our team s capacity to provide timely notifications. Assessment: In a recent survey of care providers, we asked about removal of the result notification process. Over 70% of respondents (n=105) either said the process did not need to be reinstated or they did not have an opinion. Recommendation: We have discontinued the result notification for genetic send-out tests, and providers should rely on CIS Message Center for notification. We will continue to monitor result retrieval rates and reassess in the future.

5 Providers report minimal testing delays as a result of the case review process % more providers never experienced a delay. 5% fewer providers experienced one delay.

6 Preauthorization Process 2016 Preauthorization Process 2017

7 Summary points for preauthorization process There was a 4% increase in provider attitudes towards the new preauthorization process which includes CIS communication order and lab genetic counselor support. There was a 13% increase in provider attitudes related to communication from IPD regarding the outcome of the preauthorization. There was no change in the (overall positive) attitudes towards the lab genetic counselors clarification requests. There was no change in the (overall positive) attitudes towards the information provided for the insurance preauthorization process.

8 Generally, providers do not feel that the case review process is obstructive % more providers do not feel that the process is obstructive.

9 Attitudes towards the policy on limiting genetic testing in the inpatient setting. N = 102 There have been recent changes to the Preauthorization Policy of Genetic Test Requests related to genetic testing in the inpatient setting: "Genetic testing will only be coordinated in the inpatient setting in rare, exceptional cases. Requests will be considered when the patient is not expected to be discharged anytime soon, there is a reasonable expectation that results will return prior to discharge, and/or results could impact management during the inpatient admission. Testing requested with the sole purpose to prevent possible loss of follow-up does not apply." In your opinion, this policy is (choose all that apply):

10 Representative positive comments 2017 I think all providers should view the UM process as a partnership between the clinician and the lab with the goals of improving patient care and decreasing cost. It should not be viewed as an adversarial relationship, which has been a problem for some of my colleagues. I deeply appreciate the assistance I have gotten from the lab GCs. It has made a difference in the documentation that I now include in my notes, and they have helped me ensure that I am ordering testing appropriately and in a cost-effective manner (i.e.-reflex). Thank you! These are great and very welcome programs. I can't tell you how much I appreciate the assistance of both the genetic counselors and the preauthorization folks! I have been extremely happy with my interactions with UM, and find the information they provide to be very helpful to clinical practice.

11 Representative constructive comments 2017 It is unfortunate that test ordering needs to be placed on hold for several weeks after DNA banking due to a CMS policy. This delays testing and clinical care more than the insurance pre-approval process. I do wonder if Genetics can request to either have certain testing reviewed or exempt, based on the providers comfort level with the testing request. Input is appreciated and even required on some testing, yet there are other more routine cases that most likely should skip the UM process as the testing is straightforward and the review could be considered a waste of resources. The increasingly common requirement that Genetics Counseling be undertaken before pre-authorization for DNA or related testing occurs is a pain in the neck, and yet another loophole/burden that limits efficient care. Some providers feel like the UM process is dictating how they do their jobs. I know that it is not the intent of the program, but some interactions have left those providers feeling defensive about their clinical judgment. Perhaps a different communication style could be beneficial.