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Utilization Management 2013: A practical approach for pathology and clinical laboratory test utilization

Utilization Management 2013

A practical approach for pathology and clinical laboratory test utilization

October 8, 2013
The Loews Atlanta Hotel
Atlanta, Georgia

Conference Description

In this time of decreasing reimbursement and demand for standardization across health care practices, the laboratory can play an essential leadership role in directing cost-effective and appropriate lab testing to ensure the continued delivery of high-quality care to the patient and prevent commoditization of the laboratory. The speakers at this course possess firsthand knowledge in developing and implementing laboratory test utilization management solutions in diverse practice settings. Following this conference, attendees will have clear insight on how to begin or advance utilization management efforts in their own laboratories.

Conference Objectives

Upon completion of the conference, participants should be able to:

  • Determine how the clinician, laboratory and pathologist can work together to build a utilization control program
  • Identify tools and strategies that may be useful in both evaluating and controlling test utilization
  • Analyze the causes behind inappropriate utilization of laboratory tests
  • Recognize the value of utilization management to both in-patient and out-patient populations
  • Communicate the value of utilization management as an outreach program offering with key stakeholders
  • Develop and implement utilization support and processes for outreach clients

Intended Audience

  • Chief medical officers
  • Hospital leadership
  • Pathologists
  • Physicians
  • Scientists


Attendance at this Mayo conference does not indicate nor guarantee competence or proficiency in the performance of any procedures that may be discussed or taught in this course.

Conference Agenda

Pre-Conference Check-in/Registration
Monday, October 7, 2013
5:30-6:30 PM
Mercer Ballroom, 14th floor

Tuesday, October 8, 2013

6:45-7:45 AM Breakfast and Registration – Mercer Ballroom, 14th floor

7:45-8:00 AM Introduction/Overview
Don Flott

8:00-8:45 AM The Role of Pathology in Utilization Management — Getting to the Table
James Hernandez, MD

The conference kicks-off with a practical discussion by Jim Hernandez, M.D. from Mayo Clinic in Arizona. He will discuss how pathologists and laboratory leaders can identify and overcome roadblocks in their practices in order to position themselves as champions for effective laboratory test utilization.

8:45-9:30 AM Getting to the Right Test (formulary)
Curt Hanson, MD

Optimizing laboratory test utilization is an approach for performing appropriate laboratory and pathology testing with the goal of providing high quality, cost-effective patient care. A well-designed test formulary can be an essential component of a test utilization program and can serve as a valuable tool for guiding and focusing test ordering. Curt Hanson, M.D. will discuss the essential components of a test formulary and offer approaches for creating a customized formulary that will meet the needs of the laboratory and clinical teams. A portion of the talk will focus on the issues associated with genetic testing.

9:30-10:15 AM Getting to the Right Discharge Number
Brad Karon, MD, PhD

Brad Karon, MD, PhD, will discuss the obstacles to addressing inpatient test utilization, including: the medical culture which teaches repetitive testing for hospital inpatients; the creation of order sets and standing orders by clinical services generally without laboratory input; and the evolution of electronic ordering systems which often support individualized order preference buttons for provider convenience. Effective intervention strategies that the laboratory can employ to address excess test ordering on hospitalized patients will then be presented. Essential institutional partnerships necessary for implementing effective interventions will also be discussed.

10:15-10:30 AM Break

10:30-11:15 AM Algorithms and Cascade Tests in the Clinical Laboratory
Bobbi Pritt, MD

Providers are faced with an increasingly diverse and complex menu of testing options from the clinical laboratory. Too commonly, a gap exists between what the ordering provider knows and the information needed to appropriately use lab assays. The laboratory has the expertise to guide appropriate test ordering, and can provide invaluable algorithms and cascades to bridge the clinician knowledge gap, facilitate appropriate testing, and direct additional testing based on initial testing results. Bobbi Pritt, MD will use several real-life examples to demonstrate algorithms and cascades can result in decreased unnecessary testing, significant cost savings, and improved patient care.

11:15 AM-12:15 PM Blood Management
James Stubbs, MD

Appropriate blood management is a key component of a laboratory utilization management program. James Stubbs, M.D. will discuss how a robust utilization program can provide cost effective and patient-centered care, when services and products are provided based on factors such as relevant laboratory values and clinical presentation.

12:15-1:00 PM Lunch

1:00-2:00 PM Value of Genetic Counselors in Utilization Management
Mike Astion, MD, PhD

Genetic counselors and doctoral level laboratory staff can improve the value (which is equal to quality/cost) of genetic testing to the patient. Genetic testing presents unique challenges to the value equation because the tests are expensive, insurance coverage is inconsistent, and knowledge of the appropriate tests to use is lacking in care providers, especially those who are not medical geneticists. The problem of choosing the right test is exacerbated by the growth in the genetic test menu, the change in testing technologies, and the variability in the testing panels offered for the same clinical entity. This session discusses how to use genetic counselors and doctoral level laboratory staff to create a utilization management system for genetic testing. The system, which uses policies and procedures created by the genetic counselors and laboratory doctors, is based on flagging genetic test orders and actively managing them in collaboration with the ordering providers. The result is cost savings to the hospital and increased value to patients.

2:00-2:45 PM Pathologist-Driven Algorithms and Guidelines
Curt Hanson, MD

Clinical knowledge is incomplete at the time of ordering. The clinician may therefore have a large differential diagnosis and feels compelled to order multiple tests upfront as it may be the only chance to get that information. However, pathologist review of initial test results or biopsy findings can quickly narrow a differential diagnosis and greatly reduce the number of necessary tests. Curt Hanson, MD will share successful pathologist-driven algorithms and guidelines that have significant impact on improving patient care, decreasing unnecessary testing, and lowering the cost of health care.

2:45-3:00 PM Break

3:00-3:45 PM Value of Utilization Management to Outreach
Bobbi Pritt, MD

Outreach services offer important opportunities for labs to reinvest in local health care, improve the continuity of patient care and increase their revenue. However, labs need to be aware of what the clinical practices need; there are increasing pressures to limit volume, intensity and frequency of testing, and therefore utilization management is an essential component of an outreach program. This session will discuss the value of utilization management to a successful outreach program and how Pathologists and Medical Directors can partner with outreach clients to lead outreach utilization efforts.

3:45-4:45 PM Value of Utilization Management to Payors
Mike Snyder

Nationally, health insurance plans generally perceive laboratory services as a mid-value, low-priced commodity. At the same time, the insurers want to assure the appropriate use of testing (right test, right patient, right time) for their insured members without adding new barriers and cost to the physician’s workflow. Utilization management processes represent an opportunity for hospital laboratories and payors to collaborate to assure proper patient care and to increase the value for diagnostic services.

At the end of this session participants will understand the value of utilization management with respect to the payor relationship. Besides the obvious cost benefit to the payor, utilization management processes can be the impetus for value-based reimbursement for diagnostic services.

4:45-5:00 PM Closing Remarks
Don Flott


Curtis Hanson, MD Curtis Hanson, MD — Course Director
Consultant, Division of Hematopathology
Department of Laboratory Medicine and Pathology
Professor of Laboratory Medicine and Pathology
College of Medicine, Mayo Clinic, Rochester, MN

Curt Hanson, M.D. is an internationally recognized hematopathologist who is a Professor of Laboratory Medicine and Pathology at Mayo Clinic in Rochester, Minn. He received his pathology training at the University of Minnesota and subsequently did his hematopathology fellowship and research there under the tutelage of Dr. Richard Brunning and Dr. John Kersey. Dr. Hanson then became a tenured faculty in Hematopathology at the University of Michigan before moving to Mayo Clinic in 1993.

Dr. Hanson has authored more than 200 articles and book chapters and has had a long-term interest in laboratory management and bone marrow pathology with emphasis on translational research related to the study and understanding of hematologic disease. He is also the former chair of the Department of Laboratory Medicine and Pathology at Mayo Clinic.

Bobbi Pritt, MD Bobbi S. Pritt, MD — Course Director
Consultant, Division of Clinical Microbiology
Department of Laboratory Medicine and Pathology
Associate Professor of Laboratory Medicine and Pathology
College of Medicine, Mayo Clinic, Rochester, MN

Bobbi Pritt, M.D. is the Medical Director of the Clinical Parasitology and Microbiology Initial Processing laboratories and Program Director of the MD Medical Microbiology Fellowship Program at Mayo Clinic in Rochester, Minn. She completed medical school and a five-year residency in Anatomic and Clinical Pathology at the University of Vermont followed by a one-year fellowship in Medical Microbiology at Mayo Clinic. She then obtained a Master’s Degree in Medical Parasitology at the London School of Hygiene and a Diploma of Tropical Medicine from the Royal College of Physicians in London. Dr. Pritt’s special areas of interest are clinical parasitology, molecular diagnostics, trainee education, and optimal test utilization.

Don Flott Don Flott – Course Director
Director of Learning and Development and Marketing Education
Mayo Collaborative Services, LLC., Rochester, MN

Don Flott has served in in various administrative roles at Mayo Clinic for 25 years. Currently Don is providing administrative support to a group of physicians and scientists charged with leading a number of laboratory test utilization initiatives enterprise wide and for Mayo Medical Laboratories.

Mike Astion, MD, PhD Mike Astion, MD, PhD
Division Chief, Laboratory Medicine
Seattle Children’s Hospital
Seattle, WA

Mike Astion, MD, PhD is a clinical pathologist who is Division Chief of Laboratory Medicine at Seattle Children’s Hospital and Clinical Professor of Laboratory Medicine at the University of Washington. For almost two decades he worked at the University of Washington, Department of Laboratory Medicine where he was a Professor and Director of Reference Laboratory Services. His career is divided between clinical service, teaching, research and development. He has authored more than 20 software titles, 35 peer-reviewed papers, and 40 editorials. His software, which has been translated into several languages, includes both laboratory tutorials and competency assessment exams. These materials are now used by more than 40,000 clinical laboratory workers annually in 1,500 labs as part of the Medical Training Solutions laboratory training library.

Dr. Astion is the editor-in-chief of Patient Safety Focus, which appears quarterly within AACC’s Clinical Laboratory News. He is currently working actively, through grants and intellectual property held by the University of Washington, with the insurance industry in the United States to create utilization management rules for clinical laboratory testing. In addition, he is one of the founders of PLUGS, the Pediatric Laboratory Utilization Guidance Service, a unique service that helps pediatric hospitals and clinics actively increase the value of lab testing. Dr. Astion is a frequent speaker at professional meetings, where he lectures on issues related to laboratory test utilization; test interpretation; laboratory economics and outreach; medical errors / patient safety; medical informatics; and competency assessment. His previous awards include:

  • American Society for Clinical Laboratory Science Theriot Award for Excellence in Media, which he received twice for his educational software.
  • AACC Annual Award for Outstanding Contributions to Patient Safety (2006)
  • AACC Annual Award for Contributions to Management Science (2007)
  • Canadian Society of Clinical Chemistry Traveling Lectureship (2007)

A frequent winner of the AACC outstanding speaker award, Dr. Astion has been active in the AACC, including as a symposium organizer for the 2005 Annual Meeting Organizing Committee and as a previous head of the Patient Safety Taskforce.

James Hernandez, MD James Hernandez, MD
Medical Director and Chair, Division of Laboratory Medicine
Associate Professor of Laboratory Medicine and Pathology
Mayo Clinic in Arizona
Scottsdale and Phoenix, AZ

Jim Hernandez, MD, a native of Pueblo, Colorado, is board-certified in Anatomic and Clinical Pathology. Prior to joining the faculty of Mayo Clinic in 2001, he was in private community hospital practice in Minnesota in anatomic and clinical pathology from 1985 until 2001, where he was involved in starting a successful outreach laboratory.

Dr. Hernandez served as the Associate Medical Director for Mayo Medical Laboratories from 2001 to 2004. He is involved in the integration and standardization of the laboratories of Mayo Clinic. He also served as the Chairman of the Department of Laboratory Medicine's Clinical Practice Committee, which addresses lab utilization. He instituted a leadership and management program for residents and fellows at Mayo Clinic in 2003 to prepare them for their roles as future laboratory medical directors.

He has been the Medical Director of the laboratories and Chair of the Division of Laboratory Medicine at Mayo Clinic in Arizona since 2008.

Dr. Hernandez has served on the CAP Board of Governors since 2012 and he has served on several CAP committees.

Dr. Hernandez has a Bachelor of Science degree from the University of Notre Dame, a Medical Degree from the University of Colorado Health Sciences Center in Denver, and a Masters of Science in Preventive Medicine and Administrative Medicine from the University of Wisconsin-Madison, encompassing both MBA and MPH skills. He completed a residency in anatomic and clinical pathology at St. Luke’s Hospital in Denver, Colorado. He has a special interest in leadership, management, lab utilization, quality process improvements, safety and cost-effectiveness.

Dr. Hernandez has authored 30 peer reviewed publications and has a strong interest in mentoring students, residents and fellows in laboratory medicine and pathology. He is an Associate Professor of Laboratory Medicine and Pathology in the College of Medicine, Mayo Clinic.

He is the recipient of the 2010 Outstanding Contributions to Management Sciences and Patient Safety Award from the American Association for Clinical Chemistry.

Brad Karon, MD, PhD Brad Karon, MD, PhD
Consultant, Division of Clinical Core Laboratory Services
Department of Laboratory Medicine and Pathology
Associate Professor of Laboratory Medicine and Pathology
College of Medicine, Mayo Clinic, Rochester, MN

Brad Karon, M.D., Ph.D., is an Associate Professor of Laboratory Medicine and Pathology at Mayo Clinic in Rochester, Minn. He is medical director for the Hospital Clinical Laboratories and Point-of-Care Testing program at Mayo Clinic. Dr. Karon's main interests are in critical and point-of-care testing to support hospitalized patients. He previously served as chair of the AACC Critical and Point-of-Care Division, and member of the College of American Pathologist's Point-of-Care committee. Dr. Karon is also Vice-chair for Education in the Department of Laboratory Medicine and Pathology at Mayo Clinic, and holds other education leadership positions including Associate Program Director of the pathology residency program.

Mike Snyder Mike Snyder
Clinical Lab Business Solutions
Flemington, NJ

Michael Snyder is the Principal for Clinical Lab Business Solutions (CLBS), a consulting firm that engages with laboratories to deliver collaborative solutions to health plans and employer groups. Mike has 30 years of experience in the strategic development of clinical laboratories. Prior to forming CLBS, he was Vice President of Laboratory Networks for UnitedHealthcare (UHC). In that capacity, he directed the national strategy for laboratory services and participated in the development of UHC’s national provider network. Additionally, Mr. Snyder served as Director of Business Development for Mount Sinai Hospital’s Center for Clinical Laboratories, where he saw outreach revenues triple in the implementation of a business plan that focused efforts on billing solutions and demonstrated the value of the medical center’s laboratory to attending faculty. Finally, Mike also served as an executive with LabCorp (1980-2000), one of the largest commercial laboratories in the US. Mike is a frequent speaker on the subject of managed care contracting and the value of managed networks for laboratory services.

Mr. Snyder is a graduate of East Carolina University, located in Greenville, NC.

Mike Snyder James Stubbs, MD
Chair, Division of Transfusion Medicine
Assistant Professor of Laboratory Medicine and Pathology
College of Medicine, Mayo Clinic, Rochester, MN

James Stubbs, MD is currently the Chair of the Division of Transfusion Medicine at Mayo Clinic Rochester. He joined the Staff at Mayo Clinic Rochester in 2004 and assumed the position of Division Chair in 2006. He received his Medical Degree from the University of Minnesota in 1985. He received his specialty training in Clinical Pathology at Dartmouth-Hitchcock Medical Center and his subspecialty training in Blood Banking/Transfusion Medicine at the University of Minnesota. Prior to coming to Mayo Clinic, Dr. Stubbs worked at the University of South Alabama (USA) Hospitals and Clinics in various roles for 13 years. At the time he left USA in 2004, he was Professor of Pathology and Professor of Internal Medicine. He was Vice Chair of the Department of Pathology and Laboratory Medicine and Director of Clinical Laboratories for USA Hospitals and Clinics.

Dr. Stubbs has published many articles and book chapters on a wide array of subjects in Transfusion Medicine. With regard to extramural activities, he is on the Board of Directors for the American Board of Pathology and serves as the Chair of the American Board of Pathology’s Test Development and Advisory Committee for Transfusion Medicine. Dr. Stubbs is a member of the Pathology Residency Review Committee for the ACGME. He also chairs or serves on multiple committees and task forces for the AABB and is on the Blood Bank Test Committee for the American Society of Clinical Pathology’s Board of Certification.

Faculty Disclosure

As a provider accredited by ACCME, College of Medicine, Mayo Clinic (Mayo School of Continuous Professional Development) must ensure balance, independence, objectivity and scientific rigor in its educational activities. Course director(s), planning committee, faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty will also disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. Disclosure of this information will be published in course materials so those participants in the activity may formulate their own judgments regarding the presentation.


College of Medicine, Mayo Clinic, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

College of Medicine, Mayo Clinic, designates this live activity for a maximum of 7.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Mayo Medical Laboratories is approved as a provider of continuing education programs in the Clinical Laboratory Sciences by the ASCLS P.A.C.E.® Program. This program has been approved for 7.5 contact hours. Level of instruction for this program is intermediate.

Mayo Medical Laboratories is approved as a Continuing Education Accrediting Agency for Clinical Laboratory Science for State of California credit and State of Florida credit. This program has been approved for 7.5 contact hours. Level of instruction for this program is intermediate.


Registration is limited to the first 170 attendees, so please register soon to guarantee your attendance.

After registering, a letter of confirmation will be emailed to you with additional conference details.

Cancellation Policy

If you cancel your participation in this conference on or before September 9, 2013, your registration fee, less a $75 administrative fee, will be refunded. Mayo Medical Laboratories Education Department must receive written notification of your cancellation. No refunds will be made after September 9, 2013.

Mayo Medical Laboratories reserves the right to cancel or postpone any course due to unforeseen circumstances. In the unlikely event Mayo Medical Laboratories must cancel or postpone this course, Mayo Medical Laboratories will refund the registration fee, but is not responsible for any related costs, charges, or expenses to participants, including fees assessed by airline/travel/lodging agencies


Travel arrangements are the responsibility of the participant.

Lodging and Accommodations

Discounted rooms have been reserved for conference participants and guests at the Loews Atlanta Hotel. Make your reservation by August 20 to ensure availability and to receive the discounted rate. If making reservations by phone, please identify yourself as a participant of the Mayo Medical Laboratories conference. 

Loews Atlanta Hotel
1065 Peachtree Street NE
Atlanta, Georgia 30309
888-563-9736 or 404-745-5000
$167 + tax - single/double standard room

Recreation and Leisure Activities

Atlanta, Georgia is one of the South’s largest cities, with endless sightseeing, dining and shopping opportunities. Located in the heart of the city is Midtown, the geographic center of Atlanta located between Downtown and Buckhead. Midtown is home to major shopping malls, sightseeing opportunities and more than 100 restaurants and clubs. It offers something for everyone!

Attractions within walking distance of the Loews Atlanta Hotel:

Key Attractions in Atlanta: