Utilization Review Optional Rotation

I have had the unique opportunity of being the first University of Pittsburgh student to complete an optional genetic counseling rotation block in the Utilization Review Program within the laboratory at Children’s Hospital of Pittsburgh. Essentially, the genetic counselors working in utilization review are a bridge between physicians requesting inpatient genetic testing, and the hospital which absorbs the cost of uncompensated care. The utilization review team has taken up the complex task of working with physicians to ensure if requested genetic testing is 1) appropriate for the patient, 2) medically actionable in the inpatient setting, and 3) if not medically actionable, then to question whether testing could be deferred to the outpatient setting. This effort has saved the hospital approximately $100,000 in the program’s first year alone, allowing the savings to be redirected to fund other projects. 

This non-traditional rotation has highlighted the multifaceted political and psychosocial dynamics at play between medical and business stakeholders of genetic testing. Utilization review has truly demonstrated the delicate balance that must be maintained between what is best for our patients, what is the best use of our resources, what is medically necessary, and our desire to provide genetic answers to each patient. This opportunity has challenged and taught me, specifically in a way that has given me a new perspective on both the cost and utility of genetic testing. My optional rotation has allowed me to experience a rapidly growing branch of genetic counseling and will truly benefit me as I enter the work force.

-Kelly Johnson, class of 2016