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
