Journal of Genetic Counseling

, Volume 27, Issue 5, pp 1067–1073 | Cite as

Reduction of Health Care Costs and Improved Appropriateness of Incoming Test Orders: the Impact of Genetic Counselor Review in an Academic Genetic Testing Laboratory

  • Emily WakefieldEmail author
  • Haley Keller
  • Hannah Mianzo
  • Chinmayee B. Nagaraj
  • Sanjukta Tawde
  • Elizabeth Ulm
Original Research


The goal of this study was to evaluate the impact of genetic counselor (GC) review of incoming test orders received in an academic diagnostic molecular genetics laboratory. The GC team measured the proportion of orders that could be modified to improve efficiency or sensitivity, tracked provider uptake of GC proposed testing changes, and calculated the health care dollar savings resulting from GC intervention. During this 6-month study, the GC team reviewed 2367 incoming test orders. Of these, 109 orders (4.6%) were flagged for review for potentially inefficient or inappropriate test ordering. These flagged orders corresponded to a total of 51 cases (1–5 orders for each patient), representing 54 individuals and including 3 sibling pairs. The GC team proposed a modification for each flagged case and the ordering providers approved the proposed change for 49 of 51 cases (96.08%). For the 49 modifications, the cost savings totaled $98,750.64, for an average of $2015.32 saved per modification. This study provides evidence of the significant contribution of genetic counselors in a laboratory setting and demonstrates the benefit of laboratories working with ordering providers to identify the best test for their patients. The review of test orders by a genetic counselor both improves genetic test ordering strategies and decreases the amount of health care dollars spent on genetic testing.


Utilization management Genetic counselor Laboratory Genetic testing Cost reduction 



The authors thank the log-in staff, administrative staff, and molecular technologists for their continued attention to potential order errors. They would also like to thank the directors of the Molecular Genetics Laboratory as well as the Division of Human Genetics for their ongoing support of our GC team projects.

Compliance with Ethical Standards

Conflict of Interest

Emily Wakefield, Haley Keller, Hannah Mianzo, Chinmayee B. Nagaraj, Sanjukta Tawde, and Elizabeth Ulm declare that they have no conflict of interest.

Human Studies and Informed Consent

In accordance with federal regulations as determined by the Cincinnati Children’s Hospital Medical Center Internal Review Board, this study (2016–1499) does not meet regulatory criteria for research involving human subjects as defined under 45 CFR 46.102(d) and 45 CFR 46.120(f).

Animal Studies

No animal studies were carried out by the authors for this article.


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Copyright information

© National Society of Genetic Counselors, Inc. 2018

Authors and Affiliations

  1. 1.Division of Human GeneticsCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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