Reflections on the 2023 PLUGS Summit 

PLUGS stands for – Patient-centered Laboratory Utilization Guidance Services. PLUGS is housed at the Seattle Children’s Hospital and consists of a network of experts and people who care about lab stewardship from organizations throughout the county.  The mission of PLUGS is to improve laboratory test access, ordering, retrieval, interpretation and reimbursement.

Genetic Support Foundation (GSF) has had a long connection with PLUGS and so much of our work at GSF aligns with the goals of PLUGS. We have participated in the annual PLUGS Summit since the first one back in June of 2015.  We always find this meeting energizing and a great opportunity to connect with a diverse group of stakeholders across the industry who are interested in doing what’s best for the patients and thinking about the bigger questions of how to make that possible starting with patient-centered laboratory stewardship. This year, GSF genetic counselors, Julie Simon and Katie Stoll, as well as GSF board member Jessie Conta were at the annual PLUGS Summit earlier this month. These two days were full of enlightening conversations and presentations, as well as ample opportunities for networking.  

Here are some of the highlights from the 2023 Summit Presentations:  

  • Keynote speaker, Karen A. Heichman, PhD, Deputy Director, Diagnostics of the Bill & Melinda Gates Foundation spoke about bringing lab medicine into the community setting to increasing access to diagnostics in low- and middle-income countries.  Dr. Heichmann provided an inspiring look about how technology is helping to close the diagnostic gap in global health disparities, and how the COVID-19 pandemic brought these issues to the forefront.   
  • Christina Pierre, PhD, Clinical Assistant Professor of Pathology and Laboratory Medicine at Penn Medicine talked about the use of race and ethnicity in lab medicine and discussed needed changes in this area for more equitable care.
  • Matthew D. Krasowski, MD, PhD Clinical Professor of Pathology from the University of Iowa Healthcare discussed the use of sexual orientation/gender identity (SOGI) fields in electronic health records, the potential benefits and challenges of the SOGI fields, and the impact of gender-affirming therapy on laboratory testing.  
  • Lee F. Schroeder, MD, PhD of the University of Michigan spoke about how we measure goals around laboratory utilization to know that these interventions are working and that progress can be shown to payors, hospital systems, and other interested parties. 
  • Valerie Vaughn, MD, from the University of Utah spoke about guiding clinical decision making.  She spoke about how we can encourage stewardship for making the preferred path the easy path. She spoke about fast (system 1) and slow (system 2) thinking and how fast thinking can lead to diagnostic errors, yet it is where we spend so much of our time.  Slow thinning is deliberative thought and taking time to consider evidence and weighing the decisions.There is good reason to try to encourage more of this slow thinking in medicine and Dr. Vaughn provided some great advice on how we can do this through mindfulness, checklists, reminders, collaborative conversations, and time-outs.
  • Genetic counselor, Darci Sternan hosted a discussion by Whitney Neufield-Kaiser, MS CGC and Jennifer Kussman, MS CGC outlining three different scenarios for a couple going through preconception and prenatal testing for SMA. Each vignette highlighted concerns and challenges that our patients face everyday in the area of reproductive medicine. They also discussed the challenges and discomfort that many genetic counselors face in the area carrier screening market where we may feel the need to “shop around” for the best deal for our patients rather than the best test, as well as the very real situation with the difficulties in finding available options for diagnostic testing for all conditions that are now included on expanded carrier screening.   
  • Gillian Hooker, PhD, CGC of Concert genetics, Christy Moore, MS CGC of Blue Shield of California, and Amisha Shahpunj, MSc, MS, CGC of LabCorp were part of an engaging panel discussion titled, Evidence, Legislation, Grievance, & Fraud: What factors are driving insurance payment for genetic tests? With representation and viewpoints from genetic counselors working in the areas of insurance, lab utilization, and laboratory market access, it became clear how challenging billing and reimbursement for genetic testing is at this moment. The importance of guideline based decisions and consensus based medicine was highlighted. And we learned that when you’re running into trouble, especially with insurance companies and their coverage not matching these guidelines or negatively impacting patient care, submitting complaints, grievances, and appeals do get their attention! The group at PLUGS has already put together a helpful tool kit to help file these various feedback pipelines. 

The calls to action were heard around the conference room, new and old relationships were forged in the fires of data driven presentations and delicious snack breaks. We had a great time hearing about how genetic counselors are getting involved at every level of these projects. 

Thank you PLUGS, for the excellent meeting and bringing us all together each year for this great opportunity to learn and connect. We look forward to continuing to grow these relationships and these conversations.

GSF genetic counselor Julie Simon found time to connect and have some fun with her amazing classmate Christy Moore, who presented at the meeting.
April Hall, PhD, CGC is a Research Genetic Counselor working with the Undiagnosed Genetic Diseases Program at the Center for Human Genomics and Precision Medicine at the University of Wisconsin-Madison. April was presented the Member of the Year award by Darci Sternen, MS, CGC of PLUGS for her ongoing dedication to lab stewardship.
The Cleveland Clinic was recognized as a longstanding member of PLUGS, upholding the mission of improving laboratory test access, ordering, retrieval, interpretation and reimbursement in their work. Cleveland Clinic Group Award accepted by Grace Kroner and Sarah Arneson, with Jackie Riley and presented by Jane Dickerson of PLUGS.