Laboratory Costs in the Context of Disease (Laboratory Management‪)‬

Rarely are patients hospitalized without some laboratory tests being performed, but the contribution of laboratory costs to the total costs of managing patients with different diseases has not been studied systematically. Because clinical laboratory costs, as a whole, can be readily quantified, they often become a focus of efforts to reduce expenditures in hospitals. The effectiveness of such moves has yet to be determined, although Winkelman (1) in 1984 established that laboratory costs do not decrease in proportion to the reduction of number of tests. No recent studies have been performed to verify that this is still true. Before the advent of diagnosis-related groups (DRGs) [1] in 1984, the prevailing fee-for-service approach to payments for services, including laboratory tests, encouraged excessive use of laboratory tests. There was no incentive for physicians or hospitals to be efficient in the use of tests because these generated income for the hospital. The laboratory was a revenue center for the hospital. The introduction of DRG transformed the laboratory into a cost center, with the cost of any test performed on a patient included in a DRG becoming an expense without offsetting revenue. However, instead of there being an immediate reduction in the number of tests performed, the ingrained habits of physicians continued so that ordering patterns largely went unchanged. More tests continue to be performed than probably are necessary for good management of patients. Reducing costs attributable to the laboratory would appear to be feasible both by curbing the number of tests performed and by reducing the costs of individual tests. Whereas laboratorians can influence the costs within the laboratory, few have tried to convince their clinical colleagues to change their ordering patterns. The most difficult challenge for both laboratorians and clinicians is to identify and eliminate, in advance, those tests that are not likely to have any direct influence on the diagnosis and/or management of the patient.