CLINICAL LAB SCIENEC

CHAPTER 7: MEDICAL ECONOMICS AND LABORATORY EQUIPMENT 163
laboratory, along with the aforementioned departments, may also be assigned
a portion of the cost of the overall operation of the hospital, to cover the areas
where costs exceed revenue.
An example of a department that requires funds other than the amounts it
generates is the emergency department, where many patients are uninsured and
unable to pay for their care. Room rate income for hospitalized patients, although
it appears exorbitant, does not cover the costs associated with staffing the floors
and providing for supplies and equipment on a 24-hour basis, 7 days per week.
Service areas such as custodial and maintenance workers, dietary personnel,
grounds workers, and clerical personnel do not generate revenue, so they must
also be compensated from revenue generated by cost centers that provide services
for which charges are incurred.
Included in laboratory revenue are the decentralized laboratories found
in some larger facilities. Satellite laboratories that perform testing with quick
turnaround in areas where the demand is high for certain tests are economically
operated for a limited number of tests that are essential in the area in which
they are located. These laboratories do not require large quantities of specialized
equipment except for the limited tests they offer, so efficiency and economy are
possible. For instance, there is sometimes a “stat” laboratory located in the emergency
department. This laboratory would typically be able to perform only tests
routinely needed in the emergency department, such as complete blood counts,
urinalyses, blood glucose, drug screening, electrolytes, and a number of quick
screens for infectious diseases. More time-consuming tests and those requiring
large and sophisticated equipment would still be performed in the main laboratory,
by collecting the blood or other samples from the patient and transporting
them to the larger laboratory.
Reference Laboratories
Early laboratories performed almost 100% of the laboratory procedures
requested “in house” by a single hospital laboratory. However, low volumes of
certain tests made it economically unfeasible for these tests to be performed “in
house,” because quality control measures, personnel, and expensive equipment
for only a few tests per week or month required that the test bear a high cost
for performance. Of course, the insurance companies would not reimburse one
laboratory for an expensive procedure that another laboratory would be able to
perform for a fraction of the cost. This led to the birth and somewhat explosive
growth of reference laboratories.
The availability of rapid transport of laboratory samples, sometimes via air
to a distant laboratory, and the ability to transmit results instantaneously have
resulted in decisions by hospital laboratories and physician’s office laboratories
to use reference laboratories more freely. These reference laboratories are also
able to justify the cost of extremely expensive and sophisticated equipment as
they receive large numbers of samples from the entire country, which are shipped
to them via air if necessary. Reference laboratories have formed mergers over the
years, and hundreds of small, independent reference laboratories were bought by
the large corporate giants. Some of these reference laboratories even have contractual
arrangements with each other whereby they share the costs of expensive
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