CLINICAL LAB SCIENEC

CHAPTER 7: MEDICAL ECONOMICS AND LABORATORY EQUIPMENT 165
and technologists are now needed to perform the great array of testing required
by the modern hospital. However, the volume, due to a greater array of available
procedures, some of which are quite sophisticated, has increased sufficiently to
offset the need for fewer technical personnel, resulting in an increased need for
laboratory professionals in some laboratories.
Automated instruments can provide accuracy and efficiency with small volumes
of both sample and reagent that cannot be duplicated by manual methodology.
These instruments are also safer to use, and the reagents are not as toxic
as they once were, as some of the old reagents were notoriously carcinogenic.
Even the tissue and cellular pathology department has been invaded by sophisticated
technology. Instruments with templates for normal cells can match patient
samples and determine the presence of cancer or other pathological conditions
more rapidly than manual methods. An example of this type of equipment is a
system capable of screening Pap smears in large numbers in a short period of
time; originally, these had to be screened microscopically by cytotechnologists
and pathologists at a much slower rate.
Elements Involved in Calculating the Costs of Performing Tests
A great number of variables must be considered when establishing the cost of a
laboratory procedure, to determine the price that should be charged for this procedure.
In the Medical Laboratory Observer, March 2007, Daniel M. Baer stated
that the major facets of determining cost and subsequent charges for the procedures
must include certain basic requirements that must be considered before
affixing a price to the procedure. To determine the true cost of performing a given
test, the numbers obtained by the manager doing the calculations are paramount.
Technicians and technologists are often called on to evaluate new tests or new
methodology to replace a test already being performed. These technical personnel
look for accuracy, specificity, and labor involved in terms of time along with
other factors. The manager may provide other points of consideration to be used
in determining a price for an analysis under review for revision or change in
methodology.
Basic calculations would include the following information. There are two
separate costs that are important to establish. There is a cost per reportable test
and a cost per billable test. What is the difference between these two? One must
accurately count the number of tests performed in a specific time period, such
as a 1-year or a 6-month timeframe. For accuracy in the realm of reportable
test volume, counts should include patient samples, proficiency tests, controls
(including control verifications), calibrators, and a percentage of repeat tests
that are necessary because of random system errors or errors by the technical
personnel. For billable tests only, the analysis will count those tests that
were actually reimbursed. Once the technician or technologist has accurate
test volumes, the costs to run that volume of tests should be added together.
Essential costs would include direct costs such as reagents and consumables,
as well as indirect costs such as regulatory fees and proficiency testing costs.
It is extremely important to include the overhead for the laboratory only and
not for the entire facility. Allocation of a portion of the laboratory revenue for
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