CLINICAL LAB SCIENEC

166
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
the facility overhead is determined separately after the costs per reportable and
billable tests are calculated.
In calculating these costs, one must ensure that accurate costs for equipment
purchase, lease, or other manufacturer’s arrangements for procuring use of a
piece of equipment are included. Expenses such as equipment maintenance and
all personnel costs, including phlebotomists and clerical personnel and the cost
of benefits, should be added. Overhead expenses will be a difficult cost factor to
determine. Information should be sought from the office manager or administrator
to determine what is appropriate for the purpose of determining the costs
of providing laboratory services. Again, remember that a portion of the overall
overhead of the entire facility must be added as a percentage of the overhead for
which a laboratory is responsible. Professional associations are often helpful as
a resource for information on cost analysis. The sum of all costs for a particular
test divided by the correct volumes of tests performed yields the costs per reportable
test and costs per billable test. Determining all the costs by going through
contracts and invoices is a time-consuming process, but it is important to reconcile
invoices with contracts to ensure the lab does not pay more than its contracts
with outside vendors of equipment and supplies state. This often happens!
Screening Tests
For some medical laboratory tests, it is possible to perform a cheaper and easier
procedure before becoming involved with the increased work and expense to the
patient of a more extensive procedure. As a general explanation, it is possible to
determine if a condition exists in a patient, such as that for general inflammation,
before performing more costly and time-consuming tests, many of which might
yield a negative clinical finding. In some routine tests, initial test results might
need to be confirmed by another test before a more advanced procedure is needlessly
performed. A good example of this is found in the simple urinalysis where
a dipstick with chemically reactive pads is dipped into the urine specimen. A
positive protein would be significant but would sometimes require the collection
of a 24-hour urine specimen, which requires refrigeration and would be an inconvenience
for the patient, as well as an expense. A simple test using a precipitating
acid to confirm the presence of protein rather than some innocuous substance
that by use of the dipstick would give a falsely positive result will save a great
deal of money and will avoid providing the physician with erroneous results. This
will be explained in chapter 12, Procedures for Urinalysis and Body Fluid.
Although it is not the same as performing a screening test before performing
a more advanced test, some agencies find it necessary to screen large populations
for early evidence of disease. Screening tests are inexpensive methods that may
be used to screen out the healthy members of the population from those who
will require further testing for positive results. This process is often performed at
health fairs and is particularly true for government agencies that provide health
care to segments of the country’s population as well as to those in less-developed
countries. The screening procedures selected must be adequate for screening
large populations for certain prevalent diseases.
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