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Chapter 4 : Current Challenges to Financial Stability within the Diagnostic Laboratory

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Abstract:

The economics of healthcare today challenge clinical laboratories nationwide to provide quality service and patient results in spite of decreasing resources. Decreasing reimbursement for patient testing and dwindling staff resources require the laboratorian to do more with less. One must be aware of one’s professional environment and be creative to utilize the existing resources effectively and efficiently. In many cases, this will require a laboratory environment of constant and major change. This chapter addresses some of these issues and their financial implications. The challenge in many facilities is to keep a positive financial bottom line. Maintaining the status quo is not an option today, since the changing environment requires changes in our laboratory operations in order to maintain financial stability. A review of current laboratory services may reveal some labor-saving opportunities. Automation, computerization, point-of-care testing (POCT), and robotics will allow a more integrated, system-wide approach to providing high-quality laboratory services in support of patient care. Laboratory networks and multihospital systems may achieve economics of scale. The economics of healthcare have changed, decreasing the flow of dollars into diagnostic laboratories. It is imperative today that every laboratorian have a basic understanding of laboratory and healthcare finances. This financial knowledge will help the laboratory team work toward those changes that create a more efficient and cost-effective operation.

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4

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Figures

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Figure 4.1

Number of National Accrediting Agency for Clinical Laboratory Sciences (NAACLS)-accredited CLS programs by year.

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4
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Image of Figure 4.2
Figure 4.2

Relationship of satellite laboratories to the main laboratory. Turnaround time-sensitive tests are performed near the patient and providers. High-volume, more complex, and less time-sensitive tests are performed in the main (central) laboratory.

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4
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Image of Figure 4.3
Figure 4.3

Deployment of POCT. It may be possible to achieve rapid turnaround of key laboratory test results by using POCT technology under the supervision of the main (or central) laboratory in lieu of satellite laboratories. Consolidation of key testing into a “core” laboratory may facilitate rapid turnaround time for most analytes, with only a few critical areas needing POCT capability.

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4
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Image of Figure 4.4
Figure 4.4

Organization of an integrated laboratory services delivery network. Several healthcare service delivery sites developed an integrated network to deliver laboratory services. The bulk of high-volume testing is consolidated at one site, the core laboratory. Other sites may offer rapid response testing or just phlebotomy services.

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4
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References

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Tables

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Table 4.1

Annual certification of MTs by the American Society for Clinical Pathology

See reference .

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4
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Table 4.2

Comparison between accredited training programs and on-the-job

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4
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Table 4.3

Recruitment benefits options

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4
Generic image for table
Table 4.4

Potential problems from staffing shortages

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4
Generic image for table
Table 4.5

Recruitment and retention indicators

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4
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Table 4.6

POCT procedures

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4
Generic image for table
Table 4.7

Tests approved by the FDA for home testing

Citation: Dilts T, Wilkinson D. 2004. Current Challenges to Financial Stability within the Diagnostic Laboratory, p 67-78. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch4

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