Steiner J W, Root J M, Michel R L
Chi Laboratory Systems, Inc. (CLS), Ann Arbor, MI, USA.
Hosp Technol Ser. 1995 Nov;14(15):1-33.
In 1990 we predicted that the growth of prospective payment and fixed reimbursement plans would force hospitals to transform the hospital laboratory into a cost center. The need to create alternative modes of care would further lead hospitals to create regional laboratory consortia. This would include the "commercialization" of the laboratory so that it could become a regional resource and expand outreach activities. This report updates events since 1990. Indeed, the arrival of prospective payment and fixed reimbursement has caused a radical upheaval among health care providers in every part of the country. The transformation was more rapid than we expected, particularly in two areas. First, the commercial laboratory industry devoured itself. By 1995 the consolidation movement ended and three huge national laboratory chains now provide laboratory services throughout the United States. Second, not only did prospective payment arrive in the form of capitated contracts for laboratory services, but it arrived with remarkable speed. It was coupled with the absolute decline for three years in Medicare reimbursement for lab services. Such changes to reimbursement levels have seriously undercut the financial viability of the laboratory industry. Hospital-based laboratories are responding to these pressures with three strategies: reengineering, consolidation, and networking. Six identifiable trends will drive the transformation of laboratories into regional provider consortia between now and the year 2000. We predict that the speed of this transformation will be even faster than that experienced by the consolidation of commercial laboratories. This will occur because hospital labs are already a component within integrated delivery systems. As these systems transform and evolve, the laboratories must transform in concert. Our experience indicates that laboratory consolidation delivers economic benefits that are considerably greater than either networking or reengineering. Consolidation, accompanied by new testing technologies and tighter data links, will lead the transformation of today's hospital laboratory into a "virtual" laboratory. Such laboratories will be self-sufficient, capable of performing all but esoteric tests in-house. It will be a "laboratory without walls," emphasizing testing performed at the point of care, be it bedside, physician's office, clinic, nursing home, ambulance, workplace, or patients' homes. A combination of economic and organizational pressures will cause hospital-based laboratories to adopt some form of regionalization within the next two to three years.
1990年，我们预测预期支付和固定报销计划的增长将迫使医院把医院实验室转变为一个成本中心。创建替代护理模式的需求将进一步促使医院建立区域实验室联盟。这将包括实验室的“商业化”，使其能够成为区域资源并扩大外展活动。本报告更新了1990年以来的事件。事实上，预期支付和固定报销的到来在该国各地的医疗服务提供者中引发了一场彻底的剧变。这种转变比我们预期的要快，特别是在两个方面。首先，商业实验室行业进行了自我整合。到1995年，整合运动结束，现在有三家大型全国性实验室连锁机构在美国各地提供实验室服务。其次，预期支付不仅以实验室服务的按人头付费合同的形式出现，而且速度惊人。它还伴随着医疗保险对实验室服务报销连续三年的绝对下降。报销水平的这种变化严重削弱了实验室行业的财务可行性。医院实验室正通过三种策略应对这些压力：重新设计、整合和联网。从现在到2000年，有六个可识别的趋势将推动实验室转变为区域提供者联盟。我们预测这种转变的速度将比商业实验室整合时更快。之所以会这样，是因为医院实验室已经是综合医疗服务体系的一个组成部分。随着这些体系的转变和发展，实验室必须同步转变。我们的经验表明，实验室整合带来的经济效益远大于联网或重新设计。整合，再加上新的检测技术和更紧密的数据链接，将引领当今医院实验室转变为一个“虚拟”实验室。这样的实验室将自给自足，能够在内部进行除疑难检测之外的所有检测。它将是一个“没有围墙的实验室”，强调在护理点进行检测，无论是床边、医生办公室、诊所、养老院、救护车、工作场所还是患者家中。经济和组织压力的综合作用将促使医院实验室在未来两到三年内采取某种形式的区域化。
