Mrak Robert E, Parslow Tristram G, Tomaszewski John E
Department of Pathology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Acad Pathol. 2018 Apr 2;5:2374289518765435. doi: 10.1177/2374289518765435. eCollection 2018 Jan-Dec.
American hospitals are increasingly turning to service outsourcing to reduce costs, including laboratory services. Studies of this practice have largely focused on nonacademic medical centers. In contrast, academic medical centers have unique practice environments and unique mission considerations. We sought to elucidate and analyze clinical laboratory outsourcing experiences in US academic medical centers. Seventeen chairs of pathology with relevant experience were willing to participate in in-depth interviews about their experiences. Anticipated financial benefits from joint venture arrangements often eroded after the initial years of the agreement, due to increased test pricing, management fees, duplication of services in support of inpatients, and lack of incentive for utilization control on the part of the for-profit partner. Outsourcing can preclude development of lucrative outreach programs; such programs were successfully launched in several cases after joint ventures were either avoided or terminated. Common complaints included poor test turnaround time and problems with test quality (especially in molecular pathology, microbiology, and flow cytometry), leading to clinician dissatisfaction. Joint ventures adversely affected retention of academically oriented clinical pathology faculty, with adverse effects on research and education, which further exacerbated clinician dissatisfaction due to lack of available consultative expertise. Resident education in pathology and in other disciplines (especially infectious disease) suffered both from lack of on-site laboratory capabilities and from lack of teaching faculty. Most joint ventures were initiated with little or no input from pathology leadership, and input from pathology leadership was seen to have been critical in those cases where such arrangements were declined or terminated.
美国医院越来越多地转向服务外包以降低成本，包括实验室服务。对这种做法的研究主要集中在非学术性医疗中心。相比之下，学术性医疗中心有独特的执业环境和独特的使命考量。我们试图阐明并分析美国学术性医疗中心的临床实验室外包经历。17位有相关经验的病理学主任愿意参与关于他们经历的深入访谈。由于检测价格上涨、管理费、支持住院患者的服务重复以及营利性合作伙伴缺乏控制使用的激励措施，合资安排预期的财务收益在协议签订后的最初几年后往往会受到侵蚀。外包可能会妨碍利润丰厚的外展项目的开展；在避免或终止合资企业后的几个案例中，此类项目成功启动。常见的抱怨包括检测周转时间长和检测质量问题（特别是在分子病理学、微生物学和流式细胞术方面），导致临床医生不满。合资企业对以学术为导向的临床病理教师的留用产生了不利影响，对研究和教育也有不利影响，由于缺乏可用的咨询专业知识，这进一步加剧了临床医生的不满。病理学及其他学科（特别是传染病学科）的住院医师教育因缺乏现场实验室能力和教师而受到影响。大多数合资企业在启动时几乎没有或根本没有病理学领导层的参与，而在那些拒绝或终止此类安排的案例中，病理学领导层的参与被视为至关重要。
