Cost containment in microbiology.

Prospective reimbursement will impose an additional challenge on clinical microbiologists. In order to avoid an inevitable decrease in quality and increasing delay in providing results of examination of specimens, efforts must be undertaken to restrict the submission of specimens and the extent of work that is performed to that which is cost effective for patient care. This will require education and the introduction by the laboratory of controls on ordering and specimen submission. Laboratory personnel must also establish criteria to limit the extent of specimen processing to the production of information that can be expected to be clinically useful. This will involve a close interaction with infectious disease services and clinical departments. Introduction of new screening tests, rapid antigen detection procedures, computers, and automation may provide some increase in productivity but cannot be expected to solve the entire problem. Currently, most attention to controlling hospital cost is being given to the length of patient stay, and little progress has been made in establishing more effective communication between laboratory staffs, house staffs, medical staffs, and hospital administration in monitoring and controlling misuse of laboratory resources.