Cost-containment and the use of reference laboratories.

Hospital laboratories and hospital-independent reference laboratories will need to change in order to provide comprehensive, medically appropriate, and reasonably priced laboratory services in the cost-containment age we are entering. The change must be economically and technologically innovative and relevant to society's next generation of health care needs. Hospital laboratories and commercial laboratories may become weaker or stronger relative to one another, but our guess is that they will ultimately become more like one another or even may join forces to provide optimal patient care in the future. Until that time comes, hospital laboratories must decide whether to employ reference laboratory services more or less, enter a joint venture with a reference laboratory, or become a reference laboratory. Some of the items that could be considered in arriving at this decision are listed in Table 2. Some items favor hospital laboratories; some favor reference laboratories; some are a toss-up; and some suggest there are advantages in a team approach. For the present, we believe there are many arguments favoring a continuation and possibly even an expansion of hospital laboratory services, but this will likely be most feasible in financially sound and progressive hospitals having forward-looking administrators and imaginative but fiscally minded laboratory directors and managers. If decisions are made to send more tests to reference laboratories, each hospital or user laboratory must seek the best and most cost-effective services available. Various financial, technical, and medical considerations are described that should aid in the evaluation of where to have tests performed. We have provided suggestions on how agreements with reference laboratories can be established in either a formal (contractual) or an informal (verbal) way. Additionally, we have described methods for evaluating (or monitoring) the quality and quantity of services received from a reference laboratory. In general, for any significant agreement with a reputable reference laboratory, little more may be necessary for monitoring purposes than periodic financial and quality assurance audits and follow-up on any clinical complaints regarding test results. With a large contract, the user laboratory is advised to spot check results on submitted blind duplicates of patient samples (to test provider lab precision) and occasionally to split samples between the provider and one or more other reference laboratories (as a first look at possible inaccuracy).(ABSTRACT TRUNCATED AT 400 WORDS)