Economics of outreach testing in the hospital laboratory: Part I.

Hospital laboratories are faced with the dilemma of needing to maintain a baseline of testing and staffing to meet patient and physician needs while facing personnel shortages, declining reimbursement, and excess personnel and equipment capacity. Because cost cannot be reduced past some basic minimum, laboratories must find ways to increase test volumes to use the excess capacity intrinsic in the system. One solution to this dilemma is to increase the number of outpatient tests performed by developing an outreach program. If carefully managed, this solution can improve productivity, allow laboratories to operate with a lower inpatient reimbursement infrastructure, and begin to balance the uneven economic equation faced by many laboratories. This two-part article presents three case studies that illustrate decision points and results in developing a hospital outreach program. In Part I, a case study for a 300-bed hospital in a rural community is presented.