Improving laboratory testing: can we get physicians to focus on outcome?

Managed care is changing the financing of healthcare and replacing open-ended reimbursement with fixed pricing schemes. Clinical laboratory tests will remain an important part of medical practice because laboratory information is essential for diagnosis and management of patients. The relative role of the hospital-based clinical laboratory, however, remains to be determined because healthcare organizations are reevaluating their services and attempting to drive down costs through reducing unit costs, decreasing utilization of services, and improving patient outcomes. The challenge for the clinical laboratory in managed care is to achieve appropriate utilization of laboratory tests so that clinical outcomes are optimized. The clinical laboratory at this medical center has used a number of approaches to improve utilization of thyroid function tests, isoenzyme tests for myocardial infarction, beta-human chorionic gonadotropin tests, and stat laboratory services for the emergency department. These experiences suggest that the laboratory can contribute to optimizing utilization of laboratory tests. This goal will require mutual cooperation of both the clinician and the clinical laboratory physician and (or) scientist.