Clinical laboratory test menu changes in the Pacific Northwest: an evaluation of the dynamics of change

To characterize changes in on-site test volumes and test menus and to identify the factors influencing these changes, we gathered information from a network of clinical laboratories in the Pacific Northwest in 1996 and again in 1999. The two studies allow for a snapshot of these changes for specific periods and also an evaluation of the dynamics of change in clinical laboratory practices between 1994 and 1999. Throughout this 5-year span, business-related decisions have had the primary influence in determining where testing is performed. The overwhelming factor in deciding to retain certain tests on-site is whether the patient test volume is adequate to be cost-effective. Decisions to add or delete tests also are closely tied to marketplace competition, costs of testing equipment and supplies, and ability to obtain adequate reimbursement. Laboratory regulations have had a decreasing influence on on-site test menus in the network laboratories and particularly in physician office laboratories (POLs). The use of waived tests has increased dramatically, with POLs accounting for the majority of laboratories that added waived tests.