Reference test review by pathology house staff: a cost-containment strategy for the clinical laboratory

In this era of fiscal responsibility in health care, new strategies are evolving to decrease costs in the clinical laboratory. At our institution, one such strategy implemented in 1994 consisted of the review by pathology housestaff of all send-out tests that cost more than $75 to ensure that an appropriate diagnostic test hierarchy was being used and that clerical misorders were corrected. Throughout the first fiscal year this system was implemented, the annual institutional reference laboratory costs decreased by 10% ($24,784), and the number of send-out tests decreased by 23% (2,707 tests). Over the next 2 fiscal years, the number of sendout tests maintained a level approximately 25% lower than the original pre-review level and the reference laboratory costs remained 4% to 13% below the pre-review level. A major factor preventing a more extensive cost reduction over this time period was the increased frequency of orders for expensive molecular studies. Even with the increased use of these relatively expensive tests, however, our annual reference laboratory budget and number of send-out tests have remained consistently below the levels of 1994. Implementation of similar test review systems in other health-care laboratories could provide useful budgetary reductions.