Administration of the vascular laboratory: headaches for the 1990s

As has been the case in many fields in medicine, noninvasive vascular testing techniques originated in research projects to provide more exact definition of normal and abnormal physiology. Early tests were cumbersome to perform, due in part to the lack of dedicated equipment. The introduction of Doppler ultrasound technology in the late 1960s expanded the horizon for vascular testing. By the early 1970s, vascular testing had moved out of the research laboratory into the clinical arena. Dedicated noninvasive laboratories were established within hospital settings as well as part of office practices. The addition of duplex scanning greatly enhanced the capability of noninvasive laboratories and contributed further to growth of noninvasive testing. By the end of the decade, the vascular laboratories were well established across the country. The 1980s saw a great increase in the number of vascular laboratories, as well as the number of tests performed. There appeared to be unrestricted potential for growth and, unfortunately, increasing examples of abuse were encountered. As could be expected, excesses did not remain unchallenged and increasing restrictions were placed on the vascular laboratories, primarily in the areas of payment policy and levels of reimbursement.