An Analysis of Reference Laboratory Testing in a Large Urban Academic Medical Center: The Impact of New Molecular Diagnostic Technologies

Abstract

Virtually all hospitals send laboratory tests to outside reference laboratories. Typically, these “send-outs” are low-volume, esoteric tests or use assays that require special skills or expensive technologies beyond the scope of the hospital laboratory. Over time, there has been an increase in the complexity of the test menu with the emergence of a large number of molecular-based diagnostics. As a consequence, reference laboratory testing on the national level has become a multi-billion-dollar business. National commercial reference laboratories have the capacity to transport and process large volumes of samples and, by virtue of their size, they offer a diverse test menu. Typically, this results in a lower unit cost (although charges will be higher) than can be achieved in the hospital setting. In a previous study based on 2002 data, the authors reported various metrics on reference laboratory testing in their hospital. 1 At that time, reference laboratory testing comprised only 1% of the total test volume but accounted for 65.7% of the test menu and 12.4% of the total laboratory budget. 1 Molecular diagnostic testing was beginning to emerge as an important contributor to the test menu while increasing reference laboratory costs. In this study, the authors reevaluate the scope of the current reference laboratory testing in their institution and assess the impact of new molecular-based testing on hospital reference laboratory services in 2006.