PubMed · 6898161
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R de Tornyay. 1980. The task ahead--acceptance and implementation.. https://pubmed.ncbi.nlm.nih.gov/6898161/
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Health care costs in the USA have increased dramatically during the past 10 years, and it is widely believed that they have reached crisis dimensions. Vascular laboratories are a segment of the USA health care industry that has experienced particularly rapid growth in the last decade. In 1992, USA Medicare payments (for patients > or = 65 years) totalled US$304,492,588 for 3,673,695 non-invasive vascular studies. This figure represents only one segment of USA health care costs and, if all segments were considered, the 1992 total for vascular laboratory services would probably approach one billion USA dollars. The expansion of vascular laboratory utilization is attributed to a number of factors: (i) increased recognition of the clinical value of non-invasive vascular studies; (ii) replacement of invasive (angiographic) procedures; (iii) expanded surveillance application; (iv) the verification of carotid endarterectomy for treatment of carotid stenosis; (v) widespread, unlimited access; (vi) over-utilization; (vii) greed. Widespread awareness of the crisis in USA health care funding has imposed cost-containment pressure where virtually none existed previously. The vascular laboratory is no exception to this trend, and the following measures have been suggested for controlling vascular laboratory costs: (i) demonstration of the clinical and cost effectiveness of non-invasive vascular studies; (ii) utilization review; (iii) pre-approval of requests for vascular studies; (iv) linkage of vascular study reimbursement with clinical diagnosis; (v) limitations on self-referral; (vi) reduced reimbursement; (vii) capitation; (viii) diagnosis-related reimbursement; (ix) accreditation. This article summarizes the factors that have led to increased utilization of vascular laboratory services, and discusses methods proposed for containing vascular laboratory expenditure.
This article provides a high-level overview of federal, state, and accrediting body requirements for laboratory testing outside the traditional laboratory environment. The Clinical Laboratory Improvement Amendments of 1988 provide a framework for most state and accrediting-body regulations. The stand taken by all regulators at this point is that testing wherever it is performed must conform to the same standards. The most variety in regulation is seen at the state level in the area of who can perform what tests and under what circumstances. All regulation focuses on the training and competency of the staff, adequate direction and supervision of the testing, and mechanisms for assessing the reliability of test results.
Implementation of the conference consensus that alternative site testing should be under the direction of the laboratory director supported by an institutional structure of users, laboratorians, and possibly administrators will optimize success. Information is needed if, when, and where alternative site testing improves the care of patients, and if faster results are associated with better and less expensive patient care. Costs and the timeliness of both central clinical laboratory and alternative site testing must be estimated in an identical fashion, then both must be compared with the costs and timeliness attributed to all steps of the total testing process included. As has been done with glucose, accuracy and precision goals must be developed for analytes measured at alternative test sites, then agreement reached on what these goals are and whether speed of measurement can influence these goals. Consideration of successful models is essential by those implementing or reevaluating alternative site testing programs. Required scientific information cannot be obtained in a timely manner unless improved funding occurs.