Hospital Laboratories Face New Organizational Models

By Cynthia Hayward
Originally printed in the
SpaceMed Newsletter
Spring 2016
www.spacemed.com

The practice of laboratory medicine continues to experience revolutionary change

as a result of consolidation, an increasing number of waived tests, and changing
medical practices. These factors have already had a significant impact on hospitalbased laboratories and will continue to affect their operations over the next decade.
CONSOLIDATION
Like all other areas of healthcare, the laboratory has been affected by the shift of
patient care delivery from the inpatient to the outpatient setting, resulting in competition for the outpatient testing work. Many laboratories have developed outreach
programs to market their laboratory services and to optimize the test volume capacity of their instrumentation to offset their fixed costs. In some cases, the laboratory
may become one of the hospitals largest profit centers requiring a location that
allows flexibility and room for growth. Consolidating a group of smaller laboratories
into a single location while leaving a rapid response laboratory onsite to support
acute care services is becoming more common. A mosaic approach may also
be used by multihospital health systems, whereby specific testing platforms are located at a single site to serve all hospitals in a health system in order to optimize
existing space and to create economies of scale. This may also allow a health system to perform testing that previously was sent out to a reference laboratory.
INCREASING NUMBER OF "WAIVED" TESTS
The Clinical Laboratory Improvement Act (CLIA), federal legislation enacted in
1988, specified a limited number of laboratory tests that physicians can do in their
offices and may do without a CLIA Certificate of Compliance referred to as
waived tests. These tests are performed using a few drops of blood and include
blood gases and electrolytes, glucose, hematocrit, hemoglobin, and other blood
chemistry tests. Dip stick urinalysis and drug testing are also commonly performed
at the point-of-care. Since the inception of CLIA, the number of waived tests has
increased substantially along with the number of outpatient laboratories with a
Certificate of Waiver (COW). Manufacturers have been quick to develop compact
clinical analyzers that do waived tests. These can be found in many physician
offices, urgent care clinics, ambulatory surgery centers, and other healthcare
settings.
CHANGING MEDICAL PRACTICES
Changing medical practices also impact the types of tests and services performed
by the hospital laboratory. For example, autotransfusing using intraoperative cell
salvage devices that allow a patients own blood to be recycled during surgery
and new medical guidelines to prevent the overuse of transfusions are resulting in a
decreased need for blood donors and blood storage in the laboratory. A half
century ago, autopsies were performed on roughly half of all patients who died in
hospitals. With quotas no longer mandated by the Joint Commission, hospitals
rarely perform autopsies and view autopsies as a financial drain, leaving many
autopsy suites underutilized. New facilities may not even have space to store
bodies they may contract with a university or a private service to handle bodies
or require the funeral home to come directly to the floor to pick up the deceased
patient.
Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC in
Ann Arbor, Michigan (www.hayward-assoc.com).

2016.9.2

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