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The page below is a sample from the LabCE course Laboratory Effectiveness: Clinical Laboratory Utilization. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Referred Laboratory Testing: the Laboratory Formulary Concept

Clinical laboratories frequently need to send out testing to reference or specialty laboratories. The outside laboratory that you choose will depend on multiple factors including:
  • Location (the closer the better for turnaround time and specimen stability)
  • Negotiated contracts (your laboratory's choice(s) may be dictated by your organization and not by the Pathology Department)
  • Pricing
  • Menu (although even the largest referral labs will not have every test)
  • Service/quality issues/customer support
Regardless of which referral laboratory you use, or how many referral labs you use, there is no doubt that your organization is spending a significant portion of its lab budget on send-out tests. This can't be avoided, given the sheer number of tests available and the low test volume for more esoteric tests which makes internalization of these tests impractical.
To prevent overuse or misuse of send out tests, the laboratory can institute a referred test formulary. This is similar to a formulary used by pharmacy. When physicians in a health care organization prescribe a drug, they know that their pharmacy (or payment plan) only covers certain brands, generics, or formulations. They know that they cannot, and should not prescribe drugs carte-blanche. The same can hold true for a laboratory formulary. This is essentially a list of send-out tests that can be ordered by your providers and describes where the tests will be sent, who exactly can order them, and under which conditions. The laboratory may also choose to list the price of each test on the formulary. Creating a standardized send-out test formulary is a great initial project for a UM team.