Measuring productivity in the diagnostic laboratory is often measured by institution management as the revenue-per-reportable test (RPRT). The laboratory will use both RPRT and cost-per-reportable test (CPRT). The advantage of utilizing both RPRT and CPRT is that if reimbursement goes down due to new payee fee schedules (but CPRT does not), productivity has probably not changed. Once a pattern is established, benchmarks can be set that may then be monitored. For this type of system to work, the benchmark must be compared to the same RPRT and CPRT from the previous year. This system assumes that the data establishing the benchmark is useful and that no significant changes in test volume or testing have occurred. Setting benchmarks with comparison to other similar diagnostic laboratories can also be done. The challenge is that such targets do not consider the nature of laboratory testing or account for test mix variation when comparing laboratory performance to peer institutions. The variability of test mix among laboratories can account for most of the cost and productivity differences between laboratories. Added to this, each department has a different test focus. Hematology and chemistry have a lot of automation and volume compared to the microbiology and transfusion services departments. In addition, labor requirements are much different. The challenge is that such targets do not consider the nature of laboratory testing or account for test mix variation when comparing laboratory performance to peer institutions. The variability of test mix among laboratories can account for most of the cost and productivity differences between laboratories.
Although the institution's financial branch may want to rely on RPRT and CPRT for the entire laboratory, this does not provide the necessary information for the lab to identify specific areas of concern and action. A better system for measuring productivity may be managing productivity at the department level by establishing productivity target levels. Establishing productivity targets at the department level requires the laboratory to design the general ledger structure in similar departments. In the hospital laboratory, there are generally four distinct departments: core lab, which includes automated chemistry, urinalysis, and hematology; microbiology; molecular diagnostics; and blood bank. In many diagnostic laboratories, additional department units may be identified. Within each department, there are similar labor standards and test mix indices. However, those measures vary greatly between the departments. The productivity indices that work well for monitoring distinct department productivity is the labor-minutes-per-reportable test (LM/RT). To establish target benchmarks, detailed studies of LM/RT over time (preferably over a year) are needed. This is because seasonal variations often occur in testing during a year. Because of this aspect, seasonal benchmarks may also be helpful. Once monitoring begins, strategies may be implemented to discover reasons for changes in productivity and for making improvements. Some of these strategies will be discussed later.
