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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The Problem

Radiology and pharmacy departments have traditionally received much more attention with regard to utilization management (UM) than the laboratory. The reason that these departments were more apt to be detected on the UM radar is simply because the cost of their services has been much higher than that of the laboratory. A magnetic resonance image (MRI), positron emission tomography (PET) scan, or computed tomography (CT) scan can cost hundreds to thousands of dollars. It made sense for administrators to focus attention on reducing unneeded MRIs and other unneeded or redundant imaging procedures. Pharmacy departments fill thousands of prescriptions, with many patients receiving more than one prescription. Given issues of generic versus name brand medications, appropriate use of antibiotics, increases in opiate use, etc., it made sense to also target pharmacy as another department where organizations could focus utilization efforts.
But what about the laboratory? While it is true that many laboratory tests are inexpensive to perform, there are now many tests (usually sent out to reference or specialty laboratories) that cost well over $500/test. For example, the average cost for a genetic test today is about $1200. There is also evidence that the number of tests performed on each patient is increasing. Some clinicians may order more tests than are needed in an attempt to cover all bases, medically as well as legally (so called defensive medicine). Thus, the laboratory is now also a department that may need to look more carefully at utilization in order to increase effectiveness and decrease cost.