A 10-YEAR ANALYSIS OF REVENUES, COSTS, STAFFING, AND WORKLOAD IN AN ACADEMIC-MEDICAL-CENTER CLINICAL-CHEMISTRY LABORATORY

From 1980 to 1990 we found progressive increases in workload (number o f billable tests; 12.1% per year), staffing [number of full-time equiv alents (FTEs); 5.6% per year], ''revenues'' (gross billings; 25.8% per year), and direct cost (12.9% per year) in the clinical chemistry lab oratory of a large tertiary-care university medical center. The increa se in direct cost was mainly attributable to an increase in salary cos t (23.7% per year), whereas the impact of increasing ''consumable'' co st was relatively small (5.3% per year). In fact, after adjustment for inflation, the consumable cost was virtually unchanged or decreased d uring the 10-year study period. Initially, consumables represented abo ut 60% of the direct cost, and the remaining 40% was for salaries. Aft er 1982/83, however, the relative contribution of consumables and sala ries to direct cost gradually reversed. Because the workload grew at a higher rate than staffing, the workload per FTE increased from 1980 t o 1990. This was paralleled by gradual increases in both ''revenue'' p er FTE and salary per FTE in actual dollars, but by lesser increases t o no increases in inflation-corrected dollars. After adjusting for inf lation with different indices, the direct cost per test, the consumabl e cost per test, and the salary cost per test either remained unchange d or decreased in the 1980s. The findings are discussed in the context of technical advancements in laboratory testing, nationwide shortages of medical technologists, and implementation of prospective fixed-fee reimbursement practices during the study period.