Six-year trends in productivity and utilization of 73 clinical laboratories - A college of American pathologists laboratory management index program study

Objectives.-To describe longitudinal trends in the efficiency, labor produc tivity, and utilization of clinical laboratories in the United States. Methods.-Financial and activity data were prospectively collected from 73 c linical laboratories continuously enrolled in the College of American Patho logists Laboratory Management Index Program from 1994 through 1999. Each la boratory reported quarterly on its costs, labor inputs, and test activity u sing uniform data definitions. Results.-During the 6-year study period, there was a significant increase i n laboratory labor productivity (2.1% more tests/full-time equivalent/y; P < .001). Productivity increases were offset by increasing labor expense (1. 5%/full-time equivalent/y; P < .001), consumable expense (1.7%/on-site test /y; P =.005), and blood expense, which comprised more than 10% of laborator y expenses by 1999 (4.4% increase/y; P < .001). As a result, overall expens e per test showed no significant change in non-inflation-adjusted dollars. Reference laboratory expense per test did not change significantly during t he study period; the proportion of tests sent to reference laboratories gre w slightly (0.06% increase/y; P < .001). Test volume of the median laborato ry grew by 5442 tests per year (2.3% annual increase; P < .001), while the proportion of testing from inpatients declined by 1.7% per year (P < .001). Inpatient test utilization declined on a discharge basis (annual decline o f 1.2 tests/inpatient discharge; P < .001) and on a per them basis (annual decline of 0.08 tests/inpatient day; P =.002). Inpatient laboratory expense declined on a discharge basis (annual decline of $2.40 or 1.3% per dischar ge; P < .001), but did not change significantly per inpatient day. Most of the reduction in the expense per discharge occurred during 1994-1996. Conclusions.-Between 1994 and 1999, clinical laboratories in the United Sta tes experienced significant changes in the cost of operations, utilization, and labor productivity. Laboratory administrators who compare local instit utional performance with that of peers are advised to use current or forwar d-trended peer data. Quarter-to-quarter improvement in many measures of lab oratory financial activity may not signal a superior operation, as performa nce of the whole industry appears to he improving.