• What are your anticipated operating
and capital budgets? (important
determinant for changes to
instrumentation and level of
automation)
• Is adequate work space available to
accommodate all phases of new
patient testing from specimen
collection to test result reporting?
“ It is important to do a
realistic assessment
of not only what you
want to offer your
patients, but what you
can realistically
offer them.”
The answers to these questions will
provide general guidance for on-site
testing, which tests should be sent out,
expectations of turn-around times by
ordering physicians, and the needs of
the patients.
Next, perform a cost/benefit
analysis of your present operation,
and proposed test system changes
When there are proposed changes to
your test menu and instrumentation, it is
important to perform a comprehensive
realistic cost/benefit analysis. It is by
taking into account the internal as well as
external factors in the laboratory
environment, that the decisions made will
have the best chance of success.
Items to consider for your cost/benefit analysis:
• Instrument capacity for current or
proposed test menu (is it “right-
sized” for test volume and level of
staffing?)
• Instrument cost (purchase or lease?)
• Reagent cost (are you obligated to
purchase reagents from a particular
manufacturer?)
• Reagent life (expiration dates: days,
weeks, months before/after opening
packages)
• Storage requirements for reagents
(do you need to buy a new
By strengthening relationships with ordering
physicians, laboratories can more accurately forecast
future service needs and make the best decisions as to
test menu, instrumentation, and staffing, including
which tests to outsource or maintain in-house.
Irwin Z. Rothenberg, MBA, MS, CLS(ASCP)
refrigerator or freezer?)
• Frequency and expense of Quality
Controls, Calibration, and
Maintenance
• Tests run singly or in batch mode?
• Comparison of in-house testing with
reference laboratory charges and
turn-around time
• Staffing requirements: number,
training expenses; qualifications and
experience beyond present staffing;
continuing education
• Proficiency Testing requirements
• Facility space, ventilation, electrical
needs; hazardous disposal
requirements
• Time and involvement of the Lab
Director, and the Technical
Consultant
• Document storage requirements /
LIS capability
• Adjusting the front office staffing to
handle additional pre and post
analytical paperwork and
communications
Of course, providing the highest level of
service for your patients may justify costs
associated with the above considerations,
but you must make sure that your
instrumentation can handle the projected
demand in terms of test volume capacity,
variety of tests offered, operating times
and staffing. However, having a
laboratory with excess capacity and
operating requirements can ultimately
bankrupt a practice as well. Investigate
which instruments can meet your
present needs, and for the near future,
and be cost effective.
Some additional key strategies that
can facilitate the appropriatene ss
of a laboratory’s test offerings,
and the instrumentation needed.
• Analyze your present test mix,
and outsource low-volume
tests. Don’t be surprised to find
low-volume tests (perhaps added to
the menu due to a single physician
request in the past), which can be
outsourced to a reference laboratory
at a lower cost and with a better
turnaround time.
• Project test demand and costs
to determine which tests to
perform in house. Conversely,
analysis of send-out volumes may
indicate opportunities to bring
certain tests in-house.
• Partner with reference
laboratories. Reference
laboratories can provide valuable
support in the form of financial
analysis, methodology assessment,
and provision of clinical samples to
help make in-source-versus-
outsource decisions and to establish
and increase on-site test...
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