Abstract
To The Editor,
Reference lab testing is defined as testing that is sent from one institution to another for completion. As the number of available tests increase, the amount of money hospitals are spending on reference lab costs is ever increasing. This is especially concerning to pediatric hospitals because the number of genetic tests, many of which cost more than $1000, seems to go up on an almost daily basis. A survey of Society for Pediatric Pathology (SPP) members was conducted by the Society for Pediatric Pathology Practice Committee [1] in Summer 2011 to assess the amount of money spent on reference laboratory testing and to determine whether systems were in place to check large expenditures. The survey was sent to the entire SPP membership (500+ physicians and scientists) via email, and 20 responses were returned. The major limitation of the survey was the inability to decipher how many institutions were represented in the results. The results of the survey are submitted on behalf of the Practice Committee.
Of the respondents, 55% were from freestanding pediatric facilities and 45% were from mixed pediatric and adult facilities. The number of beds ranged from 151 to 200 (10% of respondents) to more than 350 beds (50% of respondents). All respondents replied to these initial 2 questions. Fourteen respondents reported the total amount spent per year on reference lab testing: 0–$250 000, 7.1%; $250 000–$500 000, 14.3%; $750 000–$1 million, 7.1%; $1 $1.5 million, 14.3%; $1.5 $2 million, 14.3%; $3–$3.5 million, 7.1%; $4–$5 million, 7.1%; $5–$7.5 million, 7.1%; $7.5–$ 10 million, 21.4%.
The survey asked for information regarding each hospital's primary reference laboratory. Eighteen participants responded: 33% ARUP Laboratories, 27.8% Mayo Medical Laboratories, 11.1% LabCorp, 38.9% Quest, and 16.7% other. When asked if any laboratory tests require prior approval, all participants responded and 50% said “Yes.” The question asked for specific examples, and the following responses were given: tuberculosis, polymerase chain reaction, miscellaneous other tests; requests >$500; too many to mention; >$2000 or sent to a lab not on approved list; those over a certain cost; and all except the basics. When asked if there was a price cutoff requiring pathologist approval, 53.8% of the 13 respondents said “No.” Of the 46.2% who said “Yes,” the price approval cutoff was specified as varies by type of test from $75 to $100, >$100, >$500, >$1000, and >$2000. Finally, participants were asked if their laboratory used third-party billing. Third-party billing is the practice of allowing a reference laboratory to take charge of all the billing associated with a particular test to include working with the patient's insurance, medical assistance, and the family on securing payment. This practice alleviates the hospital's financial risk, because the hospital lab is no longer billed for the test in question. Of 17 respondents, 52.9% said “No” and 52.9% said “Yes,” meaning 1 respondent answered both “Yes” and “No.”
As more and more genetic tests become available, hospitals will have to face difficult decisions about how to utilize testing in a manner that is appropriate for patient care and that is fiscally responsible. With the field of genetics in constant evolution, pediatric pathologists and geneticists must work together to find ethical solutions to testing that take into consideration the needs of patients, families, and hospitals.