American Association for Clinical Chemistry
Better health through laboratory medicine
January 2011 Clinical Laboratory News: CLN Survey Comments
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January 2011: Volume 37, Number 1


To accompany our article on the outlook for the in vitro diagnostics industry, CLN surveyed readers about their thoughts on top issues in the lab field. More than 600 responded to the online survey in November, and more than 120 provided open-ended comments. A sample of the comments follow.

“We live in tougher economic times compared to the last 20 years. Downsizing continues as health care costs escalate and insurers decrease coverage. Everyone is looking at ways to decrease health care costs and decreasing laboratory testing could be one of them if used judiciously. The lab needs to develop better and more comprehensive assays that can be both cost effective and diagnostically useful.”

“The volume of lab tests will increase due to expanded access to healthcare. Laboratorians have an opportunity to influence the use/interpretation of tests more than ever. If we don’t, others like pharmacists, nurse practitioners, etc. will do so. We will end up losing revenue as tests are abused and paid for through decreased reimbursement. We need volume but only appropriately ordered and used and fairly reimbursed.”

“Tension between increasingly complex testing, need to make diagnoses efficiently, cost of testing, and manpower limitations.”

“Automation will play a larger role due to the aging workforce. Genetic testing will continue to grow at a faster pace than any other laboratory discipline. Histology and cytology testing outsourcing will continue due to a lack of personnel including pathologists.”

“The lab test is being viewed more and more as a commodity and not an integral tool for patient care. In the past, the quality of our results was part of our cost analysis to payors. Now they don't care if the result is good or not...just cheap.”

“Medical necessity will finally come into play to limit tests that can be ordered by physicians. Testing will therefore be reduced and reimbursement will also be reduced. A small number of highly trained techs for the most demanding tests will survive, but the bulk of lab testing will be performed by less qualified workers tending automated analyzers. Hospital labs will shrink in favor of reference labs.”

“Technology will continue to progress in leaps and bounds, but quality patient care cannot happen without the quality phlebotomists and technologists on the front lines and on the bench who believe that their efforts make a difference.”

“There is an area hospital "getting out of the lab business". All stat work will be done by nurses in ER on POC analyzers. The rest of it will be outsourced to a bigger sister hospital with courier service every 2 hours. The entire lab staff has been let go. The repercussions of cost-cutting mechanisms like this has me seriously concerned about the future of laboratory technology, not to mention the threat to the quality of patient results. The average patient or even the CFO's do not understand the difference in a speedy POC result as opposed to the accuracy and precision of a laboratory-based analyzer. Our industry needs to be a lot more vocal about the value of the work that we do.”

“The FDA will take a much more active role than in the past. This will affect laboratories because products they have validated for their own use may be pulled off the market because the manufacturer didn't re-apply for clearance every time they tweaked the product to improve performance.”

“Molecular diagnostics will be a key driver of implementing more personalized medicine; and better understanding of molecular pathology will enable "rules based" medicine.”

“Reduced budgets, staff shortages, increasing workloads and increased regulatory oversights will make the clinical laboratory business very challenging in the near and far future.”

“Evidence-based practice (EBP) regarding pre-analytic and post-analytic processes impacting medical decision-making will be increasingly more important and emphasized. EBP is necessary to assure the appropriateness of utilization and ordering of laboratory information.”

“The lab workforce shortage will have a huge impact on whatever the future may bring. Even if lab volume drops overall because of changes in utilization, the tests that remain will require qualified technical individuals to perform them, and they are lacking. Also, the decreased availability of qualified clinical laboratorians in remote areas will adversely affect the ability to effectively serve the healthcare needs of that population.”

“With the implementation of health care reform, the need for more accessible and less expensive laboratory testing is inevitable. The trend over the past decade that has resulted in fewer numbers of medical laboratorians entering the field will undoubtedly combine with the need for more accessible and less expensive lab testing to create the potential for a lack of service excellence in our field.”