Into this whirlpool lands an article by Rogers et al. at Children's Healthcare of Atlanta. (The context above is by me, not the authors). See Archives of Pathology and Laboratory Medicine, here. In the abstract, they write that:
Disruption of outpatient laboratory services by routing the samples to commercial reference laboratories may seem like a cost-saving measure by the payers, but results in hidden costs in quality and resources to support this paradigm...Outpatient testing was sent to 3 different laboratories, specified by the payer.My internist is affiliated with a famous health system, and I've had lab reports in different years come back with circa $150 test charges (from the health system outreach lab) or circa $50 charges (from a reference lab), so I can see the payers' point of view.
Here's the new contribution. Rogers et al. document that turn around times (TAT) to result rise from 1.3 hrs at the hospital lab to 39 hours at the reference lab, and that thousands of delays per annum occurred (such as miswritten date of birth). They assert there are many hidden costs to forced routing of outpatient lab tests away from the health system lab.
Article was covered by Genomeweb's 360DX website, here.
The article contains some interesting information on salary costs for different levels of staff, including computer staff (epub p 2), and interest distribution-of-costs of different phases of lab testing (e.g. their p5 color bar chart, epub p 5).