Under nationwide DRG-based prospective payment, the hospitallab’s shift from revenue center to cost center sometimes soundslike a reason to be defensive or apologetic about performing tests.
Butmore and more evidence verifies that laboratory procedures can do agreat deal to help hospitals stay afloat in the DRG system. Much of the evidence is harvested from New Jersey, that earlytesting ground for Diagnosis Related Groups. Extensive interviews inMLO’s January 1984 cover story–“The Impact of DRGs on NewJersey Labs”–documented just how hospital labs are optimizingclinician utilization of their services, accelerating diagnosticprotocols, and reducing turnaround time. Now comes a study disclosing that hospital administrators considerthese moves highly important responses to the challenge of prospectivepayment.
Forty-seven New Jersey hospitals participated in the study,which was conducted by the Medical Research Bureau of Minneapolis andthe New Jersey office of Touche Ross and Co. for Du Pont’sDiagnostic and BioResearch Division (the study’s universe was thestate’s 59 hospitals using Du Pont ACAs). Thirty-three laboratory managers as well as 34 administrators werepolled. Administrators alone were first asked about four strategies toreduce average length of stay.
Sixty-five per cent said efforts to cutdiagnostic time are boost preadmission testing are critical for reducinglength of stay, while 59 per cent said programs to disseminate DRGinformation and speed stepdown of care levels are important. Figure I, based on data from both administrators and lab managers,details rising lab activity in a number of areas. In addition to morepreadmission testing since DRGs, increases were reported by 61 per centof the labs engaged in organ profiling, 50 per cent of the labsperforming off-hours testing, and 42 per cent of those doing massprofiling. A third of the labs also had higher.
Stat volume sinceDRGs. Preadmission testing is almost universal–98 per cent of thehospital labs in the study report they follow the practice. Total test volume has climbed at the majority of labs since DRGswere introduced. Hospitals entered the program over a three-yearperiod, and a study summary says testing increases “as hospitalsgain experience with the program” (Figure II).
The majority of hospitals have made changes to cut turnaround timein each of three areas–getting the specimen to the lab, testing, anddelivering results. Faster reporting of results topped the list, citedby 85 per cent for effectiveness in reducing length of stay. As for changes made to reduce test analysis time, automation wasimplemented by 72 per cent of the labs. Adding staff ranked second,mentioned by 24 per cent.
Other moves to cut testing time ranged fromsteps to raise staff skill levels and schedule changes to addingcomputers to lab operations. I hope this study has whetted your appetite for more DRG data. MLO is putting together its own 1984 national summary of DRG statistics andtrends. Look for it in the December issue.
