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A microcomputer test-costing program.

A microcomputer test-costing program

Financial challenges keep expanding the areas of responsibility for clinical chemists and laboratory managers, impelling them to continuously make cost analyses and comparisons.

At our 500-bed metropolitan teaching hospital, determination of test costs for reportable patient results has become a most important task. To carry it out, we have developed and refined a microcomputer program called Testcost over the last 2 1/2 years.

The program has helped us answer a wide variety of critical financial questions. For example, should we perform clinical toxicology analyses on-site or at a reference laboratory? Should we acquire a dry-slide chemistry analyzer? What is a reasonable, competitive price for the reference toxicology procedures we perform? Which of our chemistry instruments --a discrete test-pack analyzer, a wet chemistry batch analyzer, or a centrifugal batch analyzer--can perform high-volume tests like magnesium, iron, TIBC, theophylline, and acid phosphatase in the most cost-effective manner?

In its latest version, this program meets most current laboratory test-costing needs. It can be rapidly and effectively used to do the following: 1) determine cost per reportable patient result; 2) calculate a cost-effective batch size; 3) perform break-even analysis; 4) identify constant and variable costs; 5) forecast costs based upon changes in fixed or variable expenses; 6) determine test costs on the basis of anticipated volume; and 7) account for all the "hidden' factors (calibration costs, instrument depreciation, workload units, etc.) when performing instrument/method cost comparisons.

Written in Basic, the program can be used on the IBM PC and Apple IIe. It is screen-interactive and requires entry of up to 28 variables. Data for CK isoenzyme cost calculations, entered in response to screen prompts, are shown in Figure I. Most entries fall into six major cost categories: consumables, reagents, labor, calibration, instrument depreciation, and service or maintenance.

The user may select either a break-even or a batch-size mode. In the former case, a predetermined dollar amount would be entered, perhaps to match a reference lab's price for a particular test. In the latter case, the user might enter the laboratory's current batch size or a larger batch size that is anticipated as a result of new business. The program then calculates incremental costs--expenses per test when one patient test is run, when two patient tests are run, when three are run, and so on--until the predetermined dollar amount or batch size is reached. At that point, a detailed breakdown of cost per reportable patient result is displayed on the screen and run on the printer (Figure II).

Flags in the program alert the user when an entered batch size exceeds either the number of tests in a kit (cost calculations are based on that number) or the physical limitations of the instrument. Provision is also made for the duplicate testing required in RIA and other immunoassay methods. Additions to the program include a subroutine to calculate the cost of reagents formulated in the laboratory or of reagents purchased in bulk, and an optional calculation of indirect costs as an assigned percentage of direct costs.

This accurate test-costing program has contributed strongly to effective financial management during our hospital's transition to prospective payment. Readers interested in obtaining information about the program may write to the author at the Clinical Laboratory, Mt. Sinai Medical Center, University Circle, Cleveland, Ohio 44106.

Photo: Figure I Entering cost data in response to screen prompts

Photo: Figure II CK isoenzyme test cost calculations
COPYRIGHT 1986 Nelson Publishing
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Copyright 1986 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Sealfon, Michael S.
Publication:Medical Laboratory Observer
Article Type:column
Date:Dec 1, 1986
Previous Article:Quality control in the new environment: statistics.
Next Article:Dealing with over-the-counter tests.

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