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New data: how labs help hospitals weather DRGs.

Under nationwide DRG-based prospective payment, the hospital lab's shift from revenue center to cost center sometimes sounds like a reason to be defensive or apologetic about performing tests. But more and more evidence verifies that laboratory procedures can do a great deal to help hospitals stay afloat in the DRG system.

Much of the evidence is harvested from New Jersey, that early testing ground for Diagnosis Related Groups. Extensive interviews in MLO's January 1984 cover story--"The Impact of DRGs on New Jersey Labs"--documented just how hospital labs are optimizing clinician utilization of their services, accelerating diagnostic protocols, and reducing turnaround time.

Now comes a study disclosing that hospital administrators consider these moves highly important responses to the challenge of prospective payment. Forty-seven New Jersey hospitals participated in the study, which was conducted by the Medical Research Bureau of Minneapolis and the New Jersey office of Touche Ross and Co. for Du Pont's Diagnostic and BioResearch Division (the study's universe was the state's 59 hospitals using Du Pont ACAs).

Thirty-three laboratory managers as well as 34 administrators were polled. Administrators alone were first asked about four strategies to reduce average length of stay. Sixty-five per cent said efforts to cut diagnostic time are boost preadmission testing are critical for reducing length of stay, while 59 per cent said programs to disseminate DRG information 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 more preadmission testing since DRGs, increases were reported by 61 per cent of the labs engaged in organ profiling, 50 per cent of the labs performing off-hours testing, and 42 per cent of those doing mass profiling. A third of the labs also had higher. Stat volume since DRGs. Preadmission testing is almost universal--98 per cent of the hospital labs in the study report they follow the practice.

Total test volume has climbed at the majority of labs since DRGs were introduced. Hospitals entered the program over a three-year period, and a study summary says testing increases "as hospitals gain experience with the program" (Figure II).

The majority of hospitals have made changes to cut turnaround time in each of three areas--getting the specimen to the lab, testing, and delivering results. Faster reporting of results topped the list, cited by 85 per cent for effectiveness in reducing length of stay.

As for changes made to reduce test analysis time, automation was implemented by 72 per cent of the labs. Adding staff ranked second, mentioned by 24 per cent. Other moves to cut testing time ranged from steps to raise staff skill levels and schedule changes to adding computers 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 and trends. Look for it in the December issue.
COPYRIGHT 1984 Nelson Publishing
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Copyright 1984 Gale, Cengage Learning. All rights reserved.

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Author:Fitzgibbon, Robert J.
Publication:Medical Laboratory Observer
Article Type:editorial
Date:Sep 1, 1984
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