192 Inpatient Reference Laboratory Test Utilization at Kingman Regional Medical Center, 2023 to 2025

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Abstract Introduction/Objective This study examines the cost versus volume utilization of Kingman Regional Medical Center inpatient reference testing from January 2023 to January 2025. The analysis focuses on identifying high-cost tests, tests with significant cost discrepancies, and tests with long turnaround times. Key findings include the identification of tests that are not suitable for inpatient settings due to their high costs and long turnaround times. Recommendations are provided to optimize test utilization, improve patient care, and reduce healthcare costs. Methods/Case Report Inpatient reference testing records from January 2023 to January 2025 were analyzed. The data was extracted from Business and Clinical Applications (BCA), Meditech, and Kingman Regional Medical Center’s Structured Query Language (SQL) databases. Inclusion criteria were limited to completed tests, ordered for patients admitted for inpatient care between January 2023 and January 2025, and performed by Mayo Clinic Laboratories. Exclusion criteria encompassed cancelled orders, tests performed by Laboratory Corporation of America (LabCorp) or other external reference laboratories, and tests originating from outpatient settings. The study focused on quantitative analysis of test volume, cost, and turnaround time. Data analysis was performed using Microsoft Excel. Analytical methods included the calculation of total charges, identification of high-cost tests, and comparative analysis of utilization patterns against established benchmarks. From the data analyzed, an test restriction evaluation matrix was created that considered clinical insignificance, substantial cost burdens, unfavorable reimbursement dynamics, Prolonged turnaround times and the inherent financial risk associated with the volume of certain high-cost, low-reimbursement tests, amplifying their overall economic impact on the institution. Results During the study period, 255 unique tests totaling 2039 were performed, with total estimated reimbursements ranging from $88,768.80 to $887,688. The laboratory would achieve a positive margin if average reimbursements exceeded 12%, while rates below 10% would create a substantial financial burden due to $92,878.53 in reference lab costs. Fourteen high-charge tests (>$200) and 58 tests priced above $50 were identified. Leukemia/Lymphoma Phenotype testing showed the largest cost difference, with reference lab charges exceeding hospital charges by $1,649.21. Several tests with minimal cost differences warrant pricing review. Turnaround time analysis revealed that many tests, including those with high charges or cost discrepancies, had turnaround times of 3-5 days, extending to 5-7 days with shipping. This delay could lead to discharge before results are available, potentially impacting reimbursement, especially considering Arizona’s average inpatient stay of 5 days. Tests with even longer turnaround times (7-14 days) pose further challenges. In consultation with the clinical decision team, 25 tests have so far been restricted from inpatient ordering, the highest volume test Coccidioides Ab Screen is now offered inhouse, and more are still under review. Conclusion This study analyzed inpatient laboratory test utilization based on cost, reimbursement, and turnaround time. It identified high-cost, low-reimbursement tests with long turnaround times as candidates for restriction. Conversely, most high-volume tests were recommended for review with a focus clinical significance, optimizing testing algorithms and in-house options. The study concludes that a data-driven approach is crucial for balancing diagnostic needs with financial responsibility and efficient patient care, guiding test ordering practices and resource allocation.

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