Changing health policies and clinical laboratory services.

Recent changes in Medicare financing policy and in state certificate of need (CON) policies have greatly altered the environment in which hospitals and physicians must operate. These policy changes likely will influence the development, adoption, and use of new technologies, including those employed in clinical laboratories. Some hospitals, particularly large academic health centers, are responding to the new incentives under Medicare prospective payment by (1) implementing integrated case mix and financial information systems, (2) monitoring and evaluating physician practice patterns, (3) improving the quality of analyses underlying their technology acquisition decisions, and (4) striving toward improved relations with medical staff. Clinical laboratories are also responding to these financial pressures through (1) more cautious adoption of new technologies, (2) selective automation of tests that reduce direct costs, (3) more prudent "make-or-buy" decisions regarding test performance sites, and (4) focused effort to improve turnaround times for inpatient testing and reporting.