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Medicare Laboratory Payment Policy: Now and in the Future (2000)

Chapter: Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000

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Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

APPENDIX D
Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996–1998, 1999-Early 2000

Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

TABLE D.1 Estimated Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaiveda Test Status, 1996

Facility Type

Number of Laboratories

Waived Test Volume

Nonwaived Test Volume

Total Test Volume

Hospital

8,888

91,883,111

2,886,279,172

2,978,162,283

Independent

5,751

15,886,008

1,529,300,443

1,545,166,451

Physician

Physician office

89,432

119,593,903

402,642,748

522,236,651

Community clinic

5,016

15,104,518

46,914,077

62,018,595

Health maintenance organization

959

6,879,396

58,602,448

65,481,844

Other practitioner

2,135

3,353,899

34,017,314

37,371,213

Total Physician

97,542

144,931,716

542,176,587

687,108,303

Other

11,216

64,978,527

235,688,932

300,667,459

Blood bank

338

9,037,496

108,378,714

117,416,210

Insurance

38

953,783

88,211,516

89,165,299

Ambulatory surgery center

1,160

1,892,906

24,881,423

26,774,329

Comp. outpatient rehabilitation facility

60

152,069

344,189

496,258

Ancillary test site in health facility

2,254

21,152,745

54,292,331

75,445,076

Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

End-stage renal dialysis facility

1,919

7,034,302

3,698,366

10,732,668

Health fair

213

452,066

8,433,499

8,885,565

Home health agency

8,676

9,193,602

734,261

9,927,863

Hospice

596

377,998

2,020,628

2,398,626

Industrial

1,343

1,006,668

6,516,089

7,522,757

Intermediate care facility

626

419,097

1,570,654

1,989,751

Mobile unit

718

1,166,534

596,277

1,762,811

Pharmacy

288

150,911

142,638

293,549

School or student health service

1,175

1,072,946

3,797,719

4,870,665

Skilled nursing or nursing facility

13,933

37,638,543

5,968,203

43,606,746

Tissue bank

29

92,580

5,519,625

5,612,205

Rural health clinic or federally qualified health centerb

Ambulanceb

Total Other

44,582

156,772,773

550,795,064

707,567,837

Total, All Facility Types

156,763

409,453,608

5,508,551,266

5,918,004,874

aTests are put in the waived category under (CLIA) regulations if they are simple to conduct, highly trained staff is not needed, and the chances for error are small. Facilities that conduct only waived tests do not have to meet the same personnel requirements as facilities that conduct moderate- or high-complexity tests.

bNew facility types effective November 1998.

SOURCE: 1996 CLIA Provider Files. Health Care Financing Administration.

Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

TABLE D.2 Estimated Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaiveda Test Status, 1997

Facility Type

Number of Laboratories

Waived Test Volume

Nonwaived Test Volume

Total Test Volume

Hospital

8,766

95,533,576

2,890,447,242

2,985,980,818

Independent

5,246

16,010,004

1,694,570,874

1,710,580,878

Physician

Physician office

91,979

125,431,118

531,817,599

657,248,717

Community clinic

5,667

16,507,804

56,348,445

72,856,249

Health maintenance organization

872

6,139,609

59,289,436

65,429,045

Other practitioner

2,113

3,087,842

38,034,249

41,122,091

Total Physician

100,631

151,166,373

685,489,729

836,656,102

Other

12,190

65,765,571

329,945,790

395,711,361

Blood bank

341

8,984,653

112,267,650

121,252,303

Insurance

36

953,348

106,422,639

107,375,987

Ambulatory surgery center

1,474

1,906,826

22,801,571

24,708,397

Comp. outpatient rehabilitation facility

86

120,763

313,722

434,485

Ancillary test site in health facility

2,629

22,165,830

57,195,905

79,361,735

Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

End-stage renal dialysis facility

2,343

7,916,703

7,394,763

15,311,466

Health fair

262

536,936

8,229,977

8,766,913

Home health agency

11,202

10,594,655

759,040

11,353,695

Hospice

829

301,566

1,587,633

1,889,199

Industrial

1,375

993,481

19,482,917

20,476,398

Intermediate care facility

700

543,964

1,658,198

2,202,162

Mobile unit

1,074

1,403,132

2,871,039

4,274,171

Pharmacy

677

312,452

149,426

461,878

School or student health service

1,372

1,155,195

4,430,107

5,585,302

Skilled nursing or nursing facility

14,389

39,749,678

3,916,131

43,665,809

Tissue bank

33

93,830

5,492,474

5,586,304

Rural health clinic or federally qualified health centerb

Ambulanceb

Total Other

51,012

163,498,583

684,918,982

848,417,565

Total, All Facility Types

165,655

426,208,536

5,955,426,827

6,381,635,363

aTests are put in the waived category under (CLIA) regulations if they are simple to conduct, highly trained staff is not needed, and the chances for error are small. Facilities that conduct only waived tests do not have to meet the same personnel requirements as facilities that conduct moderate- or high-complexity tests.

bNew facility types effective November 1998.

SOURCE: 1997 CLIA Provider Files. Health Care Financing Administration.

Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

TABLE D.3 Estimated Annual Volume of Laboratory Tests by Laboratory Type and Waived-Non-waiveda Test Status, 1998

Facility Type

Number of Laboratories

Waived Test Volume

Nonwaived Test Volume

Total Test Volume

Hospital

8,644

94,196,474

2,861,419,809

2,955,616,283

Independent

4,871

15,272,621

1,380,135,459

1,395,408,080

Physician

Physician office

93,763

129,153,794

363,417,570

492,571,364

Community clinic

5,535

15,390,658

42,097,551

57,488,209

Health maintenance organization

751

5,042,666

30,487,001

35,529,667

Other practitioner

2,004

2,984,083

24,256,184

27,240,267

Total Physician

102,053

152,571,201

460,258,306

612,829,507

Other

11,995

64,685,709

217,678,933

282,364,642

Blood bank

316

8,595,502

96,113,181

104,708,683

Insurance

36

952,898

88,346,869

89,299,767

Ambulatory surgery center

1,507

1,933,819

20,287,811

22,221,630

Comp. outpatient rehabilitation facility

91

130,747

313,462

444,209

Ancillary test site in health facility

2,384

21,546,469

34,021,429

55,567,898

Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

End-stage renal dialysis facility

2,386

7,742,580

5,875,977

13,618,557

Health fair

270

656,215

5,622,353

6,278,568

Home health agency

10,859

10,245,942

423,745

10,669,687

Hospice

847

305,926

1,415,242

1,721,168

Industrial

1,363

963,861

6,030,475

6,994,336

Intermediate care facility

665

520,100

624,787

1,144,887

Mobile unit

1,094

1,131,722

280,678

1,412,400

Pharmacy

773

447,319

110,149

557,468

School or student health service

1,379

1,214,093

3,648,558

4,862,651

Skilled nursing or nursing facility

14,008

38,971,818

3,006,791

41,978,609

Tissue bank

31

93,830

5,416,065

5,509,895

Rural health clinic or federally qualified health centerb

Ambulanceb

Total Other

50,004

160,138,550

489,216,505

649,355,055

Total, All Facility Types

165,572

422,178,846

5,191,030,079

5,613,208,925

aTests are put in the waived category under (CLIA) regulations if they are simple to conduct, highly trained staff is not needed, and the chances for error are small. Facilities that conduct only waived tests do not have to meet the same personnel requirements as facilities that conduct moderate- or high-complexity tests.

bNew facility types effective November 1998.

SOURCE: 1998 CLIA Provider Files. Health Care Financing Administration.

Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

TABLE D.4 Estimated Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaiveda Test Status, 1999-Early 2000

Facility Type

Number of Laboratories

Waived Test Volume

Nonwaived Test Volume

Total Test Volume

Hospital

8,560

95,931,042

2,862,826,492

2,958,217,534

Independent

4,936

15,057,780

1,499,093,551

1,514,151,331

Physician

Physician office

96,357

133,563,773

347,739,610

481,303,383

Community clinic

5,978

18,360,107

40,200,559

58,560,666

Health maintenance organization

717

4,768,920

79,774,094

84,543,014

Other practitioner

2,037

3,350,368

28,679,024

32,029,392

Total Physician

105,089

160,043,168

496,393,287

656,436,455

Other

12,605

66,900

265,612,004

265,678,904

Blood bank

340

9,044,389

74,538,000

83,582,389

Insurance

44

961,946

79,440,076

80,402,022

Ambulatory surgery center

1,943

2,239,255

19,114,207

21,353,462

Comp. outpatient rehabilitation facility

107

317,250

450,541

767,791

Ancillary test site in health facility

2,650

22,437,640

4,116,747

26,554,387

Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

End-stage renal dialysis facility

2,804

8,628,068

2,386,960

11,015,028

Health fair

315

501,270

12,732,801

13,234,071

Home health agency

8,461

17,570,371

326,868

17,897,239

Hospice

897

1,028,376

1,733,518

2,761,894

Industrial

1,428

954,110

6,224,404

7,178,514

Intermediate care facility

696

538,212

944,477

1,482,689

Mobile unit

1,203

1,663,769

2,140,582

3,804,351

Pharmacy

1,450

910,779

81,794

992,573

School or student health service

1,526

1,314,250

3,666,849

4,981,099

Skilled nursing or nursing facility

14,695

43,496,738

3,056,795

46,553,533

Tissue bank

41

99,930

7,633,868

7,733,798

Rural health clinic or federally qualified health centerb

233

699,531

431,327

1,130,858

Ambulanceb

79

20,360

-

20,360

Total Other

51,517

112,493,144

484,631,818

597,124,962

Total, All Facility Types

170,102

382,985,134

5,342,945,148

5,725,930,282

aTests are put in the waived category under (CLIA) regulations if they are simple to conduct, highly trained staff is not needed, and the chances for error are small. Facilities that conduct only waived tests do not have to meet the same personnel requirements as facilities that conduct moderate- or high-complexity tests.

bNew facility types effective November 1998.

SOURCE: March 2000 CLIA Provider Files. Health Care Financing Administration.

Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
Page 220
Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system.

Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.

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