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Controlling the Hemorrhage of Routine Coagulation Tests

Gary N. Fox, MD
JAMA. 1990;263(20):2749-2750. doi:10.1001/jama.1990.03440200051017.
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To the Editor.—  The article entitled "Routine Use of the Prothrombin and Partial Thromboplastin Times"1 indicates that "education and other types of feedback have been tried with minimal or no long-term reduction in (inappropriate) laboratory use" by physicians. We contend that the reason for this is simple: hospitals generate profit from this testing.In our institution, Medicare patients represent 34% of the volume on a case basis (50% of the volume on a charge basis because of increased length of stay and complexity of illness). The number of patients eligible for testing is calculated on a case basis. If 50% of patients who undergo prothrombin time and partial thromboplastin time studies were funded on a fee-for-service basis and the markup on these tests were 100%, the hospital would break even. The hospital would have no incentive to intervene at this break-even point because of the cost of instituting educational programs


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