Controlling the Hemorrhage of Routine Coagulation Tests

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