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Controlling the Hemorrhage of Routine Coagulation Tests-Reply

Stephen B. Erban, MD
JAMA. 1990;263(20):2750. doi:10.1001/jama.1990.03440200051018.
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In Reply.—  Dr Fox is clearly correct in his assertion that hospitals can generate significant profit from laboratory tests, but I disagree that this is the sole reason why unnecessary ordering of tests such as the prothrombin time and partial thromboplastin time has endured despite "education and other types of feedback." Many physicians continue to order these and other tests because of force of habit or fear of litigation1 and probably not out of some sense of financial responsibility to the hospital. As the number of capitated patients in any hospital rises, the profit to be gained by laboratory testing declines. Perhaps this factor may lend added incentive for hospital administrators to devise new methods for decreasing the use of unnecessary laboratory tests.Although our article used direct costs for our analysis, these figures excluded other potential costs such as those associated with the evaluation of false-positive results.2

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