Relevance of Clinical Laboratory Immunology for Health Care in the 21st Century
The face of health care in the United States has changed and will continue to change with widespread implementation of the Affordable Healthcare Act. Recent estimates from the Office of the Actuary at the Centers of Medicare and Medicaid Services indicate that health care spending will steadily increase at an average annual rate of 5.8% between 2012 and 2022, thereby comprising approximately 20% of the gross domestic product by 2022.7 Laboratory tests presently account for approximately 4% of health care costs and this share is projected to increase at an annual rate of 20% to 25%. However, coupled with this growth is proposed legislation that will decide the future of laboratory test reimbursements, with higher-volume tests targeted for reduced reimbursement bundling of tests on the hospital side of testing. The new reality of laboratory test reimbursements mandates a new approach and paradigm to diagnostic testing, such that the "value" component is satisfied. As good stewards of laboratory resources, laboratorians should ensure that value is obtained from diagnostic testing by advocating the right test for the right patient at the right time, performed in the right way. Thus, "value" in the diagnostic laboratory setting could be defined as outcomes plus service plus safety measured by cost over time. An optimal approach to diagnostic immunology testing is profoundly limited by a lack of understanding on the part of physicians in medical specialties of the complete scope and utility of the tests ordered. This problem is compounded both by the increased availability of an array of esoteric and complex immunology tests as well as the huge "information explosion" in the field of clinical immunology. The concept of test utilization necessitates a new role for the diagnostic immunologist/laboratorian as an integrator, ie, gatekeeper and content expert, for the laboratory evaluation of immunologic diseases. Therefore, training programs and board certification directed specifically toward clinical laboratory immunology have immense value because these trained individuals will form the "new face" of laboratory testing in the 21st century health care environment.