When doing a macro cost analysis, the first step is determining the number of reportable patient tests done over a specific period. This is a routine data collection process for most laboratories because this number is required for accreditation and is helpful to the administration in accessing productivity. The next step is to perform the cost study breaking the costs down into fixed and variable. Once the cost data has been determined for the cost/revenue centers, the total, fixed, and variable costs are divided by the reportable patient tests to determine the cost per reportable (billable) test for these categories. These are valuable indices to watch over time to help determine if productivity is increasing, decreasing, or stable. If unfavorable variations occur in a specific category, this is an area to investigate. Table 3 depicts a sample macro cost analysis for a hematology section of a clinical laboratory. The variable costs in this example are the costs that can potentially be altered. The fixed costs are much harder to alter. In this example, reducing variable costs for supplies and reagents, purchased services, variable salaries and wages (possibly overtime), unscheduled maintenance, and eliminating paper reports by implementing electronic reports could result in a better total and variable cost per reportable test index.
Table 3 Hematology Laboratory Macro Cost Analysis
| Cost Description | Annual Costs | Fixed | Variable |
| Direct Costs | | | |
| Salaries & wages | $150,000 | $130,000 | $20,000 |
| Purchased services | $50,000 | | $50,000 |
| Supplies & reagents | $110,000 | | $110,000 |
| Instrument depreciation cost | $15,000 | $15,000 | |
| SUBTOTAL | $325,000 | $145,000 | $180,000 |
| note: variable Salaries and wages cost is from overtime | | | |
| Indirect Costs | | | |
| Minor equipment | $1,000 | $1,000 | |
| Report from printing | $1,500 | | $1,500 |
| Unscheduled maintenance | $5,000 | | $5,000 |
| Scheduled maintenance | $13,500 | $13,500 | |
| SUBTOTAL | $21,000 | $14,500 | $6,500 |
| 100,000 reportable tests | | | |
| TOTAL DIRECT & INDIRECT COSTS | $346,000 | $159,500 | $186,500 |
Performing the macro cost analysis regularly (monthly) will assist the laboratory manager in recognizing seasonal variations in cost per test and provide a stimulus to look at adjustment strategies if the variations seem pretty significant. For example, in a university laboratory, the number of laboratory tests done in the summer might drop by 50% or more with fewer students enrolled. A strategy would be to recruit laboratory personnel that would like summers off or a reduced number of days during the summer. Another possibility might be to outsource low-volume tests during the summer allowing for seasonal adjustments in labor. Hospital laboratories may have seasonal adjustments in cost per test depending on the demographics of the population they serve. A good strategy for maintaining productivity would be to reduce costs during significant downswing periods.
