title: Using fee-for-service testing to generate revenue for the 21st century public health laboratory.
abstract: OBJECTIVE
  The decrease in appropriations for state public health laboratories (SPHLs) has become a major concern as tax revenues and, subsequently, state and federal funding, have decreased. These reductions have forced SPHLs to pursue revenue-generating opportunities to support their work. We describe the current state of funding in a sampling of SPHLs and the challenges these laboratories face as they implement or expand fee-for-service testing.
  
  
  METHODS
  We conducted surveys of SPHLs to collect data concerning laboratory funding sources, test menus, fee-for-service testing, and challenges to implementing fee-for-service testing.
  
  
  RESULTS
  Most SPHLS receive funding through three revenue sources: state appropriation, federal funding, and fee-for-service testing (cash funds). Among SPHLs, state appropriations ranged from $0 to more than $6 per capita, federal funding ranged from $0.10 to $5 per capita, and revenue from fee-for-service testing ranged from $0 to $4 per capita. The tests commonly performed on a fee-for-service basis included assays for sexually transmitted diseases, mycobacterial cultures, newborn screening, and water testing. We found that restrictive legislation, staffing shortages, inadequate software for billing fee-for-service testing, and regulations on how SPHLs use their generated revenue are impediments to implementing fee-for-service testing.
  
  
  CONCLUSIONS
  Some SPHLs are considering implementing or expanding fee-for-service testing as a way to recapture funds lost as a result of state and federal budget cuts. This analysis revealed many of the obstacles to implementing fee-for-service testing in SPHLs and the potential impact on SPHLs of continued decreases in funding.
authors.affiliation: New Hampshire Public Health Laboratories, Virology and STD Laboratory, Concord, NH.
authors.forename: Carol
authors.initials: C
authors.lastname: Loring
authors.forename: R Brock
authors.initials: RB
authors.lastname: Neil
authors.forename: Laura
authors.initials: L
authors.lastname: Gillim-Ross
authors.forename: Matthew
authors.initials: M
authors.lastname: Bashore
authors.forename: Sandip
authors.initials: S
authors.lastname: Shah
mesh_terms: D019411:Clinical Laboratory Techniques / Q000191:economics; D003625:Data Collection; D018588:Fee-for-Service Plans / Q000191:economics / Q000458:organization & administration*; D005380:Financing, Government / Q000191:economics; D006077:Government Agencies / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007753:Laboratories / Q000191:economics* / Q000458:organization & administration; D011634:Public Health / Q000191:economics*; D011635:Public Health Administration / Q000191:economics; D013219:State Government; D014481:United States