Scenario: You are the laboratory manager. The hospital is required to report Clostridium difficile (C. diff) infection rates to the state, which if hospital acquired will result in an omission of reimbursement by Medicare. It is not uncommon for patients to be admitted with C. diff disease, so timing of the sample and testing is important. The hospital has 3 calendar days to investigate the probability of C. diff before it is deemed a hospital acquired infection. Currently, C. diff testing is sent to a reference lab for testing and the turn-around-time (TAT) is over 24 hours. The current cost is $35.43 per test. During this wait, patients are placed in isolation at substantial cost. Administration has asked for testing be brought in-house to improve TAT. The Infection Prevention team is asking to use the same testing platform used by the reference lab for consistency in reporting. Knowing the reference lab performs testing using the GeneXpert Xpress, you contact the vendor who provides a quote. The testing system contains all required consumables to run the test, but not for collection. There are three levels of control that must be run every 8 -hour shift or every time the test is run (that is, no need to run controls if no samples during that 8-hour shift). Your laboratory performs an average of three C. diff assays per shift. To complete the cost benefit analysis, here are some additional items you will need to know: For this test, the patient's stool is collected and put into a single Cary-Blair Transport Media container. Upon arrival in the lab, the technologist will use a single swab to collect the stool for placement into the GeneXpert test cartridge ( 1 cartridge per test or sample). The technologist will use an average of three sets of gloves during the procedure. The tum-around-time, if done in-house, is 1.25 hours. The current CPT reimbursement ( #87493 ) through CMS is $37.27 per test. Questions: Instructions: Please answer the following questions. For short answer questions, please keep the answer short and to the point (no more than a single short paragraph). 1. What is the salary cost as a per reaction figure? (Show calculations) ( 3.5 pts) 2. As a per reaction figure, what is the cost for all three controls during a single shift? (Show calculations) ( 3.5pts) 3. What is the Cepheid GeneXpert cost (instrument, kit, and control) as a per reaction figure? (Show calculations) ( 3.5pts) 4. What is the non-Cepheid consumable cost as a per reaction figure? (Show calculations) ( 3.5pts) 5. What is the direct cost per reaction associated with running this new assay? (Show calculations) ( 3.5pts) 6. What is the total charge per reaction (i.e., the CDM charge)? (Show calculations) ( 3.5pts) 7. Based on total cost to run this test, what is the profit associated with this assay? (3.5 pts)
