Thousands of doctors who used to perform routine medical tests in their offices now send specimens out or send their patients to outside laboratories for even simple tests - practices that usually increase costs for patients. Meanwhile, the cost of performing tests has risen dramatically for the 100,000 to 150,000 in-office physician labs still operating.

The reason is 1,600 pages of federal regulations covering test equipment, procedures and technicians' proficiency resulting from the Clinical Laboratory Improvement Amendments of 1988 (CLIA).

• The CLIA regulations add $1.2 billion to $2.1 billion annually to the cost of health care, according to the Health Care Financing Administration (HCFA).

• The cost of testing for mononucleosis, for instance, has tripled because doctors must now test two additional control specimens.

• According to a study published in the Journal of the American Medical Association in 1994, almost a quarter of all pediatricians have stopped or plan to stop office testing for strep infections.

About 17,000 commercial and hospital medical test labs have been federally regulated since Congress passed the Clinical Laboratory Improvement Amendments of 1967. Physicians' labs were added more than 20 years later due to scare stories in the media alleging inaccurate test results.

Yet evidence gathered by the Ambulatory Sentinel Practice Network suggests that 83.4 percent of lab-related problems occur before or after the actual performance of the tests themselves. And of the 10 problems judged to have a significant impact on patient care, half occurred because specimens were delayed or lost - hazards related to transporting specimens to outside labs.

Source: Sandra Mahkorn, "Cutting Red Tape on Clinical Labs: Why Congress Should Deregulate Doctors," Backgrounder No. 1056, October 10, 1995, Heritage Foundation, 214 Massachusetts Avenue, NE, Washington, DC 20002, (202) 546-4400.