The U.S. Medical Laboratories Industry (9th Edition)

Table of Contents

Introduction: Report Scope & Methodology

Executive Overview of The Industry: Major Findings

• Nature & Characteristics of The Industry: Discussion of industry characteristics, influence of government agencies, routine vs. esoteric tests, in-hospital, commercial and physician-office labs, how tests are processed, lab facilities (regional labs, sales ports, collecting stations, etc.), industry structure, lab marketing and advertising practices.
• Highlights of ALL chapters: Discussion of 2005-2006 key industry trends & developments, discussion of industry consolidation, market size (1993-2005 actual, 2006 & 2007 estd., 2008-2012 forecasts), share of mkt. by hospitals, commercial labs, POLs, home test mkts., size/outlooks for the major test mkts. (Pap tests, drug tests), nature/size of esoteric test mkt. (list of top competitors/sales), industry structure & key operating ratios of medical labs, industry profitability. Includes tables, opinions of brokerage analysts, industry consultants, recent legislative developments.

Market Size, Growth, Market Segments

• Discussion of industry size as estimated by: brokerage firm analysts, major lab chains, consulting firms, government sources - merits/limitations of each.
• Government Census: commercial lab receipts (1980-2005), annual percent changes, analysis
• Competitor & brokerage analyst estimates of industry size, comparison, discussion (1999-2007),receipts as % total health care expenditures
• Marketdata estimates of industry size: 1993-2006, industry demand factors/indicators, forecast for 2007-2012 for lab receipts & healthcare expenditures
• Industry receipts by test segment (routine, esoteric, anatomic pathology (1999-2006, 2007-2012 projections, in dollars and as % total industry)
• Composite weighted sales increase for 2003 of 12 leading lab firms.
• Major test provider share of industry sales: breakdown by: hospital labs, independent commercial labs, physician office labs, other (1999-2006, $ and % of total, 2012 projections)
• 10 largest medical lab companies: 2004 7 2006 receipts.

THE MAJOR LAB TEST MARKETS:

The Pap Smear Test Market

• Summary of Pap screening, evolution of guidelines from 1990s to date
• Analysis of new technologies boosting growth of this segment: Cytyc' s ThinPrep test vs.AutoPap test by Tripath Imaging, DNA Pap test by Digene, etc.
• Profiles/descriptions & Revenues of Cytyc, Digene, Tripath Imaging
• Demographics of users: results of Prevention Index survey (frequency of testing: 1987-95, demographics), Natl. Health Interview Survey (demographic profile of women tested)
• Market Size: Marketdata & competitor estimates of no. of tests performed and $ value, historical and current year, growth rate, avg. prices,
• Who performs Pap tests?, public vs. private sector (Planned Parenthood tests 1986-2005, no. performed by physician offices for 1990-2005).
• Discussion: Can existing professionals handle the work volume? No. of cytology training programs, rebound since 1988, 2006 salaries/vacancy rate of cytotechs, daily workload limits, recent reforms, discussion of past error rates, poor work/screening practices

The Employee Drug Testing Market

• Estimated cost of drug abuse in the U.S. workplace, societal costs
• Size/growth rate of testing, no. of tests done, scope of drug testing in U.S. today, estimated no. of workers tested, transportation workers (NIDA, trade journals opinions, AMA)
• Types of drug tests used (urine, blood, hair), shift to hair and saliva analysis - discussion of new emerging tests, changes in Federal testing planned (SAMHSA)
• Trends in drug use: formation of DATIA trade assn., latest 2006 findings of Quest Drug Testing Index (1988-2003), increase in amphetamine usage, test positive rate trends
• Table: annual positivity rates for U.S. workforce: 1988-2006
• Table: positivity rates, by type drug: 2002-2006, by testing reason: 2002-2006

• Market size: Marketdata estimates of drug test mkt. $ value,/growth for 1989-2006, demand, outlook to 2010 F-negative effects of a recession and hiring on mkt., reasons for flat growth major competitors involved, avg. test costs
• Table: Estd. Revenues of the top 5 drug testing companies: 2004-2006
• The home drug test market. Nature of, Mkt. size estimates, problems testing teens
• Testing by the insurance industry: Discussion of, Lab One, Clinical Reference Labs, Osborn Labs - estimated shares of market, mkt. size in $
• Major findings of AMA Drug Testing Survey (2004 is latest): prevalence of testing, by corporations,testing of current employees, new hires, test-positive rates, employer actions, avg. cost per employee, effectiveness, testing methods used, etc.
• 2004 AMA survey results: workplace medical testing, 1997-2003 trends: tables for… testing rates by companies for new hires/current workers, reasons for drug testing, historical dat
• The private sector - worker privacy issues, court rulings, random testing, state policies
• The public sector - DOT/transportation worker testing (regulated industries): labs qualified by SAMHSA, certification requirements

List: Name, address, phone no. of the 48 labs certified by NIDA for federal testing.

Competitor Profiles (in-depth descriptions, estd. and actual drug test revenues, etc.) for: Quest Diagnostics, Lab Corp. of America (and labOne), Medtox Scientific.

The Esoteric Test Market

• Discussion of what defines esoteric vs. routine tests, no. of labs performing, major trends emerging (pricing, effect on billing practices)
• Coverage of latest mkt. developments
• Competitor & brokerage analyst estimates of esoteric vs. routine, other test segments
• Discussion of Genzyme Genetics report re genetic testing mkt. (2001-20050
• Market size/growth: sources of data (The Dark Report, Lab Industry Report, Genzyme, Marketdata research, estimates), analysis of mkt. $ size and rationale for estimates. Analysis of growth - 2000-2006 mkt. size estimate, 2012 forecast.
• Ranking of top companies in the market: 2006 (Marketdata estimates or actual sales),
• The 7 main classes of esoteric tests (oncology, immunology, toxicology, genetics, hematology, etc.)

Competitor Profiles

(address, capabilities, specialties, no. of tests performed, revenues-when available) for: ARUP, American Esoteric Labs, Bio-Reference Labs, Clinical Pathology Labs, Genzyme, LabCorp of America (Esoterix, Dianon, Viromed, Dynacare), Mayo Medical Labs, Medtox Scientific, Quest Diagnostics (AML, Ameripath, Unilab, LabOne).

Physician-Office Labs

• Discussion of estimated number in U.S., growth/decline, regulations that have cut their share of industry revenues, estd. current share of industry receipts in 2006, effects of CLIA on group practices, historical investigations about overuse of lab tests, conflicts of interest, debates, etc. Brokerage firm estimates.

Tables:

• No. of POLs, by lab type (2006 CMS data)
• POLs, by CLIA certification type (2006)
• No. of labs, by type/location of facility (2006 CMS data)
• No. of all labs and POLs, CLIA registered: 1993-2006
• POLs, by application type: 1995-2005
• Annual receipts and avg. receipts per POL: 1999-2006, projected 2007-2012

Structure & Operating Ratios Of The Commercial Lab Industry

• Summary and discussion of key findings: no. of US labs, 1982-2002 20-year industry ratios summary, single vs. multi-unit operations, legal form of organization, ratios by receipts size of company & establishment (lab), top 50 firm' s mkt. share levels, geographic analysis/receipts by state (1997 vs. 2002 Census data), financial health/composite industry balance sheet ratios
• Discussion of 2002 Census data (estabs, receipts, avg. receipts per estab., lab revenues by type, top 50 mkt. share ratios, etc.).

Tables:

• 20-year summary of industry structure: 1982-2002
• Non-employer stats. For 2002, receipts, by legal form of company
• Medical labs, by legal form of organization: 2002, 1997 & 1992 (corporation, individual proprietorship, partnership, etc.)
• Industry concentration ratios: 2002, 1997 & 1992
• Medical labs, by annual receipts size of FIRMS: 2002, 1997 & 1992, (no. of firms, labs, receipts, as % total industry)
• Medical labs, by receipts size of FIRMS (under $100,000/yr.-$100+ mill.): 2002, 1997 & 1992, receipts, annual payroll as % receipts, no. of employees)
• Medical labs, by receipts size of ESTABLISHMENTS (under $10,000/yr.-$10+ mill.): 2002, 1997 & 1992, receipts, annual payroll as % receipts, no. of employees)
• Labs' ratios (as above) by single vs. multi-unit operations: 2002, 1997 & 1992
• No. of medical labs, by state: 1997 vs. 2002
• No. and receipts of labs, avg. receipts per lab, by state: 1997 vs. 2002
• Receipts of medical labs, ranked by state (1992, 1997, 2002)
• Composite financial statement for medical labs as a group- average balance sheet & income statement: 2002-2006.

Lab Staff Issues: Salaries, Vacancy Rates, Turnover

• Results of 2005 ASCP/Lab Medicine Magazine Survey:
  • Discussion of hourly wages and % increases in beginning/avg. pay scales: medical technologists, cytotechs, histologic techs, ML techs, phlebotomists, national data:2000-2005 comparisons.
• U.S. Bureau of Labor Statistics data: employment of lab techs/technologists: 2000-2005, no. employed and avg. annual income, 2007-2014 projections
• Summary of ASCT salary survey, Nov. 2006, cytotech vs. other positions, yearly salaries
• Vacancy rates: ASCP 2005 survey (budgeted vs. vacant positions), ASCT survey findings, percent of labs with vacancies, by region.
  • Table: cytotechs avg. starting salaries: 1981-2003
  • Table: Percent increases in median avg. hourly pay, by job (staff, supervisors) 2000-2003
  • Table: Lab personnel, avg. hourly pay, by job - 2000, 2002, 2003
  • Table: Lab staff vacancy rates, by job - 1990-2000
  • Table: No. of cytotechnology programs, no. of students placed: 1976-2004

• Medical Lab Observer Magazine 2003-2007 survey highlights:
  • Summary & discussion of, tables for:
    • Annual salary, medians: 2002-2007, by 7 job types, staff & supervisory
    • Annual salary, medians: 2002-2007, by region
    • Annual salary, medians: 2002-2007, by education
    • Annual salary, medians: 2002-2007, by years in the field
• Discussion of medical lab staff training programs
• Tables:
  • no. of accredited cytotechnology programs: 1976-2000
  • grads from accredited programs: 2001-2004, annual increase in workforce
  • projected yearly increase in medical lab techs 2005 to 2014

Company Profiles - The Top Industry Competitors

(For most companies below: historical development of firm, kinds of tests performed, 2004-2006 financial performance, divisional breakdowns and structure, recent mergers, acquisitions or joint ventures, marketing agreements, company strategies, etc.)

• American Esoteric Labs
• AmeriPath
• Associated Regional & University Pathologists
• Bio-Reference labs
• Clinical Pathology Labs
• Laboratory Corp. of America Holdings
• Mayo Medical Laboratories
• Quest Diagnostics
• Spectrum Laboratory Network
• Sonora Quest Laboratories

Reference Directory Of Industry Information Sources

(Lab industry trade associations, trade journals, consulting firms, government agencies, special reports and surveys, stock analysts, etc.), address, phone, key contacts