To place a cloak of reality on business prognostications, the first questions to answer are (1) what is the real business in consideration, (2) what are the components or analogs to that business that may be affected differently by the predictions, (3) what are the key drivers that help direct change in that business, and (4) what are the key impediments to change? The business in consideration is not simply performing laboratory testing but rather the delivery of diagnostic medical information to health care providers. Hospital-based outreach laboratories are in the business because they can generate revenue from underutilized capacity. The hospital requires a laboratory, already has significant sunk costs in the form of equipment and staffing, and must maintain excess capacity especially at night. Therefore, additional specimens from novel sources can generate revenue at the margin. Political reasons to provide the service may also exist, but essentially, hospital-based laboratories got into the business because they had capacity, there was a need, there was a market, and there was potential revenue flow. They stay in the business because they are accustomed to the cash flow and the local political goodwill is often strong.