The Drug Testing Controversy

Friday, April 13, 2012 | 0

If patients are prescribed opioids, 'best practices' calls for:

Assessment of risk for dependency and addiction;
Completion of an opioid agreement;
Ongoing assessment of pain and functionality, and
Random urine drug testing (UDT).

This last has become for some yet another of the myriad ways to suck money out of the workers' compensation system. Yet there's no question UDT is a necessary component of opioid management.

The April 9 edition of WorkCompCentral arrived with an excellent piece on the issue authored by Greg Jones. The premise of the article is a flap involving accusations of overbilling by a former employee of a company that allegedly does billing for drug tests.

The details of the controversy aren't what's important.

What's important is for payers to understand two things:

a) drug testing is a critical piece of opioid therapy; and
b) just like physician dispensing, MRIs. Physical therapy, surgery, heck almost anything, it can be gamed, over prescribed, abused, and made into the proverbial money tree.

Properly done, drug testing enables physicians to determine if the patient is taking the prescribed drug; if they're taking other drugs that may be contra-indicated; and/or if the patient is taking illicit drugs. Given the issues with addiction, abuse, diversion, and misuse, drug testing is a critical component of the medical management process.

Grossly over-simplifying the issue, it boils down to this: Fee schedules and reimbursement rules allow physicians and labs to bill multiple codes for multiple 'tests' for different drugs so, the more tests, the more money. Typically, physicians bill for testing that just indicates the likely presence or absence of certain drugs, and a lab bills for 'confirmation' using much more sophisticated processes and technology.

There's a reasonable argument to be made that paying docs to test in their offices encourages compliance with opioid management best practices, as long as the amount paid is also "reasonable." Unfortunately, the research indicates UDT is grossly underutilized; one study found fewer than one of every seven physicians treating patients with opioids test their patients.

In-office testing is also much less reliable than lab-based testing; therefore any office-based test result must be confirmed with a test at an accredited lab.

So, the conundrum is this: payers want to encourage drug testing, but don't want to get stuck with outrageous bills. There are several tactics payers can use.

1. Inform contracted physicians that drug testing in office will be reimbursed at $XX.XX - a flat rate regardless of the number of drugs tested for.
2. Drop physicians who refuse to comply from your network.
3. Require proof of testing and assurance that the prescribing doc has reviewed the test results and factored those results into ongoing treatment.
4. Contract with a lab for a flat fee to cover a comprehensive list of drugs; this ensures the physician has a full view into the patient's drug consumption while capping the payer's fees at a 'reasonable' rate.

What does this mean for you?

Drug testing is necessary, it's also ripe for abuse.

(Disclosure - Millennium Labs is an HSA consulting client)

<i>Joe Paduda is owner of Health Strategy Associates, a Connecticut employer consulting firm, and co-owner of CompPharma, a consortium of pharmacy benefit managers.</i>