Is high-tech drug testing Medicare's new fatted calf?


Medicare payments have shot up for high-tech tests that detect frequently-abused drugs: In 2012, program spending for 22 of these urine tests was $445 million, which represents a 1,423 percent increase over five years, according to the Wall Street Journal.   

After Medicare created rules capping payments for cheaper, simpler drug tests--including test strips that change color when exposed to drugs in urine--doctors began switching to high-tech tests that can be big money-makers for practices and laboratories.

Medicare separately reimburses each substance checked for in urine samples including amphetamines, benzodiazepines, cocaine, ecstasy, hydrocodone, opiates and PCP (or angel dust). So one sample can generate multiple payments. Many doctors purchased mass-spectrometry devices for office use that count substance particles in urine. Other doctors became laboratory owners or began profiting indirectly from testing deals with labs, the WSJ reported. As a result, Medicare payments for drug testing have topped many pain doctors' earnings for patient care. "Urine drug testing is how I pay the bills," pain management specialist Robert Wadley, M.D., told the WSJ.

Wadley believes high-tech tests are medically necessary since their increased accuracy reduces the odds of missing patients with substance abuse problems.   

In some cases, testing for many drugs may be warranted, the WSJ reported; but only approximately one out of 1,000 older adults abuses or is addicted to illegal drugs, the newspaper noted. And experts say high-tech testing should be reserved to confirm results of cheaper screenings. Overall, "there's a compelling public health need to do urine drug testing," said Gilbert J. Fanciullo, M.D., chief of pain medicine at Dartmouth-Hitchcock Medical Center to the WSJ, "and there's an enormous profit motive to overdo" it.   

Overdoing drug testing may be an unintended consequence of efforts to curb nationwide painkiller abuse. When opiate narcotics were first introduced for pain management, there was little anticipated risk of developing the self-destructive behavior characteristic of addiction, as FiercePracticeManagement reported. However, many medications on the market today absorb into the body quickly, making them compatible with addiction.

And addiction drives up claims costs: An internal audit by one payer revealed that 30,000 members received prescriptions for opioid painkillers lasting longer than 30 days in a one-year period, which may be a stepping stone to drug dependency.

For more:
- here's the Wall Street Journal article

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