Many of you, regardless of specialty, understand the need for toxicology testing but also recognize that it can present an ethical dilemma not only on how it can influence patient care but also on the financial abuse of the health care system, as a whole. While, legally, you may not benefit financially from confirmation testing and point-of-care testing usually does not provide a financial boon to your practice, many of those that own confirmation testing labs have had a large revenue stream for years and have often had business practices that can, at best, be described as being in a grey legal area as far as how they operate.
Many questions have arisen that have lead to increased scrutiny on the toxicology testing realm. Many do, in fact, stem from abuse of the system; many examples include over-testing samples and generating large bills, kick-back practices by confirmation labs, and blanket testing every patient entering through the doors of a practice. Legal restrictions have corrected many of these abuses while reimbursement changes have helped to correct others.
So, why did toxicology testing, as a business, become so large so fast, and what does it mean? To first understand this, look no further than the CDC and their findings on the subject of opioid pain-killer abuse here in the United States. Two CDC Vitalsigns articles entitled, “Prescription Painkiller Overdoses in the US” and “Prescription Painkiller Overdose A Growing Epidemic, Especially Among Women,” published in 2011 and 2013, respectively, outline the increase in opioid painkiller use, abuse, and death rates in the United States and how the problem has only increased throughout the years in spite of recognition and all efforts to stop it. In fact, the CDC has explicitly defined it as an epidemic, illustrating how it is a problem that is only growing and becoming worse.
Another paper, published by the Behavioral Health Coordinating Committee, Prescription Drug Abuse Subcommittee, of the U.S. Department of Health and Human Services entitled, “Addressing Prescription Drug Abuse in the United States Current Activities and Future Opportunities,” discusses the background that has created the issue at hand, drug abuse prevention, patient/public/provider education, as well as tools, oversight, treatment, and prevention for prescription drug abuse.
So a market was created out of America’s growing abuse of prescription medications, usually synonymous with opioid painkillers but, in all actuality, many mood or mind-altering pharmaceuticals.
When confirmation labs moved in and began to work with clinics, kickback practices had to be addressed. Stark Law and other anti-kickback regulations were put in place to address the exchange of revenue for utilizing a lab’s services. This includes, but is not limited to, reimbursing a clinic for sending a confirmation sample to a confirmation lab with revenue and/or supplies. What it comes down to is this, unless a clinic is directly involved in a confirmation lab, through ownership, they are legally restricted from the financial reimbursement involved in toxicology confirmation testing.
Addressing the ethical questions involved in testing, while it may become a moot point because of legislation currently in-place and new regulations coming into play, many physicians wonder if testing violates the patient-physician relationship. As a physician, you are trained to recognize the behavior of patients and can begin to judge their trustworthiness and, at some point, you have to rely on what a patient is telling you in order to treat them. Does asking your patient to take a toxicology test in order for you to prescribe them a painkiller/anti-anxiety/amphetamine or any other form of mind altering prescription cross a line and violate trust on some level? At the foundation of medical practice, you are taught to do no harm and even to put a patient’s interests above yours in order to provide adequate care. Other tests utilized by physicians are performed to give an idea of how to proceed with treatment, they define a baseline of sorts. Toxicology testing is no different.
A paper published in the July/August 2002 issue of The Clinical Journal of Pain provides a strong argument as to why testing should be utilized. Entitled, “Role of Urine Toxicology Testing in the Management of Chronic Opioid Therapy,” it specifically states, “Recognition is growing that self-report of drug use, prescribed or otherwise, among patients with chronic pain treated with opioids is often unreliable. This fact is well known to the addiction management community.” In consideration of this, as a caretaker, you have to be aware of a patient and the appropriate or inappropriate use of a prescription you gave your patient. You are not only providing care by managing their condition through medication, but by ensuring they are actually being responsible with your decision to prescribe to them a medication, you are promoting health and well-being.
At AMS, we offer a complete solution for toxicology testing and invite you to meet with us so that we can address your questions. Our resources allow us to offer a ground up analysis of your practice that allows us to offer an ancillary service that works for you and addresses all legal restrictions and regulations in place. Please get in touch with us today so that we may work to provide you a service that promotes patient care and works to ensure patient responsibility.