The dramatic rise in opioid use and abuse in the United States has created a unique set of market challenges and pressures for laboratories that run toxicology and pain management panels. While the Centers for Disease Control and other experts acknowledge the importance of repeated drug testing to ensure the safety of patients who are taking opioids long term, federal, state, and private payers are reducing test reimbursements to cut overall healthcare costs.
Like everything related to the opioid epidemic, the challenges related to opioid testing are complex, but they fall into three main areas of concern:
- Operational risk: The financial and legal risk in opioid testing runs the gamut from failed audits to False Claims Act lawsuits. Laboratories have paid millions of dollars in payer recoupments, clawbacks, and judgements. Much of the increased scrutiny of drug testing concerns duplicative and unnecessary testing. The main way to combat these concerns is to prove medical necessity. In order to prove necessity, documentation must go beyond basic lab results to provide drug consistency information and patient overdose risk scores.
- Physician risk: As lab clients and opioid prescribers, physicians are also facing ever-changing regulations and requirements. Many providers lack the in-depth knowledge to fully interpret toxicology results on their own; they need context, such as the relationship between parent drugs and metabolites. Laboratories are the experts needed to offer this context and ensure that providers have the required information to determine whether more investigation is needed.
- Patient risk: State and federal governments, private payers, physicians, and laboratories may have different motivations, but they have the same goal: they don’t want patients to die from drugs. The key to opioid misuse and overdose prevention is forming a complete picture of the patient’s response to treatment. By arming physicians with the complete prescription picture from a full PDMP history to current drug test results, laboratories can help physicians focus on each patient’s specific needs.