Drug Testing—Getting it Right

Payer policies have recently changed to address medical necessity for drug testing. They’re focusing on individualized testing and proper utilization of drug test results and basically what that means is, don’t test everything under the sun but instead do some more rational patient-centered balance testing and then apply the results to the individual and use them in a timely fashion.

• If you get a new patient with pain, it’s appropriate to ask what’s in the patient’s system before giving them an opioid. Prescribers need to think:
  • What’s really rational?
  • What is in that patient’s history?
  • What’s in their area as a common drug of abuse?
  • Is that test really necessary or is it just being done to CYA or to line somebody’s pocket?
• Timely utilization:
  • Is the provider getting the drug test results on time and in a fashion where they can do something that might need to be done for the patient?
  • If a provider waits and only looks at drug test results just prior to the patient’s next visit, they may be missing a lot of information in that 30, 60, even 90-day-time span.
  • They could be missing things that could indicate the patient has a problem and that can lead to trouble if a licensing board has to investigate an overdose death.
• The government asks:
  • Are you really using these results in a timely fashion to affect the care of the patient?
  • Are you making reasonably prudent decisions?
  • If they see a pattern of not using those drug test results in a timely fashion, it can lead to trouble. Medical experts are going to examine if the prescribing led to the patient’s death.