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Urine drug testing of injured workers in California is on the rise amid the expanded use of opioid painkillers, according to a new report published by the California Workers' Compensation Institute on Monday.
Rampant use of opioids among injured workers in California is contributing to a significant increase in the administration of costly urine drug testing.
The use of opioids in California's workers comp program has continued near record levels despite efforts to curb both utilization and costs, according to The Utilization and Cost of Drug Testing in the California Workers' Compensation System report. Urine drug testing is a prime example of the indirect costs of the opioid epidemic and the use of these services has dramatically risen over the past decade, the report found.
Using a database of 2.8 million clinical lab service records for urine drug tests performed on California injured workers between 2002 and 2014 for which claims administrators paid $108 million, the report found that these tests as a percentage of all California workers comp lab services rose from 10.2% in 2007 to 59.1% in 2014. This drove payments for these tests from 23% up to 77% of workers comp lab payments over the same period, according to the report.
There is an ongoing debate over the cost and the benefits of urine drug testing, not only in workers compensation, but in all health systems, with studies on both sides of the debate, the report noted. One analysis highlighted the misuse and abuse of testing due to financial incentives, and the other cited the existence of a direct relationship between the number and frequency of tests for clinical pain management and the benefits to the patient and society, estimating that billions of dollars in potential savings could be derived from using these tests.
“The correct public policy perspective toward the use of (urine drug tests) undoubtedly lies between these two diverse opinions,” the report stated. “Performance of a test, or in the case of (urine drug tests) multiple tests, does not automatically translate into direct savings, and it is less likely to produce savings if testing is prompted by a desire to increase revenue based on the frequency of use.”
Amounts paid for drug screening tests in California workers comp system are based on Medicare billing rules, which were revised in 2010 and 2011 to curb what Medicare deemed questionable billing practices for drug screens, according to the institute's press release. Following those changes, drug screens used to identify the presence or absence of a drug accounted for a smaller share of the tests while quantitative tests — which were not subject to the tighter Medicare billing rules — used to measure the amount of a drug in a sample increased sharply.
“The purpose of testing is to assist in medical management, and as such, testing should be done based on medical necessity related to a claimant's medical presentation, dispensed drugs and evidence-based medicine protocols,” the report stated. “Financial incentive should not be the driving force.”
California Gov. Jerry Brown has signed a bill to establish a closed formulary for medications prescribed in the workers compensation system.