By Michele Settel, Vice President, Workers’ Compensation Division, Cordant Health Solutions
In 2012, the California Workers’ Compensation Institute (CWCI) conducted a study on drug test utilization, using data compiled from national and regional workers’ compensation insurers. The number of drug testing visits in the institute’s study sample increased from 4,012 in 2004 to 186,023 in 2011 (4,537%) (Jergler, 2012). Many question if this level of drug testing is necessary, as there is little evidence opioid usage has decreased among workers’ compensation claimants.
On average, healthcare providers spend about fifteen minutes with each patient during an office visit (Crane, 2013). Many providers now test for drugs at every scheduled visit, often even for patients not taking opioids. This could be due to limited patient-doctor interaction, and often can occur as a prerequisite for writing additional prescriptions or to simply increase revenue. Regardless, healthcare providers should consider the following:
- Unnecessary testing will drive up claims costs
- Drug testing solely for prescribed medications does not provide a comprehensive insight into a patient’s prescription history or potential illicit activities
An initial patient assessment can yield red flags that may lead the healthcare provider, adjuster or case manager to consider drug testing to establish a baseline. While this is a valuable part of the claims management process, information gathered through these initial assessments is not only subjective in nature but often requires further actions that disrupt normal workflows. Taking the time to discuss drug testing with a provider may not be a high priority for an adjuster. Adjusters often do not consider a provider’s decision to drug test until the adjuster subsequently realizes the financial cost of the drug testing. Conversely, many adjusters have expressed dissatisfaction when one of their claimants should have been tested but the provider refused to consider it.
The key to targeted and appropriate drug testing is to use a comprehensive and objective set of data that includes a combination of claims and prescription information. The goal of targeted testing is to identify potential risk factors that exceed specific durations and dosage levels with clinical support for potential misuse or abuse. Initial assessment combined with targeted, appropriate testing at certain milestones throughout the treatment plan can provide a thorough view of a patient’s compliance (or noncompliance) with their treatment plan.
Consider the following example:
In a recent Cordant Health Solutions™ study, two distinct groups identified for potential risk through different methods were reviewed. The first group (Group 1) was drug tested at the treating provider’s discretion – i.e., they were tested based on when the provider thought it was medically necessary as part of the patient treatment plan. The second group (Group 2) was evaluated based on claims and prescription data received from their payer. Patients meeting the initial identification criteria were tested and their results analyzed.
Group 1 – Based on prescriber discretion, 36% of this group produced inconsistent test results. The term “inconsistent” means testing yielded a discrepancy, related either to a prescribed medication or a medication or substance detected that was not reported or prescribed.
- 12% tested positive for an illicit drug
- 13% tested positive for a non-disclosed medication
- 11% tested negative for their prescribed medication
How do these results compare to those who were identified by pharmacy data for testing?
Group 2 – 74.5% of this group produced inconsistent test results.
- 19% tested positive for an illicit drug
- 42% tested positive for a non-disclosed medication
- 13.5% tested negative for their prescribed medication
This study demonstrates the value of a targeted approach – using data, rather than a provider’s subjective assessment, to drive risk identification.
Last year, Cordant conducted a study to determine the efficacy of combining prescription and laboratory outcomes to identify high-risk opioid users. Cordant evaluated over 1,500 toxicology tests for injured workers across 48 states. The test subjects met targeted risk identifiers using the payer’s data. 72.1% of claimants tested in the study produced results inconsistent with their prescribed medication regimen. This outcome supports the previous study mentioned, with a very similar percentage in inconsistency rates.
Analysis of additional testing performed after the first inconsistent result for this population revealed another positive outcome. Cordant saw a 25% improvement in consistency rate when a second test was completed for patients who yielded previously inconsistent test results. Generally additional testing performed after two inconsistent tests continues to lead to improved treatments and outcomes, but greater improvement is achieved when the provider, adjuster and/or case manager intervenes with an action plan to drive the injured workers’ compliance.
While a high inconsistency rate could be seen on its own as negative, these studies demonstrate that targeted testing effectively identifies correct populations for testing. The high percentages identified in both studies reinforce the fact that a combination of data identifies propensity for risk. Clear algorithms for additional testing based on risk levels helps to manage testing overutilization and reduce waste.
Applying key risk indicators to initially identify appropriate testing, combined with the results of drug testing, produces actionable results. Using this approach, providers treating claimants with a pattern of non-compliance are equipped with a complete view of their patients’ compliance with their medication treatment plans. A targeted drug testing program supports payers’ and providers’ efforts to effectively manage injured workers’ treatments and reduce overall cost.
A comprehensive approach to responsible drug testing supports the efforts of all parties involved to reduce the patient’s dependence on opioid prescriptions. The key is not more testing. It is testing the right people at the right time.
- Bohnert, A., Valenstein, m., Bair, M., Ganoczy, D., McCarthy, J., Ilgen, M., & Blow, F. (2011, April 6). Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths. Retrieved from JAMA: http://jama.jamanetwork.com/article.aspx?articleid=896182&resultClick=3
- Crane, M. (2013, April 25). Physician Earnings: Income Is Up, Morale Is Split. Retrieved from Medscape: http://www.medscape.com/viewarticle/782575_4
- Jergler, D. (2012, May 23). Study: Drug Testing Driving Calif. Workers’ Comp Costs. Retrieved from Insurance Journal: http://www.insurancejournal.com/news/west/2012/05/23/248703.htm
About Michele Settel
Vice president of the workers’ compensation division for Cordant Health Solutions™, Michele Miller Settel has over 23 years of experience in the workers’ compensation industry. Before joining Cordant Health Solutions™ in September 2013, Michele was responsible for developing operational best practice standards, training, sales, new account implementation, product development, business process reengineering and pharmacy operations for TechHealth/One Call Care Management, where she served as executive vice president of business development. She has extensive experience developing ancillary programs including pharmacy benefit programs for all payers. This broad experience was the foundation for the Cordant managed drug testing program’s incorporation of cost containment strategies with a focus on quality service delivery.
Michele has broad executive experience in managed care strategies including telephonic and field case management, utilization review and peer review services. She served as vice president of sales support for Coventry Workers’ Compensation Services for more than 17 years. She was responsible for developing enhanced product offerings and overseeing new account implementations.
Michele holds a BS in Business Administration from Missouri Baptist University, where she graduated cum laude.
About Cordant Health Solutions
Cordant Health Solutions™ offers a consolidated approach to serving the medication monitoring needs of healthcare providers and payers, offering a flexible solution and bridging scientific gaps. We offer a variety of testing options and technology platforms, plus experienced representatives to deliver a high level of service to you and your clients.
Cordant’s unique testing protocols and consolidated data systems are a roadmap through a complicated world. In a landscape full of questions about prescribing, paying for opioid therapy and the evolving laws on drug testing, we provide clear insights and straightforward answers.