Opioids have been a topic of discussion for months now, and every week it seems as though a new company or individual is in hot water over opioid prescribing practices, or over alleged opioid prescribing practices.
One facet of the opioid epidemic that has not been touched upon is the requirement many pain management physicians and others have that when a patient is under their care and receiving opioids and/or habit-forming prescriptions, the patient must affirm that they are not seeing other physicians for prescriptions and/or that all prescriptions are being filled at the same pharmacy. To that end, the patient typically must be willing to submit to random drug testing.
Recently, Bloomberg News published an article attempting to highlight the physicians who are “getting rich” off of this aspect of opioids. The article begins by focusing on one such group, Comprehensive Pain Specialists in Tennessee. The article notes that the doctor-owned network of 54 clinics is the largest pain-treatment practice in the Southeast. Medicare paid the company at least $11 million for urine and related tests in 2014, when five of its professionals stood among the nation’s top billers. One nurse practitioner at the company’s clinic in Cleveland, Tennessee, single-handedly generated $1.1 million in Medicare billings for urine tests that year, according to Medicare records.
Kaiser Health News, with assistance from researchers at the Mayo Clinic, analyzed available billing data from Medicare and private insurance billing nationwide and found that spending on urine screens and related genetic tests quadrupled from 2011 to 2014, to an estimated $8.5 billion a year—more than the entire budget of the Environmental Protection Agency. The federal government paid providers more to conduct urine drug tests in 2014 than it spent on the four most recommended cancer screenings combined.
While one may think that being tested to ensure compliance with a prescribed medication regiment may be a good idea to help stymie the opioid epidemic, the analysts took issue with the concept. The concern seemed to center on the lack of national standards regarding who gets tested, for which drugs and how often. Medicare has spent tens of millions of dollars on tests to detect drugs that presented minimal abuse danger for most patients, according to arguments made by government lawyers in court cases that challenge the standing orders to test patients for drugs.
Unfortunately, the way the article is written, it seems that Bloomberg has more interest in promoting an agenda against industry than in promoting what may be a good idea. The article notes, “As alarm spread about opioid deaths and overdoses in the past decade, doctors who prescribed the pills were looking for ways to prevent abuse and avert liability. Entrepreneurs saw a lucrative business model: persuade doctors that testing would keep them out of trouble with licensing boards or law enforcement and protect their patients from harm. Some companies offered doctors technical help opening up their own labs.”
Former CPS Chief Executive Officer John Davis, in an interview, described the urine-testing lab as part of a “strategic expansion initiative” in which the company invested $6 million to $10 million in computerized equipment and swiftly acquired new clinics. Kroll, one of the owners of CPS, said the idea was to “take the company to the next level.”
Davis, who led the initiative before leaving the company in June, would not discuss the private company’s finances other than to say CPS is profitable and that lab profits, “to a great degree,” drove the expansion. “Urine screening isn’t the reason why we decided to grow our company. We wanted to help people in need,” Davis said.
Dr. Peter Kroll, the CEO of CPS, also stated that the drive and impetus behind his passion for his career comes from watching his brother suffer and wanting to be in a position to help those similar to his brother – to try to make their life less painless and easier to live.
As we have seen before, any time a profit can be made, there will always be critics who say the action is only being taken because of the money behind it. While the money certainly helps to keep businesses (and charities) moving, it is hard to say the money is the reason for the action. We will keep an eye on urine testing to see if this possible solution to the opioid epidemic will be excoriated by the public, or if it will be accepted.