Opioid Management

Putting UDT to the Test

Data analytics help pinpoint which opioid patients need more or less urine drug screening.
By: | January 20, 2016

Rick Miles M.D. practices medicine in the Appalachian region of Kentucky known for rampant prescription opioid drug abuse, and now the increased use of heroin following measures to shutter area pill mills.

He knows that many local physicians work diligently to help stem drug abuse by appropriately requiring urine drug testing to monitor patients prescribed addictive opioids.

But he also knows that some doctors over utilize drug testing to increase revenue. And still other physicians are too pressured by business demands to see whether more testing is appropriate for certain patients prescribed the narcotic pain killers.

“It’s hard to get it right,” Miles said of the level of drug screening necessary to assure pain-management patients are neither selling narcotics prescribed to them, nor supplementing consumption of their prescriptions with illegal substances.

Increasingly, though, the workers’ compensation industry is trying to get it right by turning to data analytics to determine the amount of urine drug testing that is optimal for individual patients.

Under a program launched in November, for example, Coventry Workers Compensation Services analyzes its pharmacy benefit management data to identify risk and medical factors that can help pinpoint the level of urine testing beneficial for specific claimants, said Dannielle Foroozandeh, Coventry director of pharmacy product development.

Risk factors that Coventry looks for include: prescribed drug dose amounts, the mix of drugs prescribed, comorbid psychiatric diagnosis such as depression, and any history of abuse or addiction.

“We incorporate all that into our algorithm to identify the overall risk for that patient,” Foroozandeh said. “We can actually become more precise on the patients who should be getting tested more versus those who should be getting tested, but maybe not as frequently.”

Coventry can then relay the information to adjusters and claimants’ doctors in hopes of promoting the efficient administration of urine drug testing (UDT).

The effort follows the rapid rise of various forms of UDT in recent years. Treatment guidelines call for testing when doctors prescribe opioids to any patient, but there is lack of agreement on the appropriate level of testing, leading to criticisms that excessive UDT has become a profit generator for drug-testing companies and physicians billing for urine sample analysis in their offices.

In California alone, claims administrators paid $108 million for UDT performed on injured workers between 2002 and 2014, according to a California Workers’ Compensation Institute report released in October, 2015.
CWCI found that from 2007 to 2014, UDT reimbursements increased from 23.1 percent to 77 percent of all workers’ comp lab payments.

“Absent an accepted empirical, evidence-based protocol on the appropriate level and scope of testing, it is difficult to reconcile the noted increases in the volume and variety of drug testing with clinical appropriateness and favorable outcomes for the injured worker,” the CWCI report said.

In contrast to the excessive application of UDT, the Workers Compensation Research Institute has previously reported that many physicians prescribing narcotics do not use tools, such as UDT and psychological evaluations, recommended for monitoring pain-medication patients to prevent drug abuse.

That is where Coventry’s program can play a role alerting doctors when more testing should occur. Because Coventry recently launched the service, however, its effectiveness in controlling costs remains to be measured. That goal that will soon be realized, though, the company said.

A majority of claim alerts that Coventry sends to adjusters are resulting in approval of UDT for specific patients.
“Which basically shows us we are identifying the right patients,” Foroozandeh said. “We are not going for the lower risk candidates; we are going for the high risk.”

As the program matures, Coventry plans to combine UDT data with other information, such as bill review data, to uncover which doctors may be driving unnecessary costs by over-utilizing the testing.

Combining PBM data and UDT frequency data could also expose cases where test results show a patient should be weaned off opioids, but the doctor continues to prescribing the drugs while simultaneously continuing to bill for UDT services, said
Stacy Jones, senior research associate at CWCI.

“The tests are valuable when they are used right and it would be nice if they were actually used the way they were intended, and that is to monitor whether the patient is or isn’t adhering to their treatment plan, not just getting tested for the sake of getting tested,” Jones said.

In Kentucky, meanwhile, Miles the M.D. sees business and financial pressure on physicians impacting the frequency with which they test patients.

In the past, doctors might have spent 40 minutes with a patient. That has been reduced to perhaps 15 minutes, an inadequate amount of time to ask questions that can determine whether more testing is appropriate, Miles said.

Conversely, about 25 percent of physicians will rationalize the need for more UDT when they are sold UDT equipment that is used in the doctor’s offices, he said.

“The company comes in and says ‘put this machine in your office, and you do so many a month and you can make this much money.’ So they are doing it for profit,” Miles said. “But people have to understand, and especially workers’ comp has to understand, everybody has reduced what they pay physicians.”

Miles said he foresees increased scrutiny of doctors to evaluate their prescribing of opioids and their frequency of testing. Thanks to data analytics, that scrutiny is already starting to intensify.

Roberto Ceniceros is a retired senior editor of Risk & Insurance® and the former chair of the National Workers' Compensation and Disability Conference® & Expo. Read more of his columns and features.

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