Drug testing to monitor opioid use could open comp system up to liabilities

Drug testing workers' comp claimants as a way to monitor and control the use of opioids is on the rise. However, a new report raises questions about drug testing's effectiveness and costs, possibly warranting new rules and regulations.

Drug testing payments in the California workers' comp system totaled an estimated $98 million in 2011 and may reach $150 million in calendar year 2012, according to research from the California Workers' Compensation Institute. But more study is needed to determine whether the tests "actually lead to better outcomes for the injured worker," according to the research.

Drug testing claimants is one intervention stakeholders have begun using to address the increase in the use of opioids. Others include:

Utilization review to confirm that opioids are appropriate for a specific injury.
Physician education programs.
Peer-to-peer discussions with physicians.
Prescription drug monitoring programs.
Opioid contracts with injured workers.

Use of Schedule II narcotics decreases among California injured workers (08/13/12)
IAIABC, ACOEM target state workers' comp agencies with opioid message (10/24/11)
Study shows increasing frequency, costs of physician-dispensed meds (09/06/12)
Opioids, physician dispensing continue to concern practitioners (02/25/13)
Opioids, physician dispensing are major concerns among WC payers (02/11/13)

For this study, the researchers looked at data from insurers over the period 2004 to 2011 to get an understanding of the scope of drug testing in the California workers' comp system. The insurers represented 42 percent of all California workers' comp premium.

The study identified 27 specific procedure codes that claims administrators used to reimburse drug testing service visits. These codes were associated with 450,873 drug testing visits during the eight years, $78 million in billed charges, and $50 million in payments.

"This study confirms a viral-like growth rate in the volume of drug testing and in the amounts billed and paid for these services," the report says. "At the same time, the results show a 315 percent increase in the average amount paid per testing encounter, suggesting that both the number and the relative complexity of tests per office visit may be on the rise."

The California Division of Workers' Compensation Chronic Pain Guidelines adopted in 2009 provide a framework for drug testing as part of the guidelines criteria for opioid use. Nevertheless, the authors noted that, unlike federal drug testing programs, those in the workers' comp system do not provide explicit rules and regulations.

"The increased use of drug testing in workers' compensation creates potential public policy issues for all stakeholders," the report says. "For example, the rationale that is used to justify the testing, the specific test that is administered, and the confidentiality issues related to how test results are distributed may create potential liabilities for the injured worker, employer, claims administrator and the medical provider."

The researchers said it is understandable why stakeholders would want to test claimants to verify the use of a prescription according to the treating physician's specifications. However, "the result is a compounding, self-reinforcing system of inappropriate opioid prescribing that fuels ongoing drug testing."

More research is needed to determine whether the increasing costs of drug testing are justified. "Are injured workers who are tested more or less likely to become addicted or overdose?" the research asked. "Conversely, are they more or less likely to transition off opioid medications, receive alternative pain management therapies, return to work, or if necessary, enter rehabilitation programs?"

The authors also suggest examining the potential hidden cost drivers, such as increases in office visits, diagnostic testing, and administrative fees.

"The lack of clarity and agreement between medical specialties and medical treatment guidelines contributes to an inefficient system of checks and balances in which the mandate to provide medical care 'reasonably required to cure or relieve the injured worker from the effects of his or her injury' must be weighed against the need to assure safe, appropriate and cost-effective treatment," the study says. "Despite the addition of the chronic pain management guideline into the California workers' compensation medical treatment utilization schedule, there is a growing acceptance that the use of pain management therapies that include Schedule II drugs may require additional regulations to curb the overutilization and inappropriate use of opioids for work-related injuries."

Read more at the WorkersComp Forum homepage.

June 21, 2012

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