Urine drug testing in the treatment of chronic noncancer pain in a Kentucky private neuroscience practice: the potential effect of Medicare benefit changes in Kentucky

• Published in: Pain physician 2010-03, Vol.13 (2), p.187-194
• Main Authors: Gilbert, John W, Wheeler, G R, Mick, G E, Storey, B B, Herder, S L, Richardson, G B, Watts, E, Gyarteng-Dakwa, K, Marino, B S, Kenney, C M, Siddiqi, M, Broughton, P G
• Format: Article
• Language: English
• Subjects: Addictions; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Drug abuse; Drug testing; Humans; Kentucky; Medicaid; Medicare; Medicare - trends; Neurosciences; Opioid-Related Disorders - diagnosis; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - urine; Pain Clinics - economics; Pain Clinics - standards; Pain Clinics - statistics & numerical data; Pain management; Pain, Intractable - drug therapy; Patient Acceptance of Health Care; Patient Compliance; Practice Patterns, Physicians' - statistics & numerical data; Predictive Value of Tests; Reimbursement Mechanisms - trends; Retrospective Studies; Sensitivity and Specificity; Substance Abuse Detection - economics; Substance Abuse Detection - standards; Substance Abuse Detection - statistics & numerical data; Substance abuse treatment; United States; Urinalysis - standards; Urinalysis - statistics & numerical data; Urine
• ISSN: 1533-3159; 2150-1149
• DOI: 10.36076/ppj.2010/13/187

Because the symptoms of drug misuse are nonspecific and difficult to detect, pain physicians have relied heavily on the results of urine drug tests to diagnose and treat chronic noncancer pain in patients who are prescribed controlled substances. However, changes in Medicare local carrier determinations for Medicare Part B providers in Connecticut, Indiana, Kentucky, and New York went into effect on July 1, 2009, whereby qualitative drug screening was no longer recognized as medically reasonable and necessary in the treatment of patients with chronic noncancer pain unless the patient presents with suspected drug overdose. A retrospective review of urine drug testing services. To determine the extent of urine drug testing in patients with chronic noncancer pain in a large, Kentucky neuroscience practice offering pain management services combined with neurologic and neurosurgical services to better understand the potential effects of recent changes to Medicare benefits. An audit of services provided during 2007 was conducted using computer software. Outcome measures included the number of practice services, number of urine drug tests by payor, and the number of noncompliant patients by payor who self-released from care. Urine drug tests represented approximately 18.2% of professional medical services rendered in 2007 to patients with a diagnosis of chronic noncancer pain. Of these, UDTs represented approximately 22.2% of services provided to Medicare patients and 24.6% of services provided to Medicaid patients. In 2007, 2,081 patients with noncompliant UDTs self released from the practice against medical advice. Of these, 23.1% were enrolled in Medicare and 47.5% were enrolled in Medicaid. Approximately 40% of patients were referred to the CARE Clinic on the basis of noncompliance as indicated by UDT and/or behavioral health issues. Of these, approximately 50% remained in treatment. Urine drug tests were also instrumental in revealing that 19.6% of patients showed signs of drug abuse or addiction. Of these patients, approximately 60% were government insured. Not a prospective, double-blinded study. We approximated the proportion of patients potentially affected by drug abuse or addiction as the percentage of patients self releasing from medical care. In 2007, UDTs were used as an effective tool in adherence monitoring in a private neuroscience practice in Kentucky that offers pain management services combined with neurologic and neurosurgical services. UDTs