A new study from the California Workers' Compensation Institute (CWCI) found drug tests have been added to more Workers' Compensation pain management programs in published treatment guidelines throughout the state of California. The increased use of opioids over the past decade and growing concerns about the long-term reprecussions have influenced this increase, says CWCI.

In the report, titled "The Utilization and Cost of Drug Testing in the California Workers' Compensation System," CWCI analyzed a database of 2.8 million clinical lab service records for urine drug tests (UDTs) performed on California injured workers between 2002 and 2014, for which claims administrators paid $108 million. According to Stacy Jones, CWCI senior research associate, UDTs as a percentage of all California WC lab services increased nearly six-fold over the last eight years — from 10.2% in 2007 to 59.1% in 2014. As a result, UDT payments went up from 23% to 77% of WC lab payments over the same period.

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According to CWCI, these increases reflect a growing number of injured employees who were tested, as well as an increase in the average number of drug testing dates, tests performed on those dates and the duration of testing within the life of the claim.

The amount paid for drug tests in California WC are based on Medicare billing rules. These rules were revised in 2010 and 2011, after Medicare determined there were questionable billing practices for drug tests taking place.

The CWCI study found that after those changes were made, the mix of tests used on injured workers changed. Drug screens, which are used to identify the presence or absence of a drug, accounted for a smaller share of UDTs. Meanwhile quantitative tests, which are used to measure the amount of a drug sample, increased sharply. CWCI notes quantitative tests are not subject to the tighter Medicare billing rules, perhaps explaining the increase.

(Click the chart on the left for full size.)

The study also notes that from 2007 to 2014, the percentage of UDT payments to the top 10 providers or labs fell from about 80% to 46%.

(Click the chart on the right for full size.)

At the same time, CWCI notes the number of providers who were paid for testing injured workers climbed from 428 in 2008 to 876 in 2014. Much of that growth is attributed to a migration towards physician in-office testing.

For more information and to read the whole report, "The Utilization and Cost of Drug Testing in the California Workers' Compensation System" from CWCI, download it HERE.

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Workers' Comp