Kaiser Health News published a fascinating investigation by Fred Schulte and Elizabeth Lucas into the lucrative realm of urine testing yesterday. (Yes, really.) The team sifted through reams of billing data from Medicare and private insurers with the help of researchers at the Mayo Clinic 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.” In the last of those years, the reporters discovered, the federal government actually spent more on urine-based drug tests than it did on “the four most recommended cancer screenings combined.”
Much of this has been driven by the national opioid epidemic. As doctors began prescribing an ever-growing number of pain pills, medical boards, state regulators, and insurers sought a way to track the medicines in patients. Prescribers, meanwhile, also hoped to limit their own potential liability and satisfy licensing boards that they were doing their due diligence in monitoring patients. Naturally, ambitious entrepreneurs set out to meet these needs—transforming many pain management clinics into drug-testing facilities.
Some of this testing, to be sure, is medically appropriate—though it’s not clear how much. Last year, the CDC recommended that patients be tested when they begin opioid therapy and that long-term users be checked annually, though it left further testing decisions to the discretion of the health practitioner.
That discretion, it seems, has led to a financial boon for some pain clinics, Schulte and Lucas say. “In 2014 and 2015, Medicare paid $1 million or more for drug-related tests billed by health professionals at more than 50 pain management practices across the U.S.,” they report. The team also found 31 practitioners who “received 80 percent or more of their Medicare income just from urine testing”—a fact that federal officials who reviewed the findings called “troubling.”
Last year, Medicare imposed tougher scrutiny on urine testing and cut its reimbursement levels to providers, say Schulte and Lucas. But even so, many have continued to mine for this “liquid gold.” The story is definitely worth a read: Here’s another link.
This essay appears in today’s edition of the Fortune Brainstorm Health Daily. Get it delivered straight to your inbox.