Monday, October 21, 2013

Genetic Testing?!

The reason lawmakers and regulators create rules that seem onerous and ponderous to the vast majority of us is because there are "outliers" that ruin it for everyone else because of indescribably selfish behavior.

There's always someone taking a new angle to take advantage of the liberal rules of workers' compensation for their own profit regardless of the social consequences. This seems particularly acute in California, but nevertheless occurs in other jurisdictions too.

Recently posted in the WorkCompCentral Forums was an inquiry as to whether anyone else in the community is starting to see bills for unsolicited services related to genetic testing for drug addition predisposition.

The author of the post, an attorney for the employer/carrier, says that the case in question had been settled. In preparing the settlement documents a review of California's Electronic Adjudication Management System database was conducted to identify all parties. Nearly all lien claims had been settled, but one remained stubbornly immovable (and I'm not even clear that the parties were ever properly served and/or noticed of this particular vendor until the end of the case).

For this one particular lien the claim file notes apparently show a request for billing and report after discovery of the vendor in the EAMS search. The carrier got fax copies of a bill and report with a demand for payment.

The bill was for $3,626.00 for the genetic testing.

According to the post, the initial report, based on an exam 5 months post injury, is silent about any request. There was nothing about the injured worker previously having any problem with any type of medication which might make a doctor want to see if a predisposition existed.

The reason given in the report for the genetic testing was the patient "presenting with clinically-validated, and established risk factors."

I wonder if the injured worker actually knew that he had presented "clinically-validated, and established risk factors" of drug addiction...

The forum post further says that buried in the documents including the Explanation of Benefits is an unsigned form by the doctor, quoting ACOEM without citation stating genetic testing is supported "when it is clear that the genetic trait directly affects job performance, when the trait being screened for predisposes a worker to significant, constant adverse outcome following an otherwise acceptable workplace exposure. Clearly, opioid abuse is such a significant consistent adverse outcome following acceptable exposure to prescribed pain medication."

Apparently the lien claimant also forwarded to the defense attorney an EOB from some company in Wisconsin claiming a value of $2,352.00.

Here's the really sad part - the attorney admits that it is a real possibility that the carrier will just settle rather than take the issue to trial.

This testing in my opinion is just another new attempt to milk a comp claim by an unscrupulous provider. There is no reason, no justification whatsoever, for genetic testing to determine predisposition to addiction. Please... there is no valid medical science that can justify this.

It's a shame if the carrier settles. Doing so just provokes more of this BS, and frankly it would show that the carrier doesn't really care about the employer, or about the work comp system in general because the cost just gets passed through to the employer via x-mod. My guess is if this were a vigilant self-insured there would be no question about a challenge and putting an end to such madness before it escalates.

This is the kind of crap that absolutely should not be tolerated in work comp. I'm all for treating an injured worker with the benefit of a doubt and providing medical TREATMENT and benefits that are reasonable, necessary, and supported by valid science.

Genetic testing for pre-disposition to addiction is silly, unwarranted, with no valid basis whatsoever. If the physician is concerned about addiction then the remedies are already available: ACOEM, ODG and the others all have guidelines for the APPROPRIATE prescription of pain medication, including opioids; OR just don't make such prescriptions!

Maybe I'm wrong. Maybe there really is some valid, justifiable reason for over $3,000 of genetic testing ... beyond someone's shameless, unconscionable profiteering off the backs of injured workers and their employers.

I try to keep an open mind. But I just can't in this case.

Postscript: The case number involved is ADJ8124670, and I understand the vendor is SALUGEN MEDICAL GROUP - the case is set for a lien conference on 10/23.

8 comments:

  1. I first saw the genetic testing at least a year ago, and only a handful of treaters (primarily applicant attorney referred) seem to be utilizing this. So I'd expect to have seen this be more prevalent by now. However I believe the next bigger scam/abuse is so called "Medical Foods". Stay tuned!

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  2. This is the first I've heard of it. I tend to see expensive "education" systems, like "explainmysurgery.com" and a bill for $700 to explain various procedures as though the patient is a 5 year old. Im taking the liens to trial since this is nonsense.

    I wish I ended up with the dubious genetic testing, because I would absolutely not settle that lien.

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  3. Dear Colleagues -

    By way of introduction, I am the Communications Manager of Proove Biosciences (http://www.ProoveBio.com). We are the Company which has invented the testing you speak of. We are also the Company that has presented research on this testing at every major pain medicine scientific meeting this past year (peer-reviewed and accepted for presentation) at the American Academy of Pain Medicine, American Academy of Pain Management, PAINWeek, the International Conference on Opioids, and more. We are not only the research leader in the field of pain medicine genetics, but we also own the world's largest database of practice-based evidence (PBE) consisting of over 10,000 patient subjects in the genetics of pain medicine. We did acquire the billings of Salugen Medical Group - a corporation that no longer exists.
    To address some of the objections that have been raised in this post, the American Society of Addiction Medicine and the National Institutes of Drug Abuse have concluded that about half (50%) of substance abuse is due to genetic factors. Prescription pain medicine abuse has risen to epidemic proportions and now 3 times as many people die from or are addicted to prescription pain narcotics than all of the illegal narcotics combined (cocaine, heroin, etc.). If you are NOT using genetic testing to screen for such a risk, you are purposefully ignoring a risk factor that accounts for 50% of this epidemic. It doesn't account for 100%, but it is significant. According to the ACOEM Guidelines on the Chronic Use of Opioids, candidates for long-term opioid therapy should be screened for 3 risk factors - genetics, co-occurring psychiatric conditions, and a personal history or current utilization of illicit drugs, alcohol abuse, or tobacco.

    Genetic testing is an objective, rather than a subjective way to find out if a patient's is at elevated risk for misuse. We have two tests - one test is the Proove Narcotic Risk Genetics Profile which identifies patients at elevated risk for misuse of narcotics with an 80% positive predictive value (+PPV) - that's twice as accurate as routine cholesterol testing is predicting heart disease. Our second test is the Proove Drug Metabolism Genetics Profile which identifies patients who are predisposed to deficient, compromised, broad/normal, or accelerated drug metabolism. Our testing is performed in our CLIA-certified laboratory in Irvine, CA - Proove Medical Laboratories.

    Both of these tests are valuable. To a patient just starting narcotic therapy, they can provide insights to guide whether a patient should be taking these types of medications, or if they don't respond, they provide evidence or "proof" to "improve" the decisions that are being made.

    Merely guessing through "trial and error" is expensive and dangerous. This is an evidence-based approach to cut down on the abuse of narcotics, the ridiculous amounts being spent on these medications, and many workers compensation cases that can be closed - not to mention addressing Medicare set-asides. We look forward to speaking with you more.

    We've been doing this for over 3 years and have the data to back it up. For those concerned about cost, we only bill at the Medicare fee-schedule for workers compensation, private insurance, and Medicare/Medicaid claims. We don't mark things up by payer category like some providers do. It's the same Medicare price billed to every insurance company. We feel it is the ethical thing to do.

    So, the initial question was "genetic testing for addiction predisposition?" And the resounding answer is "Yes". When 50% of the addiction is due to genetic factors, and we have a test that identifies those patients with high accuracy, I am proud to say we are part of the answer to improving care and reducing cost.

    I invite you to visit our website or call us toll free at 855-776-6832 to set-up a time to speak with someone on our staff.

    Sincerely,
    Nicole McMillan
    Manager, Communications

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    Replies
    1. I see absolutely nothing in your arguments Nicole that changes my opinion. As posted in another forum to this same post:

      How would the results of the testing change the MD/DO's treatment plan? It is the same question that we should be asking our physicians whenever they request diagnostic testing of any kind, especially at the first or second visit.

      Would you "just say no" to those with the genetic pre-disposition? Would the test be utilized by the doctor to just pat the chronic pain patient on the hand and tell them, "here is you heating pad, ice pack, and a bottle of 600 ibuprophen? That's all I can give you because of your genetic test results?"

      In addition, the way that these tests are being administered, mostly "in the closet" without prior authorization from the IC/TPA/self insured, without explanation to the patient, and with only one very nondiscript sentences in the report. No wonder these tests are questioned, and are automatically red-flagged by all except for the doctors who charge a boatload of $$ to administer.

      Let's also ask another question. What is the relationship between the lab doing the testing and the doctor who performs the collection? Does money change hands there?

      ***********

      How about this for controlling narcotics - stop prescribing outside label! These meds weren't designed for back pain or any of the other off-label uses they are being Rx'd for and for which the problems arise. They are for cancer patients, not back pain issues. We don't need genetic testing.

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    2. I am a chronic pain patient. I have a fused back and hip replacement from a slip and fall at age 30 (very bad fall with fracture). I have been on pain meds for 20 yrs. other than surgery, there has been no lost wage claims. I have never tested positive for illegal drugs. I have not had a med increase (or asked for one) in ages. So tell me please WHY my work comp carrier Broadspire all of a sudden wants to genetically test me??? There could only be one reason. Money. I will obviously need to find a good comp lawyer again. They tried to hassle me 15 years ago and when I had the MRI they said "oh sorry" it was a mistake. yea... It is ALWAYS about money. Not patient care. My pain meds enable me to work and be productive. Am I physically addicted? No doubt. Do they 'get me high'? Never. Ever... Truly. Never. This isn't my doctor jacking up his billing either. WC called him and he told them they are crazy because I am a model patient. He doesn't understand why they would want this test either. I am more than pissed at the moment that they are obviously using this testing to either say I need to change to a less expensive or God knows what. So thanks. All of you people that have never suffered chronic pain need to LISTEN to those of us that have lived with it forever and still function.

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    3. Just as I thought... look at this entry on Broadspire's website.

      "Pharmacogenetics Testing
      This advanced approach is now available as a tool for treating providers to customize medication treatment strategies based on an individual’s unique genetic variation and response to opioid medications. Each patient’s metabolic type and response markers are identified and an appropriate, tailored treatment plan may be put into place, potentially decreasing medication costs and speeding recovery."

      Like I said, it is all about the money.. not me. They won't care that i am productive, functioning just fine and any change in my meds could vastly and quickly disrupt that. Do I WANT to be a test subject for a change in meds? No. What I am on is working just fine. I shouldn't have to and they should not have the right to make me change if the meds I'm on are FDA approved and working. I am the injured worker. It was MY life that was forever curtailed because of my injury. They should care about me, not their bottom line. This just sucks.

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  4. I know I am late to the comments on this, but my pain management clinic has been pressuring me to undergo DNA testing "to see which medication is best for you when you develop a tolerance to this one" - which seems like a very stupid reason. The company is Proove, of course. I have done some reading and their testing is not done independently - they fund their own research. That's not at all objective. And the remark that it's "proven" that 50% of addiction is due to genetics is just actually opinion - opinion by people in the rehab field who buy into the disease model, and who make their profits from treating addicts (as a retired drug counselor, I am familiar with this field).

    I don't want anyone testing my DNA, and I resent this attempt to pressure me into it. The physician's assistant who was trying to talk me into it got exasperated and said, "Why won't you do this? Medicare pays for it!" as if this was my only objection. He also couldn't tell me how it worked. The Proove rep just repeated the nonsense written above by the Proove person who replied to your blog post. I notice she mentioned their research database, which reinforces what I already knew - that THEY conduct the research, which is not an unbiased way to do this. It's not good science and I think to ask someone to have a test that is permanently on your medical record is shameful.

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  5. I know I am late to the comments on this, but my pain management clinic has been pressuring me to undergo DNA testing "to see which medication is best for you when you develop a tolerance to this one" - which seems like a very stupid reason. The company is Proove, of course. I have done some reading and their testing is not done independently - they fund their own research. That's not at all objective. And the remark that it's "proven" that 50% of addiction is due to genetics is just actually opinion - opinion by people in the rehab field who buy into the disease model, and who make their profits from treating addicts (as a retired drug counselor, I am familiar with this field).

    I don't want anyone testing my DNA, and I resent this attempt to pressure me into it. The physician's assistant who was trying to talk me into it got exasperated and said, "Why won't you do this? Medicare pays for it!" as if this was my only objection. He also couldn't tell me how it worked. The Proove rep just repeated the nonsense written above by the Proove person who replied to your blog post. I notice she mentioned their research database, which reinforces what I already knew - that THEY conduct the research, which is not an unbiased way to do this. It's not good science and I think to ask someone to have a test that is permanently on your medical record is shameful.

    ReplyDelete