A new California Workers’ Compensation Institute (CWCI) study quantifies the growing use and cost of drug tests performed on California injured workers in conjunction with the expanded use of opioid painkillers, reveals shifts in the types of tests performed after Medicare tightened the rules used to pay for drug screening, and shows that workers’ comp drug testing is no longer the domain of the handful of high-volume labs that dominated the field less than a decade ago.

With the increased use of opioids over the past decade, and growing concerns about the long-term repercussions, drug tests have been added as an appropriate component of pain management programs in published treatment guidelines. Using 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, CWCI Senior Research Associate Stacy Jones found that UDTs as a percentage of all California workers’ comp lab services increased nearly six-fold over the last eight years, climbing from 10.2 percent in 2007 to 59.1 percent in 2014, driving UDT payments up from 23 percent to 77 percent of workers’ comp lab payments over the same period. The study shows that these increases not only reflected a growing number of injured employees who were tested, but increases in the average number of drug testing dates, the average number of tests performed on those dates, and in the duration of testing within the life of the claim.

Amounts paid for drug screening tests in California workers’ comp are based on Medicare billing rules, which were revised in 2010 and 2011 in an effort to curb what Medicare deemed questionable billing practices for drug screens, including “unnecessary and excessive utilization.” Following those changes, the study noted a change in the mix of tests used on injured workers, with drug screens, which are used to identify the presence or absence of a drug, accounting for a smaller share of the UDTs, while quantitative tests, which are used to measure the amount of a drug in a sample, (and which were not subject to the tighter Medicare billing rules) increasing sharply.

The study also documents a significant shift in UDT providers in recent years, noting that from 2007 to 2014, the percentage of UDT payments to the top 10 providers or labs fell from about 80 percent to 46 percent. At the same time, the number of providers who were paid for testing injured workers more than doubled, climbing from 428 in 2008 to 876 in 2014, with much of that growth ascribed to a migration toward physician in-office testing.

The Institute has published its study, including background information, graphics, analyses and commentary as a Report to the Industry, “The Utilization and Cost of Drug Testing in the California Workers’ Compensation System.” The report is available to the public in the Research section of the CWCI website, http://www.cwci.org/, and CWCI members and subscribers may log in to the website to view a summary Bulletin.