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尿检已经成为庞大的产业

Clifton Leaf 2017年11月12日

2014年联邦政府基于尿液的滥用药物检测支出实际上超过了“最受推崇的四种癌症筛查总开支”。

前日,新闻机构Kaiser Health News就利润丰厚的验尿生意发表了一篇有趣的调查报告,作者是弗雷德·舒尔特和伊丽莎白·卢卡斯(对,这是真的)。在梅奥医学中心研究人员的帮助下,这个团队仔细研究了美国联邦医疗保险和私营保险公司的计费数据,他们 “发现2011-2014年间,花在尿液检查和相关基因检测上的钱增加了三倍,估算年支出额为85亿美元,超过了美国环保署的全部预算”。两位作者还发现,2014年联邦政府基于尿液的滥用药物检测支出实际上超过了“最受推崇的四种癌症筛查总开支”。

其动力在很大程度上源于泛滥全美的阿片类药物。由于医生开给病人的止痛药数量呈不断增长态势,医疗管理机构、州监管部门和保险公司都在寻找追踪病人用药情况的途径。同时,开处方药的医生也希望将自己的潜在责任控制在一定限度内,同时充分履行监督病人的职责,以满足资质认证机构的要求。胸怀大志的创业者自然而然地开始着手满足这些需求,进而把许多疼痛管理医疗机构变成了药检中心。

当然,一部分检测从医疗角度而言是恰当的,只是还不清楚此类检测有多少。去年,美国疾病控制与预防中心建议病人在刚开始接受阿片类药物治疗时进行检验,长期使用者则进行年检,但该中心将是否进一步进行检测的决定权留给了医生。

舒尔特和卢卡斯指出,这项决定权似乎成了一些疼痛治疗机构的生财之道。他们在报告中指出:“2014和2015年,联邦医保为药物相关检测支付了100万美元,甚至更多,开出检验单的是美国各地50多个疼痛管理机构的医疗保健专业人士。”这个团队还发现,31位医生“80%甚至以上的联邦医保收入完全来自验尿。”阅读报告的联邦官员称这个发现“令人不安”。

舒尔特和卢卡斯说,去年联邦医保加强了对尿液检测的监督,并下调了针对检验机构的报销比例。但就算这样,仍有许多人继续开采这个“液体金矿”。(财富中文网)

译者:Charlie 

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.”

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