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”。
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.”