What Do Providers Really Need in a Toxicology Screening?

PremierTox collaborates with providers to ensure it provides only the most appropriate, cost–effective toxicology screening

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RUSSELL SPRINGS Unless you have just returned from a very long isolation stay on the International Space Station, you are aware of the epidemic of opioid addiction. This is a national problem, but it disproportionately affects people who live in Kentucky. Everyone in healthcare is affected, but much of the burden of caring for this population has fallen on primary care providers and pain management specialists.

A vital aspect of addiction management is determining what drugs the patient is taking and monitoring how much of a given drug is in the patient’s system. In response to this need, many toxicology labs have opened in the Commonwealth within the last decade. Competition for business and striving for a high gross-income-to-overhead-ratio has made an accurate description of the management and technical practices of some of these laboratories a difficult and unpleasant task. The exact opposite is true of PremierTox Laboratory in Russell Springs, Ky. Even a skeptical reviewer would be surprised and impressed at every turn in learning the corporate philosophy, the technical exactitude, and the constant attention to the long-term patient outcome through a dedicated partnership with care providers.

Steve Klipp spent many years in the pharmaceutical and internal operations aspects of healthcare before coming to PremierTox in 2011. He was named president of the toxicology testing lab in early 2015. His guiding principle has been to provide a service that allows each physician to most efficiently and effectively personalize their treatment to every patient. This dedication remains primary at PremierTox today. Klipp states, “There are over 4,300 toxicology labs in the country today. Every one of them will give the provider a number on a piece of paper, but not every lab makes every effort for testing quality like PremierTox does to ensure that the result is accurate, and timely.” So, while the testing may be what is most profitable for other labs in the short run, it is not necessarily what the provider really needs.

PremierTox takes a different approach by collaborating with providers to not only ensure that the result on the page is accurate, but also provide value-added services that will best aid the provider and support patient care. Instead of promoting test services that include running a full quantitative analysis of every drug possible on every visit, PremierTox representatives proactively educate providers on medical necessity, and make routine consultative reviews available to equip them with the knowledge to determine which patient needs a full quantitative baseline panel and which would be more appropriately served with an individualized, focused analysis. This will direct the provider’s attention where it needs to be and will be much more cost effective for the patient or third party payor. “We believe this kind of patient-centered testing will build long-term relationships that will be mutually beneficial,” says Klipp.

Under Klipp and the Chief Laboratory Officer James E. Meeker, PhD, PremierTox has grown steadily in the past three years. Klipp projects that Premier Tox will perform nearly 200,000 drug tests in 2017. This growth is achieved in toxicology testing by implementing cutting-edge automation and by hiring clinical scientists who oversee quality control. PremierTox top scientists are made available for results interpretation assistance either remotely by telephone or by in-office consultation. Klipp says that these services are available for all PremierTox clients and provided at no cost to the practitioner or patient.

“Automation doesn’t just reduce overall turnaround time of testing, it significantly reduces errors, the possibility for cross-contamination, and through bar-coding and tracking, keeps our team informed of testing quality throughout the process. Our scientists still play an important role in overseeing every step,” says Meeker. “In addition, PremierTox is creating jobs in our client services sector so that we can continue to provide personalized support of physicians’ needs in all areas of what we do.”

PremierTox has distinguished itself from other toxicology labs by attaining accreditation by the College of American Pathologists (CAP). This rigorous undertaking requires at least two years of documented precision and accuracy of test results and participation in ongoing proficiency monitoring: quarterly samples sent out by CAP with levels of substances that are known only to CAP. To maintain CAP accreditation, laboratories must report results on these proficiency tests that accurately reflect the drug and the level of the sample sent to them.

“What sets us apart is the attention we pay to ensuring quality of testing and provider communication,” says Meeker. “Our proprietary sophisticated testing methodology, known as solid-phase extraction, allows us to correctly detect very low levels of drugs in multiple specimen types. We have daily monitors and continual quality management to ensure every result meets our stringent criteria prior to release.”

Patient-Centered Care in a Hard Hit Area

Kim McKenna, APRN, is the owner/operator of One Cross Clinic in Campbellsville, Ky. She received her nursing and master’s degrees from UK College of Nursing and opened One Cross Clinic in 2015. She’s been a nurse and nurse practitioner for 25 years, serving the mostly rural Kentucky counties of Taylor, Casey, Adair, Green, and Russell.

McKenna estimates that more than 10 percent of her patient population needs a drug screening for controlled substances. For new pain patients, after a complete review of their current medical usage and a KASPER report, she typically asks for a comprehensive panel for the first screening and then monthly for the next two or three subsequent tests. When her patient’s results are negative for any drugs not prescribed, the screenings can be quarterly and then possibly every six months, as long as the results are negative and in accordance with prescribed drugs.

McKenna will ask for and receive a customized screening from PremierTox Laboratory after the comprehensive panels are validated and a patient’s history of usage is confirmed. “This is a great benefit to my patients because the customized panels are much more affordable than the comprehensive and unnecessary confirmatory panels. Patients cannot afford $1,000 for each drug screening, and they’re not necessary.”

McKenna says she has found fraud in some toxicology labs that bill both Medicare and the patient for excessive testing. “Since I started using PremierTox, I have not had one issue with double billing or excessive testing.” The quick turnaround from PremierTox is an added benefit. “I’m not going to write a prescription for a controlled substance until I see the screen results. My patients are in pain, and every day that is delayed is hard on them,” she says.

McKenna notes her desire to direct business to a local employer. PremierTox is certainly a substantial part of the economy of Russell County with over 100 employees, many of whom already lived in Russell County. As PremierTox grows toward its goal of becoming the first lab in the state to be certified to handle forensic testing, this number will grow, as will the company’s contribution to medical and legal professionals and the community as a whole.

PremierTox representatives proactively educate providers on medical necessity, and make routine consultative reviews available to equip them with the knowledge to determine which patient needs a full quantitative baseline panel and which would be more appropriately served with an individualized, focused analysis.