In a March 10, 2014 letter, Jan Favero Chambers, President & Founder of the National Fibromyalgia & Chronic Pain Association, lambasted Noridian Healthcare Solutions’ DRAFT POLICY DL 34692 (LCD for Drugs of Abuse Testing) for proposing that definitive testing for urine drug screens is not covered. While this blog is a bit out of the ordinary, it demonstrates the ignorance of third party payers and their lack of commitment to patient constituents and the public health at large.
The slang [idiom] term “pisser” defines this letter to a tee. Number 1 below describes the activity; number 2 describes the outstanding advocacy letter; number 3 describes this proposed policy; and number 4 (well you decide).
- Agent noun of piss; one who pisses.
- (US, slang) something special or outstanding; e.g. that bike is a real pisser. Often used in eastern New England and spelled pissa or pissah.
- (UK, slang) A disappointing or frustrating situation or event.
- (Australia, slang) An extremely amusing person or thing.
Below is a reproduction of their letter with permission from Ms. Chambers and a PDF attachment of their official submission and position statement. Kudos to Ms. Chambers and this patient advocacy group for being so articulate in their response.
Bernice Hecker, M.D.
Noridian Healthcare Solutions, LLC JE Part B Contractor Medical Director/s
Attention: Draft LCD Comment
P.O. Box 6783
Fargo, ND 58108-6783
policyb.drafts@noridian.com
Dear Dr. Hecker,
I am writing on behalf of the National Fibromyalgia & Chronic Pain Association in representation of our patient member constituents, many of whom are the victims of the “war on opioids,” more specifically the many who have suffered at the hands of prescribing clinicians who more often than not, lack the necessary skills to interpret urine drug tests (UDTs) or who are prohibited from performing definitive testing.
The National Fibromyalgia & Chronic Pain Association recognizes that any advocacy for inconvenient urine or blood testing by our organization could create some misunderstanding among our constituents; however, we are also wise enough to comprehend that with good medicine comes appropriate monitoring (cholesterol panels, HgA1c, INR, UDT).
As we understand it, your policy does not advocate, and precludes payment for, specimen validity testing (SVT). While our organization does not pretend to have the scientific nor medical expertise to dispute these policies, we are aware that several clinicians and scientists throughout the United States and Canada have questioned your integrity on this decision as it seems to be skewed towards financial incentive rather than the best interest of our constituent affiliates and patients, and chronic pain patients as a whole. It is especially bothersome that you oppose payment to clinical laboratories for more accurate testing because of “unnecessary” costs; yet the costs to patients and society at large are wholly ignored.
While laboratory companies and third-party payers are busy bickering in the background, the patient voice is largely ignored. It is unconscionable that large health insurance companies profit from “patient care” but flout the very people who are the bane of their existence. How is it that a non-scientific, non-medical group such as ours can understand the negative impact and implications of non-definitive urine testing yet you cannot? We don’t believe that to be the case; however, we do believe it is totally profit driven and selfish insofar as it will contribute to patient harm and maximize your profits. Furthermore, information access has made it less easy to assume patient ignorance at the hands of venal corporate revenue.
As we understand it, many clinical thought leaders, professional peer reviewed journals and resources recommend UDTs for an initial differential diagnosis regarding drug compliance, but they also concede that there is a large potential for false negative and/or false positive results in the absence of confirmatory testing by chromatography. While the dearth of definitive testing serves to vilify honest patients, allowing such tests serves to ratify their compliance. In either case, we acknowledge that UDTs are a part of the lives for chronic pain sufferers requiring treatment with controlled substances, and we are willing to live with that in support of clinician liability, public safety, and verified patient integrity.
The UDT does not definitively identify which drugs a patient has ingested, nor does it mitigate against haphazard sedative-hypnotic usage, keep patients safe from overdose, nor elucidate drug interaction risks. We want to pay for a test that returns useful information on which clinicians can rely for improved patient care and safety. Overriding a clinician’s judgment for requesting UDT confirmatory testing by a third-party payer falls outside the scope of that payer, is unacceptable, and dangerous.
As a group, we believe the in-office immune assay (IA) urine drug test is outdated and can be manipulated for the benefit of illicit access to opioid medications, which ultimately has and continues to instigate harm for legitimate chronic pain patients. It doesn’t take a Rhode Scholar to surf the Internet and find various paraphernalia specifically designed to beat these IA tests. Legitimate chronic pain patients are so afraid of losing their access to healthcare, they generally will comply with anything, and they don’t understand many of the healthcare policies thrust upon them except whether or not their insurance will pay for a benefit. Moreover, inaccurate office tests that are misinterpreted are sometimes used by clinicians to oust honest patients who are otherwise labeled as “high maintenance,” a characteristic often attributed to our fibromyalgia constituents because of comorbid depression, anxiety, sleep disorders, and inflammatory bowel syndrome.
In addiction medicine, patients receive more supportive attention when they have a positive UDT in terms of acknowledging the need for more help, generating a referral to behavior health, etc. What does the pain patient receive when a UDT yields an unexpected result? … based on your policy, a discriminating kick to the curb!
It’s time to stop the stigmatization of chronic pain patients and fairly assess criminality among chronic opioid users without hurting honest patients and frightening caregivers. Basically, you are encouraging clinicians to use an outdated model aligned with the judicial system which was designed to test for drugs of abuse, not the clinical testing necessary for treating legitimate patients. The sacrosanct clinician-patient relationships has been all but lost with the “opioid epidemic,” and it is truly disheartening to those who are living in daily fear of losing assess to the very medications that allow some semblance of normalcy and function.
As a group we respectively request, and in fact plead with you, to take the responsible approach for UDT as outlined above. Help preserve this necessary component of healing and health by providing accurate and data-driven drug monitoring with definitive analyses that support the patient-doctor relationship rather than forcing a wedge between honest caregivers and patients.
Respectfully submitted,
Jan Favero Chambers, President & Founder
National Fibromyalgia & Chronic Pain Association
Dr. Murphy; Thank you for sending a letter to Dr. Bernice Hecker of Noridian Healthcare Solutions, LLC in support of UDT policy and LCD. For our readers, a copy of Dr. Murphy’s letter is in PDF format HERE.
Kudos to Jan Chambers and the NFCPA for bravely standing up for patients’ rights and better care. However, she inadvertently uses two defamatory phrases in a single sentence of her letter while arguing against stigmatization: “It’s time to stop the stigmatization of chronic pain patients and fairly assess criminality among chronic opioid users…,” she writes.
Would it not be better for us all to say “patients with chronic pain” rather than impersonally branding these persons as “chronic pain patients”? And, “chronic opioids”? Really? Shouldn’t this be “long-term opioids”? Otherwise, the implication is that we have “chronic people taking chronic drugs,” which could not be more stigmatizing.
I don’t mean to pick on Jan, since such travesties of language appear frequently in the mass media and journals; however, we all can do better in how we label people with pain and the vital medications they rely upon.
Thank you Stew. All insightful points! And, please accept my heartfelt congratulations for the well-deserved award you received at the AAPM meeting on Phoenix!
I’m not sure about all chronic pain patients but I am sick and tired of my insurance company being charged $1500.00 a month to do this extensive test. Wouldn’t a random UDI test catch an abuser better than monthly? Plus, I do have a co-pay also monthly myself. JMO of course.. We’re all tired of being treated as drug addicts from everyone. From the pharmacy to the doctor and all the negative media. Florida is still having huge issues with filling legitimate prescriptions. Many people are forced into withdraw on a regular basis. Maybe they think that pain patients will tired of the hassles and just quit trying to be treated for chronic pain. Deaths are rising but not being counted properly for the cause of it. This is very sickening.. I wish more pain foundations would speak out publicly about these problems. I have heard very few SAY anything or try to Do anything about these problems. It’s going to get worse and not going to fix it’s self either. I have wonder when or IF will this change?
Test me. OK , But my last bill was over $1500. for a urine test sent from Pa to Georgia, after it was tested in the office… When I received the bill, that insurance PAID. I freak.. I need money. not some lab in Georgia .and a doctor I never heard of. Well my pain doc. agreeded, no more tests, if he wants one.. I can get one from RITE AID, My God.. 30 years chronis pain from accident.. give people a freaking break. NOT EVERY ONE SELLS THEIR MEDS, THEY ARE HUMAN..UNLIKE SOME PROFESSIONALS in our health system. DR K..you get it..
Very nice letter by Ms. Chambers , I hope somehow we can find a more up to date way of testing what may or may not be in a persons system. Seems are doctors are distant and we should have a better more trusting relationship with our Pain Specialist. To date I’ve taken many UDT and have not had a problem. But just one test could show the wrong results putting question in my doctors mind.
When a chronic pain sufferer finally finds pain relief I doubt they would but themselves at risk of loosing that help after suffering for so long. I would not put my treatment at risk , I had way too many days of suffering and being lost in the system when this chronic pain first came about.
The FDA recommends confirmatory testing to always be conducted and further recommends placing a warning label on the presumptive drug test that reads, “This assay provides only a preliminary result. Clinical consideration and professional judgment should be applied to any drug of abuse test result, in evaluating a preliminary positive result. To obtain a confirmed analytical result, a more specific alternate chemical method is needed. Gas chromatography/mass spectrometry (GC/MS) is the recommended confirmatory method.