Vermont Medicaid’s spending on urine drug testing at private labs has increased sixfold in three years, a spike state officials attribute to more patients seeking treatment for opioid use disorder.
In 2016, $2.4 million was spent on 28,000 tests for 4,800 patients. In 2017, $10 million was spent on 120,000 tests for 9,300 patients and in 2018, $15 million was spent for 180,000 tests on 11,500 patients.
Not included is testing at state hospitals or by the Department of Corrections and the Department for Children and Families.
That translates to an average increase in testing per Medicaid patient in drug treatment programs from five urine tests per year in 2016 to 15 a year in 2018.
Early this year, the Department of Vermont Health Access, which administers Medicaid spending, convened a group of medical professionals and experts on substance use disorder treatment to look into why the spending had increased so quickly.
At first, Scott Strenio, Vermont Medicaid’s chief medical officer, thought that Vermont providers might have been giving patients an excessive number of tests.
“Was there duplicative testing? Was it because more tests are being done than necessary? Was there anything that had been put into a protocol that unnecessarily generated more testing than was required?” Strenio said.
But after months of looking into urine drug testing practices and data, Strenio said the group found no evidence to suggest this.
They determined that the “lion’s share” of new spending stems from more Medicaid recipients seeking and receiving medication-assisted treatment for opioid addiction, according to Strenio.
Patients who are receive medication-assisted treatment and who are prescribed drugs used to treat opioid withdrawal, like buprenorphine, are frequently tested to make sure they aren’t using other substances.
New patients on medication-assisted treatment are also tested more frequently, which could explain why providers are testing patients more each year on average.
“It’s really what you would expect when you have a disease process that depends on this kind of test exploding the way it did,” Strenio said.
“It wasn’t terribly surprising when we saw that it had risen so much, given the opioid epidemic,” he added. “I would have been surprised if it hadn’t gone up.”
The Medicaid spending also includes drug tests for patients with chronic pain conditions who are monitored to ensure they don’t start abusing medications. But those tests aren’t behind the large spending increase.
The state’s “hub and spoke” system — a network of providers that offer medication-assisted drug treatment — counseling and other services, has seen rising demand.
“Spokes” are medical practices or outpatient drug treatment facilities where doctors prescribe medication-assisted treatment and other long-term care for those with substance use disorders.
According to a report released by the Vermont Department of Health in August, about 3,160 Medicaid patients were being treated in the state’s “spokes” — roughly 600 more than there were at the beginning of 2016.
Brenda Siegel, a progressive activist for reform of state policies around substance use disorder, said she was “alarmed” to hear the state’s spending on drug testing had gone up so quickly.
She said she was disappointed to learn that the state was spending millions on testing, when overdose death rates in Vermont still aren’t falling. Last year, the state saw 110 opioid overdose deaths, up from 108 the year before.
And she said she expects that strict requirements for testing at treatment facilities are likely unnecessary.
“While it might be well-intentioned, I would say we have to take a look at why we’re testing, which providers are doing the testing, and what are we getting for that,” Siegel said.
“Could that Medicaid money be used in another way that would be more effective in healing this disease?”
Sen. Ginny Lyons, D-Chittenden, the chair of the Senate Health and Welfare Committee, said that the figures might show that the state is doing a better job “identifying” and getting more people into drug treatment. But she said it raises questions about how the treatment is administered.
“On the other hand, once we get them there are we doing the right things? Is this the right kind of test to be performing?” she said.
She said that given how the spending has rapidly increased, state officials need to “evaluate the frequency of the testing.”
“Is this best medical practice? If this is, then we have to think long and hard about how we’re dealing with folks that are in treatment,” Lyons said.
“It’s a lot of money when you think about the other options for using those funds.”
Vermont isn’t the only place that’s seen an increase in spending on drug tests.
An investigation by Kaiser Health News in 2017 found that between 2011 and 2014, Medicare and private insurance dollars spent on urine testing and “related genetic tests” quadrupled to $8.5 billion.
It also found that some pain doctors billed the federal government for urine drug tests that may not be medically justified and that when it comes to the practice, there are “virtually no national standards regarding who gets tested, for which drugs and how often.”
While Strenio said he has found no evidence of inappropriate use of drug tests in Vermont, he is concerned that there are “no hard and fast clinical guidelines” about how they should be administered.
“All this testing may be exactly appropriate, but we’re not convinced that every doctor out there has the full set of resources needed to make that decision on true medical necessity,” he said.