Drug Testing Reports Require Long-Term Action Plan, Not Fast Filing

Although a previous presentation on the Medical/Legal track of PAINWeek 2013 said investigations into prescribers following patient deaths from opioid overdose are rare and overblown, Jennifer E. Bolen, JD, founder and owner of medico-legal consulting firm the Legal Side of Pain in Knoxville, TN, argued in a subsequent session that “some cases sound rare, but some of these cases aren’t that rare.”

“It’s not that you’re not good; it’s that the system has failed you,” Bolen said during her session, called “The Importance of Laboratory Test Reports to Medical Records: Legal and Clinical Perspective.” “There’s no cohesiveness in drug testing. If you look at what you’re being told and what the states say, it doesn’t match up. And that’s a huge problem if you come under investigation.”

Despite that regulatory disconnect, Bolen said it’s on the shoulders of physicians to “go back and make improvements” in lab test reporting to ensure compliance with federal and state guidelines on drug testing in the event of an audit.

“Failure to integrate lab test results in prescribing behavior and patient care plans lead to you being outside of the usual standard of medical practice. It doesn’t matter how many times the physician does it right, because if they went outside the standard of care for one patient, then investigators see them as a danger to the public,” Bolen explained. “The standard that keeps you out of that zone is on a very thin line of causation, and that causation is often connected to lab results.”

In order to be prepared for an audit at a moment’s notice — which is what happened to prescribers in Tennessee who received letters from the state medical board and had 15 business days to produce lab test reports and protocols — Bolen said physicians must start at the test ordering stage by providing the lab with a full list of medications for screening, and then matching the results with that list once the reports arrive. Otherwise, as Bolen said, it’s “garbage in, garbage out” — which means being at the mercy of the “people who do audits, who don’t write down the reasons why you’re doing what you’re doing.”

After completing the time-consuming task of looking through lab reports, Bolen recommended that physicians leave potential auditors a “cheese trail” that demonstrates whether or not the test results were appropriate or inappropriate and then notes how they were integrated into patient management, rather than just relying on what the lab says.

“Labs try to help you, and they’re there for you when it comes to the science, but it’s more about presentation than about the science,” Bolen said. “It’s on your shoulders … so say something to the lab if the reporting is not right for you or your patients.”

For more details on diligent pain management documentation, watch this YouTube clip of Bolen.