Providers and Patients – Know Your Provider Network

Kaiser Health News recently reported the federal government paid providers more to conduct urine drug tests in 2014 than was spent on the four most recommended cancer screenings combined. The article went on to point out that while much of this increased testing is driven by the heightened awareness of the chemical dependency problem that the USA is facing – including prescribed opioids – this, unfortunately, has led some providers of those services to take advantage of the situation by performing volumes of tests and expensive quantitative level testing that seems excessive. Unfortunately, the evidence based literature is lacking to give providers clear guidelines on drug testing and how to use them efficiently. 

This is a good opportunity to remind our PHG providers of a few items. First, Primary Care Providers (PCP) should have Compact Care agreements with the specialists they use. Once the agreements are approved by both the PCPs and specialists, the agreements should specify how bidirectional communication should occur, how responsibilities of care and how care coordination are defined, etc. Secondly, it’s both PCPs and Specialists’ responsibility to be aware of and seek information regarding the total cost of care for their mutual patients – including ancillary costs – such as labs. Finally, it is critical when making referrals for your patients, including labs and x-rays, to consider whether those referrals are within the provider network of the patients’ health insurer.  If not in-network, these ‘blind’ referrals (to which the patients may not have insight until after the fact) may lead to unexpected and significant cost to the patient, as well as increase the total cost of care for those patients.  

As a reminder, Compunet Clinical Labs and Quest are the sole in-network laboratory providers for PHG.  Compunet has committed to PHG to be available to our providers to answer questions about the vast array of reference lab tests available. Further, if a provider has a need for a medically necessary test not currently offered, Compunet will make arrangements with the appropriate reference lab and process the specimens for the provider.  The provider should merely contact their Compunet lab representative to discuss.

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