Angel Dust may be the drug that explains our health care system. An excellent report in the Wall Street Journal profiles the rise of high-tech drug testing for elderly patients, an often unnecessary expense that costs taxpayers hundreds of millions of dollars each year. In order to prevent patients from abusing prescription drugs, it has become standard medical procedure to test patients for drug use before they start certain treatments. But four years ago Medicare noticed that doctors were testing people too often, and making money off of tests that didn’t need to be ordered. The most common kind of drug test then was urine-based, so Medicare capped the reimbursements it offered for urine tests to discourage over-billing.The result was that reimbursements for drug testing increased as doctors found other kinds of tests, often high tech, that weren’t restricted by the cap on urine testing. Overall reimbursement for high tech drug abuse tests skyrocketed by 1,423% in five years. Many of the tests were done for types of drug use that are incredibly rare among elderly patients. In 2012 Medicare shelled out $14 million in reimbursements for Angel Dust (PCP) testing, even though older Americans almost never use that drug. Many pain doctors now make more from drug testing than they do from treating their patients. More:
The shift is “a great example of the creativity that results under [Medicare’s] payment system,” which encourages doctors to choose more-lucrative services and perform more of them, said Mark McClellan, a Medicare chief under President George W. Bush. “The technologies keep changing rapidly, and it results in this game of Whac-A-Mole,” Dr. McClellan said.
Wack-a-mole is one metaphor; another is that health care spending is like an inflated balloon. That’s the metaphor used by health care savant David Goldhill in a recent piece in Bloomberg. Goldhill argued that trying to control costs by bureaucratic fiat is like squeezing a balloon while it is being filled with air: the air doesn’t go away, it just migrates elsewhere and distorts the shape of the ballon. Doctors will always find new and creative ways to evade whatever controls a Medicare-like agency sets up. This is a problem without an easy solution, but those who imagine we can fix it by applying still more bureaucratic clamps to the balloon are missing the point.