Health Care

October 26, 2013

Direct-to-consumer testing: Taking the doctor out of the doctor’s orders?

Need a lipid test, electrolyte panel or discreet drug screening?

Need a lipid test, electrolyte panel or discreet drug screening?

You don’t have to go to the doctor anymore.

There’s a growing trend of direct-to-consumer lab testing, also called direct access testing. It means people can order their own labs – often for significantly less money than if their doctor ordered the tests.

Affiliated Medical Services Laboratory, a for-profit reference lab owned by Via Christi Health, has seen the number of people coming to it for direct testing double every year since it started direct-to-consumer service about five years ago, said Edwin Harned, senior administrator at AMS.

“We’ve kept it low profile,” Harned said. “We just wanted to watch and see how it progressed.”

AMS is the largest reference laboratory biller for Medicare and Medicaid in the state, Harned said. In addition to its direct-to-consumer services, it handles more than 2.4 million tests each year for 45 rural and metro hospitals, 125 long-term care and assisted-living facilities, 40 home health care agencies and 22 hospice providers, Harned said.

According to the Centers for Disease Control and Prevention, 34 states allow direct access testing.

Lower cost

One of the main drivers for more people using the service is the lower cost, Harned said.

At AMS, consumers can order a lipid panel for $16, a blood sugar test for $6, a comprehensive metabolic panel for $13, and a liver function test for $11, just to name a few.

About 2008, as the recession hit, more physicians were referring patients to the lab for testing since some underinsured and uninsured patients were unable to pay for diagnostic tests, Harned said.

AMS also does lab tests for Guadalupe Clinic for free. It does not accept insurance or Medicare for direct testing, Harned said.

Harned said AMS encourages people to use the Internet to learn more about what their results mean and to take a more active role in their health care. He said the service adds price transparency for the general public.

“It’s not our intent to practice medicine,” Harned said. “We are only data gatherers. We give these results to the patient with no guarantees, no diagnoses. It’s your information, and if you want to know more about it, take it to your physician.”

Most of the people who come to AMS for direct testing are knowledgeable about the chronic conditions they have, Harned said.

“Diabetics know exactly how to order and interpret their own hemoglobin test, they know how to monitor their lipids to fight cholesterol,” he said.

“They’re just informed. ... They’ve seen their doctor instruct them enough times that they feel comfortable doing it themselves.”

Provider perspective

Some area physicians don’t support the trend toward direct-to-consumer.

“Information in the patient’s hand is good, but get it in the provider’s hand where they can act on it. Otherwise, it’s disjointed health care, which is not good health care,” said Joe Davison, family practitioner at West Wichita Family Physicians.

“There’s no question they can drive down cost, but cost isn’t the entire equation. There’s also quality. ... If a lab result shows a person has a serious problem, a patient isn’t qualified to interpret it.”

The service could also add to the already estimated 25 to 30 percent of duplicated services in health care, Davison said, since direct-to-consumer tests don’t become part of a patient’s medical record with a physician unless they give it to them.

There are certain tests the lab will conduct only with a doctor’s order, Harned said, including an HIV test. The reason, Harned said, is to have a doctor’s involvement when the patient gets the report.

Donna Sweet, a Wichita physician who specializes in the care of HIV-positive and AIDS patients, said she thinks a lot of tests that people order for themselves can lead to harm.

But she does not think that it’s wise to require a doctor’s orders for an HIV/AIDS test.

“If you’re going to pick a test (to provide) without a physician order, it would have to be HIV,” she said. “I don’t understand the rationale in requiring an order for that patient if they’re smart enough to ask for the test.”

In cases where a person wants an HIV/AIDS test quickly, Harned said staff encourages them to go to the Sedgwick County Health Department.

Drug testing

Harned said it’s not uncommon for parents to bring teenaged children to be screened for drugs. He said that because the results are released directly to the consumer, the results are not part of a formal medical record.

“If they take it to their family doctor, there’s a medical record established,” Harned said.

“That medical record will contain the fact that Johnny was tested, and if he tested positive, it’s going to contain that fact. When Johnny is 25 years old and an insurance company wants a copy of his medical record because he’s applied for a life insurance policy, they’re going to go back and say we don’t want to insure this guy.”

Consumers can request to have their tests handled anonymously and pay with cash so there is no record of them having the test, according to an AMS brochure.

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