Visions recently caught up with Murray Lappe, M.D., founder and chief medical officer for eScreen, Tim Sotos, M.B.A., chairman of the board and CEO of Clinical Reference Laboratory, and Bob McCormick, vice president of Quest Diagnostics Employer Solutions, a business of Quest Diagnostics that provides workplace drug testing services, to talk about the current state and future direction of the drug testing industry.
Q: There has been exceptional growth in drug testing since the D.O.T. regulations came into being in the early 1990s. What sort of growth do you anticipate over the next 10 years and why do you feel this way?
Mr. Sotos: Substance abuse continues to plague society, posing a danger in the workplace. As such, we anticipate continued single-digit growth provided the economy begins to recover and the regulations remain in effect. However, growth could be double-digit if there is 1) a shift to less invasive collection methods including alternative fluids such as saliva, and 2) an introduction of broader test panels to detect new designer drugs entering the market.
Dr. Lappe: There has been significant growth, beginning with the D.O.T. regulations where the market expanded dramatically as employers recognized the endorsement of federal regulators and felt that they were protected. There was also a change in the social climate for workplace drug testing. It did reach a plateau in the last decade, but recently there has been, with new technologies and an increase in the use of prescription drugs, opportunities for growth where employers are looking for alternatives to standard five-panel tests using lab-based and urine-based tests. We are seeing growth in alternative paths as well as expanded panel testing.
Q: What degree of growth are we talking about?
In the 5 to 10 percent range.
Mr. McCormick: Workplace drug testing did grow rapidly in the last 10 to 15 years. But today’s
Employers have limited dollars to spend when it comes to screening a candidate. Twenty years ago, much of that spending went to drug testing, but now we see a greater portion going towards other screening methods like background checks and personality profiles.
Q: What other areas of diagnostic testing do you see growing in the coming years that may be relevant to our members? What are the implications of this presumed growth?
Mr. McCormick: Prescription drug monitoring. Prescription drug misuse and abuse is truly a national health epidemic, and it is impossible for physicians to know which of their patients are truly at risk. Monitoring patients with objective drug test results is one tool that can help physicians, and by extension payers and employers, minimize the potential for abuse or misuse. Quest Diagnostics issued a report last year that found that as many as 63 percent of patients tested for commonly abused drugs like opioids had misused their medications. This is alarming. I think we can continue to see strong interest in prescription drug monitoring services by various groups from physicians and payers to employers.
I believe there are three primary markets for this testing. At the individual level, we need to ensure that people who are prescribed drugs are actually taking the drugs they are prescribed. Secondly, we will continue to see an increase in prescription drug monitoring among medical professionals including physicians and pharmacists who provide the drugs that are at times misused by patients and therefore can benefit from monitoring. Finally, we will likely see more growth in the workers’ compensation market. While currently comprising a small percentage of overall healthcare costs, workers’ compensation professionals are looking for ways to reduce the economic and individual impact of the expanded use of opioids, including an increasing number of employees who are becoming physically dependent on and addicted to these substances.
Dr. Lappe: We are seeing increased interest by employers who screen both pre-employment and post-employment for the risk of workers’ comp-related charges. We are seeing employers who are adding services both on the drug monitoring side and in employment screening for physicals and other parameters related to injury risk. There is new testing on the pre-employment side for musculoskeletal injuries and for getting a range of motion, but they are not doing drug monitoring per se. I envision that pre-employment screening from a physical exam perspective is going to increase.
Mr. Sotos: We anticipate growth in molecular/genetic tests that support the trend to personalized medicine as well as continued growth in pain management testing. Our company is well positioned with our pain management testing menu and comprehensive molecular/genetic test menu to meet pain management testing and personalized medicine services.
Q: Look as many years ahead as you can. How do you foresee the relationship between labs such as yours and occupational health programs that work with large numbers of employers?
Mr. Sotos: We feel that we have the expertise, capacity, flexibility, and financial strength to meet the testing needs of NAOHP members and their clients. Our slogan is that “we value each and every sample as a life entrusted to our care.” We view our relationships as more than just a vendor relationship, but as a partnership hopefully for life.
Dr. Lappe: eScreen has always had a strong relationship with providers at the local level and all of the services in workplace drug testing, whether it is lab-based or point of-care, require local providers to execute the collection and management of drug testing services to local employers. The partnership between service providers will continue to be strong and occupational medical providers will likely continue to play a strong role and a stronger role in delivering those services to employers.
Mr. McCormick: I hope to see employers, particularly large employers, requiring more standardization in the delivery of their screening programs as they reap the benefits of lower costs, faster turnaround times, improved data, and increasingly streamlined programs. Providers with a broad, convenient footprint like an occupational health network where patients can have a specimen collected for testing, will be better able to leverage standardized technologies and processes to improve the delivery of a number of services. All of healthcare and indeed much of our economy today is cost-sensitive. There will always be cost pressure, and from my perspective, leveraging available economies of scale leads to greater efficiencies, which allows our partners and customers to continue to maximize their return on investment.
Q: What needs to be done to ensure an optimal relationship between a lab such as yours and our member programs? In the past, what has caused such relationships to be less than optimal?
Mr. Sotos: We want to include NAOHP members as partners for life. To achieve this ideal, we want to strive for timely and transparent communications and by making ourselves available 24/7.
Mr. McCormick: Beyond continuing education, training, and communications resources, differentiation will come from our ability to leverage our connectivity and to interconnect our logistics, technology, and laboratory services more seamlessly with the occupational health centers.
Q: Bob, define your vision of such connectivity.
Mr. McCormick: Quest Diagnostics continues to invest in technologies that enable the use of electronic chain of custody forms. By moving away from paper forms, we’re building a platform that can create some real advantages as we integrate our network with occupational health clinics. A couple of these advantages include the ability to process collections more quickly and to do so with fewer transcription or legibility errors. In response to the second part of your question, I view the industry’s decentralized approach to service delivery and a historical reliance on paper-based processes as key pieces that have prevented us from optimizing our relationship in the past.
Dr. Lappe: eScreen partners with occupational health clinics and we want them to install the eScreen platform in their clinic so that we can assist them with marketing their services. We want clinics to expand their services to include those that are provided across the platform so that we can offer their services to some employers. We hope that the clinics will continue the partnerships and look at the other services that they routinely offer such as physical exams, other pre-employment screening exams, and OSHA-regulated exams so that we can package those services to national employers and improve the footprint. Our clients would have access to a large number of services beyond drug testing across the eScreen platform.
Q: Bob, what are your thoughts on full-service packaging of a broad number of services?
Mr. McCormick: It’s absolutely essential that we are able to provide a bundled package of services such as drug test collections, instant drug testing, physicals, background checks, breath-alcohol testing, fingerprinting, and more, in order to be successful with occupational health clinics.
Q: In the past, when you have developed packaged services and you have tried to move them to market, what have you found to be a significant barrier?
Dr. Lappe: One challenge has been price variations across the country. When we sell packaged services to national employers, they want single pricing across the country and we find that there are local markets that vary dramatically. Not all occupational health clinics provide all of the services that we offer on a national level, so we hope that clinics will offer more services that employers are requesting and one way to do that is through our platform and to download requests from employers. It is a learning process and as we get more diversity in the requests, we hope that occupational health clinics step up and offer more services.
Mr. McCormick: Two things: historically there were few full-service providers, which forced employers to bundle together services from several different sources; I think there has been some reluctance in the industry to change this practice. We have our preferred vendors – it is hard to consider breaking these historic ties. Secondly, as we move toward an electronic platform, we continue to run into providers, potential partners, and even customers who have yet to see the benefit of adopting these new ways of doing business. Our ability to make it easier for customers to move to new solutions will play a significant role in breaking down barriers to the successful deployment of new services and ways of doing business.
Q: Tell us a little about various drug testing modalities. What is the “next big thing” and what processes are becoming obsolete?
Mr. McCormick: I don’t know that any of the current modalities, be they lab-based urine testing, instant urine testing, hair testing, or lab-based oral fluid testing, are going to become obsolete. What is probably going to grow as we get more electronically enabled collection networks is instant urine testing. I expect lab-based oral fluid testing to gain momentum in the future, if and when the D.O.T. approves the use of oral fluid testing as a modality. I think it could grow significantly in a short period of time.
Dr. Lappe: I am not sure there is anything on the horizon that is going to dramatically change the landscape for workplace drug testing. We are going to see more in terms of panel changes than we are in technology changes. We are seeing more expanded panel testing, but we will continue to have a mosaic of different technologies for workplace drug testing. I don’t see a dramatic shift in the landscape going forward.
Mr. Sotos: Technology is always changing. While we do not have a crystal ball to predict the future, we are ready to meet the needs of the market.
Q: What final thoughts or advice would you like to share with our members? In other words, if there is one thing you could tell our membership base, what would you tell them?
Dr. Lappe: I would tell them that they need to apply technology to their operation as much as possible, especially in the area of physical exams. We see the paperless solution continuing to be critical to employers, connecting occupational clinics to employers in a paperless fashion for as many services as possible. It is going to help both the occupational health providers and employers in being able to communicate with each other.
Mr. McCormick: Occupational health clinics will continue to play a vital role in this industry and they need to adopt new technologies and approaches to service delivery. For beneficial technologies to realize their full potential, we have to get everyone on board. Employers are driving us to continually innovate, but until our broader network of partners and collection sites adopt these new, electronic solutions, a critical piece will be missing from the puzzle. The faster we all get onboard with these new technologies, the better.
