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I think they wanted a bunch of Washington power players because their real money grab was pushing regulation changes so that patients could go and do their blood tests themselves, without a doctor's order. Surprisingly, they were actually successful in getting this passed in 1 state already- Arizona. If they were able to push that through it would be a HUGE gamechanging cash cow, because people could either self pay or even try to get Medicare to pay for it if they wanted to run their own bloodwork without seeing a PCP and getting an order.

Physicians groups, insurance companies and biomedical ethics groups aren't really hip to this idea because patient self-testing bloodwork may open pandoras box to a lot of unnecessary expenses, especially if the patient is trying to bill this through their insurance. False positives can and do happen, and they lead to unwarranted appointments, specialist visits, exploratory surgeries, etc. Other reasons physician groups are opposed to it is because they view it as profiting off people who are hypochondriacs, and a huge amount of the customers would probably be drug abusers and steroid users. Most likely, people who would go and do their own blood work are the system's "super ultilizers" and they are the ones who are already costing the insurance companies and the states $3-4 million per patient per year in healthcare expenses. It's not uncommon to have a fibro/rheumatoid arthritis/hypochondriac patient who bills $10 million per year. If these people go to the ER and cost 3k per visit every time they can't fall asleep and have anxiety (~12x per month), imagine how often they might want to go and run their own bloodwork.

Not being able to order our own labs as patients is the reason there are moral objections to for-profit hospitals selling "full body scans" and dermatologists doing unwarranted full body mole checks. Generally the proper guidelines is to only administer testing when you suspect that something is wrong.

2 comments

> Physicians groups, insurance companies and biomedical ethics groups aren't really hip to this idea because patient self-testing bloodwork may open pandoras box to a lot of unnecessary expenses, especially if the patient is trying to bill this through their insurance.

Yes, and this concern is justified. If I have to pay for your lab tests, I'm not going to let you just decide to run whatever tests you want. That would be foolish.

The solution to this is to allow people to order their own tests if they pay for them themselves. A company like Theranos could then profit by making tests cheap enough for ordinary people to afford them, which would bring much-needed competition to the health care testing industry. But first they need to be able to show everyone, by ironclad evidence, that their tests are reliable.

Will you please link to a source for the $3-4 million per patient per year figure or the $10 million per year figure for certain diseases?

It's just from what I see at work, we're consultants who do strategic case management for high acuity cases- patients who spend more than $3million per quarter (or whatever levels that specific client establishes with us) get kicked over to us.

I'm working with a guy right now who has a blood clotting disease and his meds alone are $800k yr before all the inpatient stays and procedures.

Generally once the patient starts spending and hits certain level of cost they get assigned a case manager through their insurance to 1. see if they're getting proper treatment 2. try to streamline them to the correct care first (rule out needless and repeat visits) 3. make sure all procedures and drugs are medically necessary. The people that go beyond these case managers sometimes go to a different organization for medical management.

Some states are getting even more strict, in Alaska right now if you have Medicaid and go to the doctor too much for what they view as needless visits you actually get cut off from ALL providers and then can only see certain approved providers for certain approved types of visits, can only get prescribed specific drugs and you have to "graduate" from that program after a year in order to get out of it by keeping ER visits to less than 1 every 6 months. I'll try and find you a link with more info about that program but they're trying to keep it on the dl because obviously all the patients who get put on that program are pretty outraged & they don't want the bad press about it, the perception of denying care etc.

Also everyone in the AK medicaid who is on opiates has to abide by a "pain contract" including random drug testing and med count checks and if they screw up too many times they will get banned from certain doctors/facilities, put on a stricter program (like the above) and can get kicked off Medicaid. Unfortunately this just leads to more homeless heroin addicts, so I can't really say that program has been a success.

Edit: link http://www.adn.com/article/20140703/state-aims-curb-overuse-...

Thanks for the expanded answer! I found it hard to believe because I was remembering when most insurance had a lifetime payout between 1 and 5 million, but of course that was pre-ACA and never relevant to Medicaid.