Never thought...

You are right, you cannot compare open heart screening to drug testing. Period. Two different diagnosis implications, time considerations and impact on life or death. To digress: You assume that a cath is a "must do" before bypass. Sorry but you'd kill a lot of patients with that silly point of view. Things like an EKG and blood SCREENING/level tests can be done before the need to cath. If the symptoms, EKG and blood work aligns, the cath is often bypassed. A better knowledge of medicine prior to pulling out more unrelated analogies might help.
"They are not the ones that are going to have to discharge a 80 year old women for SCREENING positive for THC when she actually was just taking a proton pump inhibitor for her gastric reflux." Once again, there is NO "have to" in this scenario. Nothing dictates the "have to" you describe. Not the government, insurance companies or more importantly, good standards and practices. It is the clinicians job to discover PPI utilization and rule out cross reactivity, not a labs. If medical decisions to keep that patient is made with a legitimate purpose, acting in the usual course of medical practice, and taking reasonable efforts to prevent abuse and diversion are done, the clinician is covered.
Insurance companies and the government do know the difference between test formats. That is why different codes are used and have been changing. They also have discovered that certain companies have been overdoing it. That has been the negative impact on healthcare. I have never stated that screening is better but pointed out that confirmation is not "required" for every patient. "At least 5 confirms" for every patient is certainly not needed.

 

I am obviously more conservative in patient care than you. You seem to base all medical decisions on screens whatever the medical implication. I can tell you are not in healthcare because this amateur thinking will get you in trouble. If time allows confirmation is a "must do" or a "have to" if you want to do what is best for the patient. Cardiac catheterization has long served as the “gold standard” for the anatomic and physiological assessment of patients with CHD. Real-time fluoroscopy with contrast injection coupled with rapid digital angiography has provided the high-resolution images of the heart necessary for successful surgical management. The direct measurement of pressures within cardiac chambers and great vessels helps to stratify patients according to risk, assists in evaluation of medical therapy, and helps to INDICATE A NEED for open heart surgery. With that said, I concur with your views of EKG, cardiac enzymes, etc. They are good screening tools and are much more reliable than $2.00 POC immunoassay screening cups for drug testing. Providers should not even be allowed to bill for them due to the unreliable results and insurance companies are slowly learning this. They are a drain on healthcare dollars if the provider's are not getting accurate results. Insurance companies have already started reducing the screening reimbursements because of all the doctors taking advantage. The majority of providers are getting reimbursed more money on screenings than confirmations because the doctors bill per dip stick. They are getting $300.00 reimbursements on a $2.00 cups. If that is not a drain on heathcare I do not know what is. Many providers are getting "recoupment" bills from insurance companies for these overages. In regards to, "They are not the ones that are going to have to discharge a 80 year old women for SCREENING positive for THC when she actually was just taking a proton pump inhibitor for her gastric reflux. Once again, you say there is NO "have to" in this scenario. Nothing dictates the "have to" you describe." I know there is no "have to" but it is a moral obligation that providers have to produce the most accurate results for their patients. In good faith I can not discharge a patient if there is a good chance I am discharging on false results. It is not fair to the patient. You mention, "It is the clinicians job to discover PPI utilization and rule out cross reactivity with THC, not a labs". Have you ever thought of patients taking PPI's and smoke marijuana concurrently. A confirmation will distinguish between a PPI and THC.

 

Nice try in passing off yourself as a clinician Googlemaster: http://circ.ahajournals.org/content/123/22/2607.full
Next time get a better and more specific resource without a cut and paste. Also note it is an article on peds, not someone presenting in an ER. Going to cath for every closed left main coronary artery or LAD is almost the kiss of death. You cannot compare these scenarios so lets move on please.
We will never agree that screening has a purpose. I do not believe it is more valuable that other testing and never made that statement.
I agree that $300 for a $2 cup is wrong. If you'd done your homework, the actual code for a cup returns about $20. I hope they are all asked for 'recoupment' since it is the clinician's job to know what code should be used.
Of course people can use PPI and smoke marijuana. Who says you have to discharge a patient for smoking?

 

You have to love someone for making an attempt to plagiarize an article. Everything they've mentioned up to this point is now null and void as they probably haven't had an original thought to date.

 

The PI on your EIA, FPIA, or ELISA assay performed in your lab say the same thing. Positive results are preliminary and "should" be confirmed. Not negative results and not if your example of the 80 year old woman who screens positive for THC says to her doctor, " Yeah, I smoked a joint yesterday" The doctor does not "have to" confirm. He/She has confirmation from their patient they smoked. No need to bill the healthcare system for a confirmation, and certainly no reason to confirm negative screens that are consistent with expected results on the remaining tests.

 

And this poster didn't even have to plagiarize an article to make people believe they were smarter or more educated.

 

2014: The year of "recoupment". It has begun already. A tsunami is silent, until it crashes against the shore. Listen. Listen. It is coming for you.

 

What if the screen does not pick up the metabolites of the prescribed drug? Should this be confirmed or should you discharge the patient on a screen?

 

I wait in hope but will believe when I see. Still a lot of fancy planes and cars at ML.

 

A redo of previous discussion. If the patient admits, it is the clinicians call. Should probably be based on more than the admission of THC but doesn't necessarily mean "confirm always".

Let the googling begin

 

Yes, I understand THC if the patient admits. What if the patient tests negative for prescribed opiates, etc? Do you discharge the patient based on a negative screen?

 

It depends. Typically not for opioid screens unless there are other factors involved.

 

I got ya. So you confirm all prescribed drugs that are negative on a screen if the patient says they are taking them and not selling. You would also confirm a THC positive screen if the patient does not admit correct?

 

Not necessarily. A lot more goes into it then just two simple observations. That is why training is important. It certainly is not "confirm everything" that fits simple categories.