Spurred by the opioid crisis and an insurance quirk that allowed labs to bill for a single urine sample, many pain doctors have established in-house physician office laboratories (POLs) to capitalize on these developments, Julie Kirkwood writes in the January/February issue of Clinical Laboratory News.

Doctors sought help from consultants who at times sold them mass spectrometry (MS) equipment unsuitable for clinical testing. Labs in the meantime were reaping the benefits of the insurance quirk, running full drug panels on every sample, a practice that lead to overuse, Charles Root, PhD, CEO of CodeMap LLC, a laboratory coding and reimbursement information company, tells CLN. “The doctors especially, since they were the ones who ordered the test as well the ones who performed it, tended to do quite a bit of testing,” Root says.

Even with federal regulators cracking down on this practice by creating new codes that have reduced the rates by 80%, POLs have not gone away, Kirkwood writes.

Gregory Ingle, CEO of Clinical Lab Consulting, a company that sets up drug testing laboratories in physician offices, says that many pain doctors continue to run their own drug testing laboratories. In addition, some addiction treatment centers have started to do urine testing in-house.

MS technology, which can take months to validate and has special requirements for power, climate control, and custom-made reagents, isn’t easy to set up in a physician’s office. “Everybody has a different way of doing it, and there’s a lot of scientific argument over who’s right,” Ingle says. Hiring the right experts can also make or break a successful POL.

Ingle adds that POLs can be done right when a practice invests the necessary time and resources. Robert B. Wilson, II, MD, for example, runs a successful MS lab set up by Ingle’s company in 2015. The founder of Piedmont Interventional Pain Care in Salisbury, North Carolina, says frustration with reference labs, not profit, was the key motivator for bringing tests in-house.

The reference labs not only were expensive, but they also pressured him to order unnecessary full test panels on every patient. “[The reference labs] were generating more revenue doing the urine screens than I was sticking needles in [the patients’] spines,” Wilson tells CLN. “We do all these things based on our clinical judgment that we never get paid to do, and by bringing in the urine screening revenue, it makes it more palatable.”

Some experts, however, are skeptical about physicians running their own MS labs. Pick up the January/February CLN and learn more about what financial and regulatory factors could eventually weaken the POL market.