Genetic Testing in Workers’ Comp UR

| | Technology & Integration, Utilization Review

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Jaelene Article Sept 2017 on Genetics
Recently in Louisiana an injured worker was asked to submit to genetic testing. The request came from Broadspire, a third party administrator, and a Colorado-based laboratory called Insight Labs. The request came in the form of a letter stating that the claimant was a “candidate” for a genetic evaluation. The letter said that the claimant was a candidate “based on current medications he/she is receiving.” The letter also said, “Please note this is not a drug test or drug screening, but a genetic test evaluating metabolic processes.” The letter also stated that genetic test results would be available within 7 days and that a report would indicate if a particular drug would not work for the patient.

The injured worker was represented by a claimant’s attorney named Bray Williams. Mr. Williams brought the matter to the attention of the Office of Workers’ Compensation Advisory Council. The Council voted unanimously in favor of drafting a bulletin stating that mandatory genetic testing will not be allowed in Louisiana. The Council also drafted a cease and desist letter to Broadspire. The Council said that genetic testing in workers’ comp was a “slippery slope” that could lead to bad results on many different levels.

Earlier this year, Washington (which has a state-run monopolistic workers’ compensation system), decided not to cover genetic testing for claimants receiving benefits from any state-run program. They made their decision after their 11-member Health Technology Clinical Committee submitted a report recommending against covering the testing. The report said they did not have enough evidence that genetic testing improved patient outcomes or was cost effective.

Also, keep in mind ODG and ACOEM do not support genetic testing. And there are no state created guidelines, like the Colorado Rule 17 Guidelines, that support such testing. So one would think there is simply no basis for genetic testing. But not so fast.

According to a Drug Topics article published in March, a patient’s DNA sample can provide information a health care provider can use to determine which medications would work best. This includes which medications would be metabolized best by the injured worker, along with which ones should be avoided as they could cause adverse reactions or even addiction. So think about it. Not only could patient safety be increased, but the system could avoid wasting medications on failed trials. But again, not so fast.

While an injured workers’ genetic information may be helpful in tailoring a course of treatment, should the workers’ compensation system require such testing? Does genetic information, in and of itself, belong to the injured worker? If the injured worker is required to give up his or her genetic information, what happens if that the genetic information is stolen? We have already seen massive cases of medical records data theft. So in the example above it isn’t much of a stretch to imagine that the servers at Insight Labs could, with all due respect to Insight Labs, be hacked. And if that happened, a work injury could result in organized crime having an injured workers’ genetic information.

While we at UR Nation believe real benefits can be harvested from genetic information, the pros and cons of mandatory genetic testing need to be thoroughly vetted. It’s kind of creepy to think about, but it’s worth discussing. If an injured worker voluntarily seeks to have his or her genetic information analyzed by a lab in order to create a more effective treatment plan, that would be one thing. But even there, the potential for abuse should not be dismissed. But the bottom line on genetic testing is more research needs to be conducted before injured workers should be asked to provide genetic information.

Jaelene Fayhee

Jaelene Fayhee

Jaelene Fayhee, AVP, Client Solutions for UniMed Direct, is a regulatory expert who works hand-in-hand with clients and the technology department to deliver technology and medical solutions to clients. Jaelene is focused on using technology to ensure compliance with current and upcoming regulatory requirements and delivering prompt and appropriate decisions to expedite medical decisions for injured workers.