The Workers’ Compensation Advisory Council (WCAC) met yesterday in Baton Rouge and took action on the pharmacogenetic testing issue, two months after Council member Bray Williams raised concerns about the practice stemming from the treatment of one of his clients for whom Broadspire was the workers’ comp third party administrator. Office of Workers’ Compensation (OWC) Director and WCAC Chair Sheral Kellar and Medical Director Dr. Jason Picard also gave an update on the Medical Treatment Guidelines (MTGs).
Broadspire and Insight Labs, plus experts, present case for pharmacogenetic testing
The bulk of the meeting was spent on the ongoing Broadspire genetic testing controversy. In the previous meeting, Director Kellar gave Broadspire attorney Rich Eason a month to respond to the allegations of several Council members that the practice of automatically referring patients for genetic testing could constitute the unauthorized practice of medicine and raise confidentiality issues. Eason brought Broadspire representative Mark Waldman and Insight Labs co-owner Gavin Copeland to speak about the testing procedures. Eason also recruited three doctors to discuss the utility of pharmacogenetic testing.
After nearly 40 minutes of presentation about the general medical science though, Director Kellar changed tactics, asking the company representatives present to answer the Council concerns. “No one here has a problem with this testing when it’s recommended by the treating physician,” she said. “It’s the blanket request that Broadspire seems to be advancing that the Council members have an issue with.”
Chuck Davoli, echoed that sentiment when he explained his thoughts on the matter to the Broadspire group. “This is all about what’s best for the patient, I understand that,” he said. “But there’s another issue in terms of opioids and addiction where there are opportunities to create disputes [based on pharmacogenetic results] over what the treating physician wants to do…there’s a second medical opinion which is used for cost containment on the medications, not really for efficacy. We’ve seen abuses in the past”
Waldman, who is the compliance manager for Broadspire, had a prepared statement (see document at the bottom of this page) at the ready which was previously distributed to the Council members. He emphasized that the testing is entirely voluntary and the informed consent of the patient is required to proceed. He also stated that the recommendation for the buccal swab sent to Insight Labs for pharmacogenetic testing comes to the treating physician as a result of inconsistent urine drug screens but that the doctor is not required to participate or ask the patient to submit.
Most Council members were visibly unconvinced of this argument. Bray Williams questioned whether or not his clients would understand the informed consent involved in getting their genome sequenced and Council member Dr. Mark Kruse said that because the referral to the treating physician is based on urine testing, the process “sounds like drug testing not patient care.” Council members Shannon Lindsey and Shannon Dartez questioned the Broadspire and Insight Labs representatives extensively regarding how many comp patients had been tested and whether or not Broadspire Nurse Case Managers are using the Insight Labs pharmacogenetic testing results to influence care. Copeland and Waldman said they did not have answers to those questions.
Director Kellar then took up the previous meeting’s motion to issue a cease and desist letter to Insight Labs regarding the letters they are sending to physicians treating comp patients in Louisiana, plus to issue a bulletin on the LWC website describing the matter. Council member Michael Morris protested the harshness of the motion, offering a substitute motion allowing Insight Labs to issue a revised letter to physicians to the WCAC. This was seconded by Council member Ray Peters but failed. The original motion passed without Morris’ and Peters’ support. Director Kellar said that the cease and desist and bulletin would be sent out as soon as possible. Director Kellar indicated that the administration would entertain new language to allow Insight Labs to issue new letters to physicians if the Council’s concerns are addressed.
Louisiana to piggyback on Colorado Medical Treatment Guidelines updates
OWC Medical Director Dr. Jason Picard presented a new strategy to the WCAC for the updates of the Louisiana Medical Treatment Guidelines (MTGs). The Louisiana MTGs are based on Colorado’s guidelines and are supposed to be reviewed and updated by the Louisiana Medical Advisory Council (MAC), which is a volunteer body and has struggled to meet regularly enough to perform the updates. Director Kellar and Dr. Picard, in order to solve the problem, have now arranged with Colorado (which has full time update staff) to share expertise from Louisiana clinicians on the MAC in exchange for the use of the completed Guidelines. The MAC will still have final authority on how to incorporate the Colorado updates into Louisiana’s MTGs.
Director Kellar also informed the Council of a bulletin on the LWC website which states that: “When a medication has been previously approved, a LWC-WC-1010 shall not be required for any subsequent refills or new prescriptions of the previously approved medication within a six (6) month period.”
The Council also reviewed the latest version of the Second Injury Board post-hire questionnaire, a revision spearheaded by SIB Director Meridith Trahant. There were a few minor edits to the document, and stakeholders can expect to see a Notice of Intent on the new form in the new year.
The WCAC will not meet in November or December.
Council members present: Sheral Kellar, Chuck Davoli, Mark Kruse, Jerry Jones, Maria Losavio, Shannon Dartez, Shannon Lindsey, Ray Peters, Michael Morris, Bray Williams, Julie Cherry, Marc Zimmerman
Council members absent: Alejandro Perkins, Edwin Murray, Arielle Collins, Pierce Nunley, Jennifer Marusak
CORRECTION 10/30/17: This post and headline have been amended to clarify the fact that the cease and desist order will be issued to Insight Labs, not Broadspire.
Image Credit: ClinicalOMICS