Executive Vice President's Report

Understanding "Direct Testing"

Philip H. Gilbert, Executive Vice President

 
Historically, all diagnostic tests were performed only when ordered by a physician, who would not only certify the medical appropriateness of the test, but also personally interpret the results and coordinate follow-up care. Recently, several companies have begun offering diagnostic tests directly to the patient, often leaving the patient's physician out of the process. While such "direct testing" has been credited with alerting consumers to potentially serious medical conditions, this practice has reportedly created a burden for some physicians who state they were unaware that testing had occurred.

Some physicians have expressed concern that with some of the companies often patients only receive the raw results of tests, without interpretation by a qualified physician. Consequently, potentially serious medical problems may not have been explained to the patient.

Many patients send the test results to their personal physician for interpretation and follow-up. The personal physician is placed in the awkward position of not knowing how to respond to these unsolicited tests. This raises several questions:

  1. What is the legal or ethical responsibility for interpreting results for tests not ordered by the physician?
  2. Does the physician have an obligation to read these results or to maintain these results in his/her patient office record?
  3. Can the physician collect a fee for the time required interpreting these results and explaining them to the patient?
  4. If the tests are not a "covered service" under Medicare or a managed care contract, can the physician bill the patient directly for interpreting the tests?

Based upon discussions with the DCMS and FMA lawyers and concern for our members, we have been advised that "failure to diagnose" is a major cause of professional liability cases. Therefore, you should always look at these test reports for extraordinary findings and, if in your medical judgment you feel it necessary, contact the patient and schedule an appointment.

For the above reasons, if you become aware of "direct testing" on the part of the patient, it is recommended that you review such results diligently, place the results in the medical record, and consult with the patient.

You should note in the record that you did not order the tests. Whether to bill the insurance company or to bill the patient for your additional services would depend upon the nature of the test ordered by the patient and upon your contract with the insurance company (e.g., is this a "covered service"). We recommend that you ask the insurance carrier if there is a question.

As a lay person, I have no idea as to the appropriateness or the quality of the test results. I have been told that several national specialty societies have these questions under study, and some of their findings are starting to appear in the literature. I would advise that the best source to answer your questions would be your state or national specialty society or the American Medical Association Council on Scientific Affairs.

August/September, 2001/ Jacksonville Medicine

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