Why won't your MD run my lab panels?

Patrick Krupka, DC, CFMP:

So a question I get regularly from patients is, can they get their family practice doctor, or gynecologist, or endocrinologist, whomever, to run our lab panels instead of us running them? Which I don't mind. I tell the patients regularly, I don't care who orders it. As long as it's got the components that I need, it'll work for us. So that comes up regularly.

Well, there are several reasons why we've had very little success getting other doctors to run our lab panels. So I just want to run through this real quickly. It's, again, something I answer pretty regularly during an average week at the office.

So number one, understand that I do functional medicine, and the lab panels that we've put together are specifically geared toward finding underlying mechanisms. Looking for problems before they are so far down the road that they're diagnosable. Looking for indications that there's dysfunction even if there's not disease at this point.

That's, to a large degree, what functional medicine is known for. Is getting down to the root cause. Think of the gas gauge in your car. You don't wait till you run out of gas on the side of the road to go put gas in the car. Although it's undeniable at that point that there's a fuel problem. In functional medicine, you would read that you're at a quarter tank, realize what's about to happen and go fix the situation before it gets that bad. That's the difference. That's what our lab panels are made for.

So understanding that, one of the first reasons that they won't do it is because insurance won't pay for many of those tests. Those tests are kind of considered screening tests. I'm looking at blood sugar, for example, four or five different ways in someone who's not necessarily been diagnosed with type 2 diabetes or insulin resistance. So the insurance company would say, "Why don't you just do a fasting blood sugar and not all these other tests? They don't have a diagnosis that would support needing that kind of monitoring." Obviously my answer would be those tests will tell me if they're becoming a type 2 diabetic, and I'd like to fix it before they get there.

Well, I'm sure the insurance company is fine with that. That's just not what they're for. That's not what they pay for. They pay to monitor and treat diseases that are already in existence, not future diseases. So they don't pay for those things. A full thyroid panel once a year on everybody. If they haven't been diagnosed with some sort of thyroid disease, the insurance company doesn't want to pay to run a full thyroid panel on them. Maybe they'll pay for a TSH, but not for the rest of it.

So in a doctor's office, if they're going to run these tests, they've got to now justify to the insurance company why they want to be reimbursed for all this testing. And so if they don't feel comfortable making those arguments or asking for justification, then they'll just refuse to do it. So that's one of the big reasons is they have to deal with the insurance machine, and that machine doesn't like the way we test things.

Number two is they don't always know how to interpret these tests. Many of these tests are tests that they don't regularly do, and I think to some degree, rightfully so, if they're not sure what that test means or why it's relevant, should they really be ordering that test?

Because you could look back at it on paper later and someone could make the argument, "look, you ordered the test. Why didn't you do anything about it? When the results came back?" And the doctor could say, "look, I don't understand that test. The patient just asked me to order it because of this other guy, but it wasn't my deal." Well, still, you ordered the test on paper, it was delivered to your clinic, and then you didn't explain it to the patient or do anything. And so I think they get nervous about getting in that situation if there were tests on the list that they're not used to doing on a routine basis, that they're not used to reacting to.

And that brings me to my third point is the reacting to it. So in a situation where that test could come back abnormal, and there's not a medication for that, there's not a fix. Like your cholesterol comes back high, they're going to want to prescribe a statin drug. But what if there's a test where it comes back out of range, and there's no drug for that? Well then, what are they going to do? Are they going to tell you, "Hey, you have a problem?" And then you say, "okay, what do we do?" "I don't know. We don't treat that." They don't want to get in that situation.

So there are several reasons why those clinics won't order the labs that I want to see. I don't fault them, but I think patients sometimes feel like, "They're lab tests. Either of you could order them. Why can't I just get them from my other doctor?" Well, there are legitimate hurdles that would keep your regular doctor, your family doctor, from ordering those tests. It doesn't always mean that they wouldn't find the results interesting, or maybe they could even counsel you on the results, but if they can't justify it to the insurance industry, then they're going to be on the hook for the price if they do it.

Especially if they're part of a group practice, that's absolutely going to be frowned upon. You're going outside the standard protocols for that group, and you're going to cost the group money and open them up to liability if you're doing tests that the group hasn't already said, "this is how we handle this. You get a patient with these issues, these are the labs you run." And then, all of a sudden, they've got a doctor doing all these extra labs that they're not used to seeing. That's going to make them very nervous. That doctor's going to get quite a bit of pushback for that.

So I just wanted to let you guys know. Those are the main reasons why other clinics typically will not run labs that I want to see or run the lab panel that I ask for. I freely give out my lab panel with order codes and CPT codes, order codes for Labcorp and Quest. I give those out to patients when I'm recommending the lab if they want to try having their other doctor run.

I can tell you in the 20 plus years I've been doing this, the only cases where I've seen other doctors run these panels in full is when that doctor is a family member of the patient. I mean, honestly, that's really the only time I've ever seen it.

So those are the issues. If you have questions or comments, or if you've run into that, let me know. Let's have a chat about it. You guys have a good one.


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