Quest Diagnostics Expands Direct-to-Consumer Lab Testing

November 23, 2016

Quest Diagnostics will allow residents of Missouri and Colorado to order complete blood counts, comprehensive metabolic panels, hepatitis C screenings, and other basic lab tests without a physician's authorization, the company announced November 21.

On its website, Quest Diagnostics urges customers who use this service to share test results with their physician so he or she can interpret them, adding that it is their responsibility to do so.

The initiative, described by the company as a pilot program, represents another example of patient empowerment or do-it-yourself medicine, depending upon one's perspective.

Some states expressly permit direct-to-consumer (DTC) lab testing to varying degrees, whereas other states expressly forbid it. Still others are silent on the matter, thus granting tacit permission. Quest Diagnostics spokesperson Kim Gorode told Medscape Medical News that Missouri and Colorado are tacit-permission states.

Quest Diagnostics already allows patients in two health systems — Banner Health in Arizona and Integris Health in Oklahoma — to order lab tests directly. Arizona enacted a law last year that expanded DTC lab testing there to include all tests, not just a limited number.

The company's initiative in Missouri and Colorado comes on the heels of rival lab company Theranos hitting bottom. Known for technology that ran tests on a single drop of blood from a finger prick, the company also offered DTC lab testing in Arizona as part of its nationwide business. However, Theranos closed its lab operations last month after federal regulators revoked the certificate for its California lab, saying it jeopardized patient safety. A series of investigative articles by the Wall Street Journal had called the accuracy of the company's testing equipment into question.

Urgent Test Results Will Trigger a Phone Call

Some of Quest Diagnostic's DTC tests available in Missouri and Colorado can be ordered individually. These include tests for total cholesterol, hemoglobin A1c, pregnancy, testosterone, and prostate-specific antigen. Urinalysis and thyroid screening also are on this singles list.

Most tests, however, come in groups, such as a basic health profile that incorporates a complete blood count, a comprehensive metabolic panel, a lipid panel, and urinalysis. Other packages include immunity screenings for measles, mumps, rubella, and other diseases; and screenings for sexually transmitted diseases, such as syphilis and herpes simplex 1 and 2.

To order tests, individuals download a form available on the Quest Diagnostics website, complete it, and bring a hard copy to a testing center. Patients must pay out of pocket for the tests. The company says it can't bill insurance because the tests weren't ordered by a physician. Test results are available online.

The order form notes that if test results indicate a "potentially serious medical condition requiring immediate medical attention," Quest Diagnostics or a retained third party will attempt to contact the customer by phone.

Some critics of DTC lab testing point out the risk of patients not being able to interpret the results, either overlooking dangerous lab values or overreacting to innocuous ones. That risk underlines the need to involve the patient's personal physician, said Michael Munger, MD, president-elect of the American Academy of Family Physicians, in an interview with Medscape Medical News.

Without a physician's interpretation, "I think it's less than optimal," Dr Munger said about DTC lab testing. He added that patients need physician guidance on whether a lab test is needed in the first place. Patients could be wasting their money.

"Just because the test is available doesn't mean the test is indicated," said Dr Munger.

Follow Robert Lowes on Twitter @LowesRobert

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