I never intended myself to be immersed in the “pill mill” controversy. In somewhat of a paradox I am.
In the early ’70’s I was sure I’d have a career in law and politics. That was abruptly changed when my best friend committed suicide after, unbeknownst to him, he became high on amphetamines and vodka mixed together and taunted to drink. As a result of this traumatic event I chose to become a psychotherapist.
My solo training in family practice clinics in Appalachia, hours away from substance abuse and mental health professionals, brought me face to face with the OxyContin abuse in 2000. One of my clinics was targeted for the prescribing of OxyContin by the physicians who worked for me.
Over 6,000 patient charts were reviewed by the federal task force for two years. It cost me $58,000 in legal and copying fees. After the investigation, my lawyer received a call from the Assistant U.S. Attorney who said “you can have Coates come get his charts. We didn’t find one case of prescription abuse. ”My attorney convinced the AUSA to deliver them to me at her cost.
How did it happen that not one non-compliant prescriptive case could not be found? It is simple, 15 years ago my physicians were audited by my compliance staff!
Everyone Needs to Be Accountable!
We had mandated enforceable protocols in the clinic and one of the protocols was the physician had to state on the record by signature he/she examined the patient and the medication was necessary and required. All other means of treatment had demonstrably failed. The audits confirmed independent evidence of failed treatments. The physician also was required to state on his timesheet compliance with all laws and rules governing their practice. Each pay period the docs had to attest compliance.
We had a second layer of safety which protected the physician. We protected the physician from the patient. Every patient was evaluated by a licensed behavioral practitioner as to the need for narcotics and even psychotropic medication, including benzodiazepines and anti-depressant medication. We had on site a confirmation moderate complexity clinical laboratory which tested urine and blood for toxicology. We tested for alcohol abuse. Point of service cups have a 40% error rate; 20% false positive and 20% false negative. We confirmed testing to protect the physician.
Is There a “Pill Mill” Problem?
I read approximately 6 news articles about “pill mills” daily. After teaching about 150 physicians and staff in Florida regarding compliance with the Florida Legislation the past five years; evaluating personally almost 2,000 individual patients for compliance; I can readily make the observation neither the physicians or patients are safe in this country when it comes to narcotic prescribing.
Our good physicians are frightened to the point of fear of being prosecuted. Most deserving patients are not even sure that they will have their script filled! And those patients working the system, will stop at nothing to try scamming the physician. I have not informed you of anything new.
How to Solve the “Pill Mill” Epidemic
After combating the problem myself for more than a decade, I can confidently say there is a solution!! The solution is so obvious, it may be automatically rejected.
The tools necessary are available in every clinic that has a computer!!!
Would it surprise you to hear that even in the best pain management clinics 60% of the patients are currently NOT following the physician’s plan of care for prescription narcotics? That is the number Pulido Coates and Associates has discovered to both the shock and dismay of their physician clients.
Wait just a minute before you make a deduction. It isn’t hard to fix. The disease of pain must be managed. And compliance with the plan of care requires education. Enter the Advanced Nurse Practitioner. Florida is one of the few states preventing prescriptive authority to the one group of healthcare professionals that are trained to take the time, expertise, and hardline questioning to “audit” the patient’s compliance, AND to watch the doctors back.
I believe pain management clinics ought to treat non-malignant chronic pain as a course of “disease management”. The protocol needs skilled professional, like the Advanced Registered Nurse Practitioner, to audit the patient. By the way, the protocol is a five step reimbursed procedure, paid for by Medicare, Medicaid, and most commercial insurance plans.
I have seen this work. I know it works. In those clinics Pulido Coates has instituted the disease management protocol, called the Pain Patient Compliance Protocol, two things are objectively reported:
- Doctors sleep better at night.
- Patients begin to get the mandate to strictly follow the physician’s plan of care.
The rate of non-compliance drops like a rock! We have consistently seen improvement to less than 5%.
Doc’s, protect your ticket to practice! Patients, try wanting to get well!
More research is necessary, however the results on more than 3,000 pain patient has been extremely promising. Doctors that have used it in their practices have reported increased revenue as a result. And in those cases where state boards of licensure have showed up, within minutes of witnessing the protocol have discontinued their audit of the clinic and discontinued the letter of probable cause.
If you want your clinic to be this bullet-proof give us a call at 888.508.1859 or email us at PPCP@SyMedica.net.