Strange prescribing practices

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I work at a group that has it's fair share of opiates being prescribed. Newer providers are slowly working this out, but as with most places there's still a long way to go. We have one provider who we thought was padding his numbers by seeing patients on a monthly basis for refills of all their medications. Especially since management is more concerned about the number of patients you see vs. quality or outcomes of those patients. Also there was a thought was he was trying to squeeze a higher charge from checking all of these chronic conditions over and over again. Incidentally, these were all chronic pain patients in for opiate refills. Turned out when asked, this provider stated that he felt that it looks better if there are other diagnoses and issues documented and since chronic pain patients need a monthly appointment, he isn't going to bother putting refills on the rest of their meds. I did mention to him that when they look at maps, the only thing that shows is controlled substances and it's the only thing they pay attention to when going after people. Which he seemed to blow off and candidly not worry about. Anyone else see anything like that?

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Specializes in Nephrology, Cardiology, ER, ICU.

So, he makes everyone come in monthly for their BP meds, DM meds, etc? Hmmm..I would doubt the pts like this and it certainly seems like a lot of extra work....

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Interesting. I ran into a situation after a pt was admitted to LTC. I ran the state narcotic report. The community NP had been seeing the pt monthly, since February, and only wrote Ativan 1 mg po tid, 30 tablets. each time. So the pt was apparently getting a 10 day supply, so what was he supposed to do the other 20 days? It eventually led to a big problem.

I don't know what the rules are where you are but many practices do require a monthly visit for certain narcotics.

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Specializes in Nephrology, Cardiology, ER, ICU.

I get it for narcotics but why not give them refills for meds they always take....non-controlled substances

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54 minutes ago, traumaRUs said:

I get it for narcotics but why not give them refills for meds they always take....non-controlled substances

He honestly believes it looks "better" from an opiate perspective because he's one of the highest prescribing providers in the practice. Annoying when he's out and others have to pick up his load. Had one guy today realize last minute he was out of the meds and couldn't get in for a week. Which means no synthroid amongst other issues.

We require a monthly visit for opiates or most controlled substances. But there's a billing difference between a simple pain med refill and stacking up a visit with multiple chronic illnesses and a range of medications/adjustments. At the end of the day, where I once thought he was naive about what he's doing I'm starting to think it's getting more into unethical.

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So he is billing for managing all these diseases but really it's just a refill?

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Just now, Oldmahubbard said:

So he is billing for managing all these diseases but really it's just a refill?

I haven't looked deep in his previous charts on what codes are being billed. But wouldn't be shocked if that's what's happening. You got enough boxes in epic and it will automatically bill a certain level. Of course he had a scribe. So that's a factor.

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Specializes in Reproductive & Public Health.

Monthly appointments for chronic medications?!?! That is setting the patient up for serious health risks.

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On 7/19/2019 at 2:41 PM, traumaRUs said:

I get it for narcotics but why not give them refills for meds they always take....non-controlled substances

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Perhaps he does not want to be perceived as only giving Rx narcotics?

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I imagine it is an attempt have more in the note in order to bill a higher level visit (more ROS, multiple co-morbidities "addressed" pushes the level to moderate decision making and a level 4 bill from a level 3 for just a narcotic refill) but who knows. Doing that monthly for many patients on a regular basis may catch up to the provider in the end.

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11 hours ago, egg122 NP said:

I imagine it is an attempt have more in the note in order to bill a higher level visit (more ROS, multiple co-morbidities "addressed" pushes the level to moderate decision making and a level 4 bill from a level 3 for just a narcotic refill) but who knows. Doing that monthly for many patients on a regular basis may catch up to the provider in the end.

Looked into a recent example. He is billing a 99213. Just pushing 30+ PPD and trying to further dilute what should be an opiate refill with fluff to make it appear better (as he noted).

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