Strange prescribing practices

[djmatte]

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?

[KatieMI, BSN, MSN, RN]

Well, in order to make it in 99213, theoretically, one Dx of "chronic pain" is enough, but one still need to document at least a short physical. If the provider feels that documenting all other stuff and acting accordingly (i.e. prescribing BP meds and such) is "looking better", it is his right. It is not illegal as long as cases are not billed higher without good and documented reasons.

I always use those "pain pills visits" for med refills, education, etc. People love it as they feel that they are "cared about", I love it because it helps to keep things under control and avoid accidental prescribing of 3 PPIs and 5 laxatives, labs falling through cracks, etc.

[djmatte, ADN, MSN, RN, NP]

38 minutes ago, KatieMI said:

Well, in order to make it in 99213, theoretically, one Dx of "chronic pain" is enough, but one still need to document at least a short physical. If the provider feels that documenting all other stuff and acting accordingly (i.e. prescribing BP meds and such) is "looking better", it is his right. It is not illegal as long as cases are not billed higher without good and documented reasons.

I always use those "pain pills visits" for med refills, education, etc. People love it as they feel that they are "cared about", I love it because it helps to keep things under control and avoid accidental prescribing of 3 PPIs and 5 laxatives, labs falling through cracks, etc.

I can't help but think a smart way would be to break up the chronic illnesses while still accounting for the monthly meds. Month 1 focus on diabetes and pain, month two cholesterol and pain, etc. Thus allowing for refills where warranted and covering pain as required. As noted, there is already a few points where patients ran out because of scheduling conflicts.

[Forest2]

I guess this makes patients be more accountable to getting in there for their meds, patients need to pay more attention, but so many expect people to do things for them. Also, I can see how this would be a problem since they only need the narc refills monthly and the others can be q6mo or annually or whatever depending on their insurance. It seems like he is just trying to simplify things, just write them ALL monthly and not worry about it. It can be an issue when other providers that have to see his patients though. So, they have to address everything each time and not for the one thing that they really need to be there for. I think he just doesn't want to try to keep track of it all.

[Forest2]

On 7/19/2019 at 7:12 PM, djmatte said:

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.

Oh...…..?