Cash pay for opioids? Sounds like a great idea. What could possibly go wrong? 🤔
Nope.Would you prescribe Oxy 30 mg QID to a patient who's insurance picked up 100% of the cost or only required a $5 co-pay for brand-name Oxycontin?
Nope.
I get the surgeons perspective on acute post surgical pain, but if they have a surgical issue or even a non-surgical issue that they are managing, I expect them to manage it. I am not going to manage pain from a humerus fracture that happened 1 week ago that is non-op. Ortho can do that. Also I am not going to see a patient 3wks s/p TKR to manage pain meds because the surgeon doesn't want to. If they don't think the patient should be on opioids anymore, they should tell them that and offer alternatives. If they do then they should prescribe it. Neither of which require my involvement. If we accepted these types of patients I would be flooded with dumps very quickly. I would be busy all day, but the wait for the patients that could really benefit from me would be longer. My procedure volume would drop a bit I am sure as well.you know this...
1. most addiction doctors are prescribing suboxone, a tightly monitored Schedule 3 drug, not Percs or oxycontin.
2. the intent of addiction and pain management are very different and this is very obvious to those who are reviewing charts
3. high deductible is not cash pay. they still have insurance, which still may be "monitoring" prescriptions. these patients are motivated towards trying all forms of treatment - when they reach their deductible. different situations.
from my perspective - the optics of prescribing opioids for cash is bad, regardless of how you sugar coat it. and they will be resistant to all other forms of care - "I cant afford it, but I can afford the Percs". and they will argue about making your visits Level 2. they don't give UDS willingly, and are often too busy working at a phantom job to come in for pill counts.
take it from drusso's perspective - $43 every 1-3 months, for someone who can take your prescription, and do who knows what with them...
from the surgeon's perspective - opioids really should be used for only the first 2 weeks or so. anything longer than 4 weeks is probably too long for acute postsurgical pain...
Would you prescribe Oxy 30 mg QID to a patient who's insurance picked up 100% of the cost or only required a $5 co-pay for brand-name Oxycontin?
Are they going to pay cash for the drug screen, MRI, procedures, PT, abuse resistant formulations and everything else you need to safely take care of them?Want to ask people's opinion on this. Has been a follower on this forum and have found the input and discussion valuable
Recently I have a few patients came to me, some by referral, but they don't have insurance, they want to pay cash for their visits but only want me to manage their opioid. Sometime I just don't know what to do with these patients, if I recommend procedures, it's probably too costly and they won't be able to afford or no interest in pursuing. I just don't like the optic of essentially they are giving me cash for a opioid prescription. Granted it's easy and don't have to deal with insurance reimbursement. What are people's thought on this, appreciate the input
Why describe prescribing for this cohort as zero sum? The CDC has built in risk tiers.
Feels unfair to me that we would make a distinction between a self pay patient and a worker’s compensation patient where the carrier continuously denies every med and every procedure outside of an opiate.
I would make the argument that none of these examples are patients who require opioids.Would you prescribe Oxy 30 mg QID to a patient who's insurance picked up 100% of the cost or only required a $5 co-pay for brand-name Oxycontin?
this is the problem. once someone is on opioids long enough at high enough dose, they become Legacy patients and cannot stop use.When they finally stop having to see you, you have successfully done your part.
I have a few legacy patients on high-dose therapy as well in similar situations. However, I would argue that your patient should likely have a greater amount of thier MMED be from long-acting meds and smaller prn dosing. Nobody needs 45MMED in one shot for chronic pain.Sure. And I have documentation to back it. The only patient I currently have on that regimen has a rare incurable and fatal disease.
I have a few legacy patients on high-dose therapy as well in similar situations. However, I would argue that your patient should likely have a greater amount of thier MMED be from long-acting meds and smaller prn dosing. Nobody should need 45MMED in one shot for chronic pain.
I would make the argument that none of these examples are patients who require opioids.
Fair enough...just out of curiosity what do you do in these situations for the cash pay or WC guy on ~20MED? Tell them they need insurance or to tell them to take it up with their adjuster and follow up PRN? Does it make a difference if the guy has cirrhosis and a mechanical heart valve and your relative risk for injections/nsaids/Tylenol is now higher than baseline?