Opioid rx obligations

[Goodlife1119]

Advertisement - Members don't see this ad

I am entering a hospital based practice to take over for a retiring physician. The practice has 200 patients on opioids all managed by a APP(under 50 OME). This APP is leaving the practice but it is unclear when. My question is for when I actually enter the practice will I be automatically responsible for these patients on chronic opioid therapy or can I refer them to a private group with more resources that would happily take them? I am trying to understand my responsibility as the new oncoming physician with no established relationship with these patients before I enter the practice. My second question is, if there is some overlap between myself and the departing APP in the practice, am I suddenly responsible for all of these patient's or can I still decline to prescribe ongoing prescriptions and refer to a outside practice. My concern isn't about the dose of the opioids but rather about the indications for which these meds were started and the administrative burden that would come with managing opioids by myself as I intended to come into the practice as a interventionalist only. Thanks in advance.

 

[au bon pain]

Only half kidding. The time to start making your thoughts and concerns about this to your new employer is right now. Be very concrete and direct and see what happens. Be prepared for bumps in the road, but in my opinion when it comes to the whole conversation about COT, it’s better for all parties (including admin types) to have the hard conversation up front as opposed to death by a thousand cuts.

 

[mille125]

I am not an attorney but my take is that even if the APP is writing the script and even if your state allows APP to write all schedules, you still have some responsibility.

If you APP causes a pneumo from a trigger point injection is your liability zero?

 

[willabeast]

I am entering a hospital based practice to take over for a retiring physician. The practice has 200 patients on opioids all managed by a APP(under 50 OME). This APP is leaving the practice but it is unclear when. My question is for when I actually enter the practice will I be automatically responsible for these patients on chronic opioid therapy or can I refer them to a private group with more resources that would happily take them? I am trying to understand my responsibility as the new oncoming physician with no established relationship with these patients before I enter the practice. My second question is, if there is some overlap between myself and the departing APP in the practice, am I suddenly responsible for all of these patient's or can I still decline to prescribe ongoing prescriptions and refer to a outside practice. My concern isn't about the dose of the opioids but rather about the indications for which these meds were started and the administrative burden that would come with managing opioids by myself as I intended to come into the practice as a interventionalist only. Thanks in advance.

Not legal advice. My understanding is that you have no legal obligation to write scripts but once you start you must provide for further care. Similarly your ?employer? can fire you if you do not appear to be working out. I once started a new job and when I started asking questions a long timer said to me (quote) "You do want to work out here, don't you?" Took her advice, figured out a work around that was politically correct, and spent the next 20 years there.

 

[Ducttape]

you have responsibility.

you do not have to continue medication, but you have to provide safe care - continue medication, provide appropriate taper off, or arrange transfer to another provider (and i use this term on purpose) to take over the medication.

 

[BobBarker]

Follow up visits pay more than epidurals on units for the time spent. You don’t want to make your RVU quota? You need to look at this as a blessing. Resources? You need to check the pmp which is in your EMR and review a periodic UDS. Not having enough resources to refill some tramadol but having enough to do interventions doesn’t jive.

 

[Agast]

Be prepared for 80% of the “stable” patients to tell you the meds aren’t working and you need to give them something stronger. They can’t help themselves, as soon as they see someone new they have to make a play for something better.

 

[mille125]

you have responsibility.

you do not have to continue medication, but you have to provide safe care - continue medication, provide appropriate taper off, or arrange transfer to another provider (and i use this term on purpose) to take over the medication.

correct..

The main issue with opioids is withdrawal so you have to give them appropriate tapering even if the prescriber has now left your practice.

 

[mille125]

Follow up visits pay more than epidurals on units for the time spent. You don’t want to make your RVU quota? You need to look at this as a blessing. Resources? You need to check the pmp which is in your EMR and review a periodic UDS. Not having enough resources to refill some tramadol but having enough to do interventions doesn’t jive.

That is true too....sadly...(speaking of f/u pay vs epidurals for unit time)

 

[Goodlife1119]

Not legal advice. My understanding is that you have no legal obligation to write scripts but once you start you must provide for further care. Similarly your ?employer? can fire you if you do not appear to be working out. I once started a new job and when I started asking questions a long timer said to me (quote) "You do want to work out here, don't you?" Took her advice, figured out a work around that was politically correct, and spent the next 20 years there.

What is a politically correct solution to this then?

 

[oreosandsake]

Be prepared for 80% of the “stable” patients to tell you the meds aren’t working and you need to give them something stronger. They can’t help themselves, as soon as they see someone new they have to make a play for something better.

YES

I come in first and let them know day 1 that I may or may not agree with the previous plan of care. When I get roped into these things I set the expectations at the first visit. I also offer opportunity for a second opinion if they aren't happy with it. if the other practice takes them over, or refuses to it still works in my favor - usually. although most refuse to go somewhere else... they know the game and it's easier to stick with you

 

[drusso]

I am entering a hospital based practice to take over for a retiring physician. The practice has 200 patients on opioids all managed by a APP(under 50 OME). This APP is leaving the practice but it is unclear when. My question is for when I actually enter the practice will I be automatically responsible for these patients on chronic opioid therapy or can I refer them to a private group with more resources that would happily take them? I am trying to understand my responsibility as the new oncoming physician with no established relationship with these patients before I enter the practice. My second question is, if there is some overlap between myself and the departing APP in the practice, am I suddenly responsible for all of these patient's or can I still decline to prescribe ongoing prescriptions and refer to a outside practice. My concern isn't about the dose of the opioids but rather about the indications for which these meds were started and the administrative burden that would come with managing opioids by myself as I intended to come into the practice as a interventionalist only. Thanks in advance.

Don't take this job. Go somewhere else where you can start fresh.

 

[Ronin1]

You should have had this discussion prior to signing on clearly.
Personally I would keep them if appropriate
200 99214 plus gcode x12 x65$
200x2.25x65. 351k. Easy money. Keep them all low dose. Don’t add any new ones
Easiest money ever made

 

[hyperalgesia]

What is a politically correct solution to this then?

Use the lead time while the APP is still there to set the stage that you have a different approach and that your position on opioids is xyz. If the APP mentions this to all their pts in advance, some will self deport. This is the first line of defense.

When the pts have their first appt with you, the person who schedules them or an MA or RN should speak with them and reinforce your policy BEFORE you see them, give them the option to establish care with A, B, or C - ranging from interventional to Dr. Feelgood. This is your second line of defense.

And finally, for the pts who remain in the practice, review the chart carefully beforehand and come up with a high quality, SOC treatment plan for them that you are fully comfortable with and stick to it.

You are likely to have a low volume at first. You will want to build up your practice the way you want it over time, not overnight.

 

[1 Up]

Don't take this job. Go somewhere else where you can start fresh.

Why?

 

[mille125]

You should have had this discussion prior to signing on clearly.
Personally I would keep them if appropriate
200 99214 plus gcode x12 x65$
200x2.25x65. 351k. Easy money. Keep them all low dose. Don’t add any new ones
Easiest money ever made

Your numbers are accurate assuming 100 percent Medicare as avg reimbursement

 

[VA Hopeful Dr]

correct..

The main issue with opioids is withdrawal so you have to give them appropriate tapering even if the prescriber has now left your practice.

I dont think that's true.