Out of State Medicaid Patient on 100mg QD of Methadone...

[drusso]

Visiting the area prior to a possible relocation. Wants to schedule a 15 minute "informational interview" with Center's medical director and manager to "determine if I'm a good fit" for your clinic...

What's your next move?

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[DrCommonSense]

Visiting the area prior to a possible relocation. Wants to schedule a 15 minute "informational interview" with Center's medical director and manager to "determine if I'm a good fit" for your clinic...

What's your next move?

Whats the diagnosis?

 

[hyperalgesia]

Visiting the area prior to a possible relocation. Wants to schedule a 15 minute "informational interview" with Center's medical director and manager to "determine if I'm a good fit" for your clinic...

What's your next move?

Staff call: "Our Medicaid panel is full"

 

[Ducttape]

must be nice as a private practice to be able to say that .

 

[drusso]

Whats the diagnosis?

Failed back.

 

[geauxg8rs]

Failed back.

Only acceptable for fibro if failed Med marijuana and gluten free diet

 

[BobBarker]

Nothing is stopping you from declining the patient as an employee either. I decline patients all of the time. The hospital doesn’t want you writing this rx, either.

 

[Ducttape]

sure you can deny seeing the patient, or deny prescribing.

but you cant say that Our Medicaid panel is full as an employee...

 

[BobBarker]

You can. It is just as likely to be true as the private practice guy saying it.

I think it is unnecessary to skirt around the truth.

 

[emd123]

Patient declined.

No reason given.

 

[Ducttape]

You can. It is just as likely to be true as the private practice guy saying it.

I think it is unnecessary to skirt around the truth.

i guess ill agree to disagree. but beware, if you are a hospital based employee and you tell someone that they are not accepting Medicaid patients, then it may get reported to CMS, and that could impact hospital reimbursement. A Question Of Refusing To Care For A Patient

 

[drusso]

i guess ill agree to disagree. but beware, if you are a hospital based employee and you tell someone that they are not accepting Medicaid patients, then it may get reported to CMS, and that could impact hospital reimbursement. A Question Of Refusing To Care For A Patient

No one should be forced by their employer to enter into relationships that aren't brokered on an equal footing. What use is to a Medicaid patient to be under the care of a doctor who does not want to care for them?

 

[Aether2000]

It is always entertaining to note hospital hypocrisy at work. If you refuse to take care of a Medicaid patient they may discipline you and report you to CMS. However, try to put in SCS in many Medicaid patients, and the hospital will complain they are losing money on these patients, and suggest there must be a modification of patient selection or they will eliminate SCS altogether for all patients.

 

[drusso]

It is always entertaining to note hospital hypocrisy at work. If you refuse to take care of a Medicaid patient they may discipline you and report you to CMS. However, try to put in SCS in many Medicaid patients, and the hospital will complain they are losing money on these patients, and suggest there must be a modification of patient selection or they will eliminate SCS altogether for all patients.

Our state's Medicaid does not consider SCS an essential health benefit.

 

[Yo GabbaPentin]

Visiting the area prior to a possible relocation. Wants to schedule a 15 minute "informational interview" with Center's medical director and manager to "determine if I'm a good fit" for your clinic...

What's your next move?

I denied the referral when I heard out of state. Or was it Medicaid? Maybe it was the methadone part.

I'm sure that someone who plans on interviewing you to determine if you are worthy to prescribe their methadone will be a good patient though.

 

[SeniorWrangler]

It's like the Charlie Brown Halloween special. Only the sincerest pain clinic in the land is worthy of a visit by the Great Pumpkin.

 

[BobBarker]

Patient isn’t going to move unless she can find someone to write the methadone for her.

 

[Ducttape]

No one should be forced by their employer to enter into relationships that aren't brokered on an equal footing. What use is to a Medicaid patient to be under the care of a doctor who does not want to care for them?

the point is being missed.

one last time: i am not saying and never said that the hospital based employee has to take care of the patient.

i am specifically stating that a hospital clinic cannot tell a Medicaid patient that they will not see them strictly because of their insurance.

 

[drusso]

the point is being missed.

one last time: i am not saying and never said that the hospital based employee has to take care of the patient.

i am specifically stating that a hospital clinic cannot tell a Medicaid patient that they will not see them strictly because of their insurance.

I believe that some employed MD's are coerced into contractual relationships with patients that, if brokered on an equal footing, they would not otherwise consent to being involved in...

 

[Aether2000]

According to the Washington Agency Directors opioid calculator, 100mg methadone = 1200 mg MS. So you could accept the patient, convert her to 120 Norco a day, then gradually wean ;-)

 

[Ducttape]

According to the Washington Agency Directors opioid calculator, 100mg methadone = 1200 mg MS. So you could accept the patient, convert her to 120 Norco a day, then gradually wean ;-)

wait, my calculator went haywire... it says converting 1200mgMS = 200mg tramadol... or is that traumeel?

 

[SSdoc33]

I believe that some employed MD's are coerced into contractual relationships with patients that, if brokered on an equal footing, they would not otherwise consent to being involved in...

i'd like to only treat supermodels with commercial insurances. but that aint happenin. we all have crappy patients to deal with

 

[geauxg8rs]

According to the Washington Agency Directors opioid calculator, 100mg methadone = 1200 mg MS. So you could accept the patient, convert her to 120 Norco a day, then gradually wean ;-)

What if they want tighter control of the med?
I think change to 5mg hydrocodone, 10 pills per hour or one every 6 minutes. Might make
For steady state relief.

 

[Ferrismonk]

Maybe I'm an outlier here, but I welcome anyone who wants to be evaluated for pain problems in my clinic. I'd schedule a full history and physical as any normal patient (not a 15 minute medical director meet & greet as requested), determine a diagnosis, and come up with my plan of treatment and offer that. Likely my recommendation in this case would include transfer to suboxone clinic for narcotic wean, follow the many rules of my clinic, and we can try to treat her pain with other non-narcotic modalities. If the patient doesn't like my plan, he/she is free to seek other opinions. I don't decline patients based on insurance and always give them a face-to-face evaluation.

 

[lobelsteve]

Maybe I'm an outlier here, but I welcome anyone who wants to be evaluated for pain problems in my clinic. I'd schedule a full history and physical as any normal patient (not a 15 minute medical director meet & greet as requested), determine a diagnosis, and come up with my plan of treatment and offer that. Likely my recommendation in this case would include transfer to suboxone clinic for narcotic wean, follow the many rules of my clinic, and we can try to treat her pain with other non-narcotic modalities. If the patient doesn't like my plan, he/she is free to seek other opinions. I don't decline patients based on insurance and always give them a face-to-face evaluation.

Agreed. Saw 40 y/o male today. 34 Rxs from 1 doc on PDMP. Has PPO and a FT job plus 2 kids and parents helping raise kids (so- different background). But Rx's are Xanax 1mg qid, Ritalin bid, Suboxone 8mg qd.
He was given policy and knew before visit I do not Rx Suboxone or Xanax or Ritalin. Nice enough guy on exam and interview. Giving him zofran, zanaflex, clonidine. Getting UDS, ICAT, counseling started. Getting Xrays and old records sent. Knows if I use meds it will be Butrans. Knows procedures unlikely to help given history of meds. Told he is going to be fine and I will block a lot of the withdrawal, but to focus on having FT job, kids, and family support.

 

[geauxg8rs]

Agreed. Saw 40 y/o male today. 34 Rxs from 1 doc on PDMP. Has PPO and a FT job plus 2 kids and parents helping raise kids (so- different background). But Rx's are Xanax 1mg qid, Ritalin bid, Suboxone 8mg qd.
He was given policy and knew before visit I do not Rx Suboxone or Xanax or Ritalin. Nice enough guy on exam and interview. Giving him zofran, zanaflex, clonidine. Getting UDS, ICAT, counseling started. Getting Xrays and old records sent. Knows if I use meds it will be Butrans. Knows procedures unlikely to help given history of meds. Told he is going to be fine and I will block a lot of the withdrawal, but to focus on having FT job, kids, and family support.

But if you review referrals ahead of time wouldn’t it be better on both ends to simply say
“I don’t write for suboxone, Xanax, Ritalin.
I would be happy to see you to discuss non opioid strategies for your pain.”

This mitigates the patient leaving your office and saying you didn’t do anything and my insurance shouldn’t have to pay and i am writing a bad review, etc. in the end i don’t want to waste people’s time, i don’t want to waste that clinic slot on something that I know is not going to go well.
I put the ball in their court but i am up front.

 

[lobelsteve]

But if you review referrals ahead of time wouldn’t it be better on both ends to simply say
“I don’t write for suboxone, Xanax, Ritalin.
I would be happy to see you to discuss non opioid strategies for your pain.”

This mitigates the patient leaving your office and saying you didn’t do anything and my insurance shouldn’t have to pay and i am writing a bad review, etc. in the end i don’t want to waste people’s time, i don’t want to waste that clinic slot on something that I know is not going to go well.
I put the ball in their court but i am up front.

Yup, patients told that ahead of visit several times. If tbey want to come in to see what else can be done I will see them. During interview if they start in on meds i walk out and they are charged. They are told this as well.