Part II: How can we mitigate controlled substance prescribing risk for the good of the patient?
...and the practice.
In "Part I: What do we see in a typical primary care chronic pain population in a primary care practice?", we described some of the typical problems we see within practices related to both documentation and chronic pain care that represent areas of substantial risk to the prescribing physician and the practice. Many of the observations we describe have led to Medical Board accusations, underscoring the serious risk threat they represent. So the natural question is, how can these risks be mitigated while improving patient care in a way that is financially beneficial to the practice? While many have turned to procedures based on economics and the carrier’s willingness to reimburse, the outcomes for patients can be widely variable and are typically short term. Is there a better alternative?
The answer is education. The Medical Board and the CDC provide many detailed topic recommendations with supporting research rationales that clearly describe the patient need and benefit. Despite all of this available information, we have found that practices do not spend the time educating patients about basic issues like informed consent, opioid harms and risks, and alternative treatments, just to name a few. The reason is always the same, "I just don't have the time." As a result, the resulting lack of clinical documentation is a clear risk.
Want to generate more revenue than you can from most procedures, contain the risk, and address some key prescribing guideline compliance issues? Group education is the tool.
When you look at the numbers of patients in your practice with the issues we identified in Part I, you can create telemedicine based shared medical appointments (group education) that are billed as a 99213, or 99214. You can educate large groups and be reimbursed for each patient. The education is appropriately documented and patients have the benefit of gaining a better understanding of complex issues. The patient that has been prescribed long term opioids for their fibromyalgia or migraines will now understand why they don't work and are now ready to engage in non-opioid treatments. You can explain this in an educational session to a group of 30 patients and for the 1 hour you spend, you will conservatively generate 30 x 99213 of income for your hour. Not bad.
For most physicians and practices, getting started is the challenge. Issues of patient connectivity, unfamiliarity with teaching proven content in a structured curriculum, and lack of experience with shared medical appointments can represent significant barriers. OPOS provides a turnkey solution based on using board certified pain specialists to deliver the education on a dedicated telemedicine platform. The solution is turnkey, including all of the patient documentation. A small sampling of current topics include:
Functional Monitoring for Patients
The Opioid Epidemic
Realistic Benefits of Opioid Therapy
Opioid Therapy Risks
Opioid Overdose Risk
Opioids and the Endocrine System
Opioids: Undesired Effects
Pain, Opioids, and Sleep
Shared medical appointments are delivered by the OPOS telepain.MD service. Just like a physician needs tools for procedures, a physician needs tools for education. Starting with a proven tool is critical in order to be effective and have great economic return. You would not make your own scalpel and then perform a procedure. While education does not address every issue we identified in Part I, it addresses most issues. The remaining issues can be addressed by a thorough chart review which is a necessary step in identifying patient candidates for educational shared medical appointments. OPOS can help you with the review and creation of a risk mitigation plan. For the risk mitigation plan, a practice revenue/business plan can be created to detail the financial return on the new educational services. For patients, the benefits they will receive are priceless.
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