dealing with government scrutiny of pain management by primary care physicians l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
DEALING WITH GOVERNMENT SCRUTINY OF PAIN MANAGEMENT BY PRIMARY CARE PHYSICIANS PowerPoint Presentation
Download Presentation
DEALING WITH GOVERNMENT SCRUTINY OF PAIN MANAGEMENT BY PRIMARY CARE PHYSICIANS

Loading in 2 Seconds...

play fullscreen
1 / 10

DEALING WITH GOVERNMENT SCRUTINY OF PAIN MANAGEMENT BY PRIMARY CARE PHYSICIANS - PowerPoint PPT Presentation


  • 145 Views
  • Uploaded on

DEALING WITH GOVERNMENT SCRUTINY OF PAIN MANAGEMENT BY PRIMARY CARE PHYSICIANS. How To Anticipate And Avoid Government Interference With This Crucial Area Of Medical Care By Alan I. Kaplan, Attorney at Law 310 420 6961 www.alanikaplan.com alan@alanikaplan.com.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'DEALING WITH GOVERNMENT SCRUTINY OF PAIN MANAGEMENT BY PRIMARY CARE PHYSICIANS' - patsy


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
dealing with government scrutiny of pain management by primary care physicians

DEALING WITH GOVERNMENT SCRUTINY OF PAIN MANAGEMENT BY PRIMARY CARE PHYSICIANS

How To Anticipate And Avoid Government Interference With This Crucial Area Of Medical Care

By Alan I. Kaplan, Attorney at Law

310 420 6961

www.alanikaplan.com

alan@alanikaplan.com

introduction origins of opiophobia
Introduction-Origins of Opiophobia
  • Food and Drug Act of 1906
  • Harrison Act of 1914
  • Webb (1919) Moy (1920), Behrman (1921)
    • The Doctor’s Dilemna-purpose of pain meds
  • Controlled Substances Act (1972)
  • DEA Reassurances
    • 2002 Asa Hutchinson speech to American Pain Society: “We never want to deny deserving patients access to drugs that relieve suffering and improve the quality of life”
type of patient at issue
Type of Patient at Issue
  • Chronic Intractable Pain
  • Other sanctioned treatment has run its course
    • E.g. workers compensation system
  • Needs pain management to work
  • Financial Limitations
  • Treating with PCP
slide4

DEA REASSURANCESThe Myth of the "Chilling Effect"Doctors Operating Within Bounds of Accepted Medical Practice Have Nothing to Fear From DEA

  • Drug Enforcement Administration (DEA) statistics show that the vast majority of practitioners registered with DEA comply with the requirements of the Controlled Substances Act (CSA) and prescribe controlled substances in a responsible manner in treating their patients' medical needs.
  • One of the the missions of the Drug Enforcement Administration (DEA), Diversion Control Program (DCP), is to prevent, detect and investigate the diversion of legitimately manufactured controlled substances. The Controlled Substances Act (CSA) requires doctors to become registered with DEA in order to prescribe, dispense or administer controlled drugs to their patients for legitimate medical reasons.
  • The DEA may initiate an investigation of a practitioner upon receipt of information of an alleged violation of the provisions of the CSA and may pursue sanctions against the practitioner based upon the facts determined from that investigation.
  • Since FY 1999 the DEA registrant population has continually increased reaching almost 1 million doctors (as of June 30, 2003). During this same time, DEA has pursued sanctions on less than one tenth of one percent of the registered doctors. The pie charts pictured put this in graphic perspective.
the chilling effect
The Chilling Effect
  • Doctors who, faced with a patient in pain, fearing being targeted by the DEA, modify their treatment in an attempt to avoid regulatory attention.
  • Distortion of the doctor-patient relationship
    • E.g. selecting less effective, more toxic non-controlled medications when a trial of opioid analgesics would be in patient’s best interest
dea distortions
DEA Distortions
  • “963,385 total registrants in 2003, only 557 investigations initiated, 441 actions against M.D.s, 34 arrests..<.1% of registered doctors”
  • Estimated that only 5000 registrants are engaged in chronic opioid therapy (Hochman, Nat. Fnd. For Trtmt. Of Pain)
  • Over 10% of Chronic Opioid treaters face DEA investigation
strategies to combat the undertreatment of pain
Strategies to Combat the Undertreatment of Pain
  • Identifying the areas of pain management most subject to greatest scrutiny
    • Long term opioid use for chronic pain states
    • Pain regimens where other family members object
    • Operating an office dispensary
    • Government databases that tabulate prescribing and purchasing patterns- CURES and ARCOS
    • Older Physicians
strategies to combat the undertreatment of pain9
Strategies to Combat the Undertreatment of Pain
  • Identify Agencies that have the most interest in the area and understand how they target physicians
    • DEA, Medical Board, Medicare, MediCal
    • Data Mining-CURES/ARCOS
    • Reports from other agencies
    • “Joint Task Forces”
    • Use of undercover operatives
strategies to combat the undertreatment of pain10
Strategies to Combat the Undertreatment of Pain
  • Risk management strategies to minimize the likelihood of being targeted
    • EHR
    • Use of CURES data
    • Second opinions and the Intractable Pain Relief Act
    • Office staff issues
    • Urine tests and other methods to expose malingering and drug seeking behavior
    • Documenting decision making with patients who have developed a tolerance or who have undergone detox.
    • Pain contracts and surveys
  • DO NOT SURRENDER YOUR REGISTRATION