tag:blogger.com,1999:blog-1627739177988026073.comments2024-03-11T22:06:39.045-07:00BehaveNet® Opinionmoviedochttp://www.blogger.com/profile/03617061594621924756noreply@blogger.comBlogger359125tag:blogger.com,1999:blog-1627739177988026073.post-86554946511252102722016-10-07T09:37:57.375-07:002016-10-07T09:37:57.375-07:00Thanks, sideways, but this discussion has been mov...Thanks, sideways, but this discussion has been moved: http://behavenet.com/opinion/dea-suboxone-audit-worst-experience-my-career-physicianmoviedochttps://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-23227607390064658432016-10-07T09:02:40.470-07:002016-10-07T09:02:40.470-07:00I am a psychiatric nurse practitioner and I worked...I am a psychiatric nurse practitioner and I worked as a research nurse back in 2000-2002 with buprenorphine outpatient detox tapering doses and post detox depot injections. Needless to say, as ASAM claimed a monopoly on prescribing it right as I was graduating I have never prescribed it myself. But does it always work such that the prescriber dispenses the suboxone? And, as for the surprise DEA inspections, I've done worked with a law firm doing legal consulting for MDs and RNs who are having issues with their licenses and the state board and I don't think I would submit to a surprise inspection. Do you sign something saying you will submit to that? Also if yuo use an electronic medical record, how do you keep separate records?sidewaysshrinkhttp://googlenoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-84459012778474129492016-07-02T15:57:38.669-07:002016-07-02T15:57:38.669-07:00I am a doc and have been abused by the DEA before ...I am a doc and have been abused by the DEA before like some of the other physicians on this blog. I understand the emotions that you are going through but in the end if you want to win the war you need to forgive them and love them despite their bad behavior. They are like your children when they misbehave. You are angry at first but you get over it. Anonymoushttps://www.blogger.com/profile/07972560271916551819noreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-63786025732273240442016-07-02T15:56:00.491-07:002016-07-02T15:56:00.491-07:00I am a doc and have been abused by the DEA before ...I am a doc and have been abused by the DEA before like some of the other physicians on this blog. I understand the emotions that you are going through but in the end if you want to win the war you need to forgive them and love them despite their bad behavior. They are like your children when they misbehave. You are angry at first but you get over it. Anonymoushttps://www.blogger.com/profile/07972560271916551819noreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-88025799845598728402016-02-01T02:45:26.408-08:002016-02-01T02:45:26.408-08:00Good Blog on Telemental health. Keep posting thes...Good Blog on Telemental health. Keep posting these kind of blgs.rayjbarretthttps://www.blogger.com/profile/17697552580228650331noreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-31693534204841168082015-12-21T14:05:15.416-08:002015-12-21T14:05:15.416-08:00If addiction was so easily cured in 1 month we wou...If addiction was so easily cured in 1 month we would not need meds like Suboxone. Sorry but I disagree, this is not a short term fix but a life changing opportunity to have a life not ruled by pain meds, it is meant to help you get through and deal with cravings and safely come off opiates then with behavior changes and counseling taper off Suboxone. We find pts that stay on for 1 yr have the best success for long term. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-50889034242593882212015-07-27T13:52:54.397-07:002015-07-27T13:52:54.397-07:00Your an agent aren't you?Your an agent aren't you?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-70406185341500701902015-07-27T13:49:02.623-07:002015-07-27T13:49:02.623-07:00Let me ask are you off them? Because once you try ...Let me ask are you off them? Because once you try to get off them you might change your tune. These docs are supposed to use Subs as an in and out program: 1 month, tops! They see an opportunity to have cattle going through their office at X amount of $$ for life, most talk about how they are helping you, which they are, but not many have an exit plan for you, you are just a "pay the ticket at the door" kind of patient, trust me I was on 3 (8's) starting in 08, I have been trying to quit all year and finally dropped on July 1, the past 4 weeks have been hell. Now on the DEA side, these guys are not much better, it seems they go after docs that defy them, or mess with the wrong person, I would assume if they don't get paid their monthly fee, that the audit is coming soon. So everyone is making out great, the patient (not sick), the docs (ka-ching) and the Feds (most likely double or triple ka-ching) Nice world we live in, everyone stays happy, except when you want out of the matrix, then your FKD.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-84001556521191982372014-12-16T19:09:58.709-08:002014-12-16T19:09:58.709-08:00Was visited by 2 DEA agents today for suboxone. Th...Was visited by 2 DEA agents today for suboxone. They had many questions and wanted to know how many patients I had on suboxone and where are my segregated files, etc. They said that I could get into big trouble for not keeping my files properly. I told them that I would be happy to cancel my suboxone license. They said I could do it right then so I did. Because of DEA harassment and nonsensical, onerous regulations I am no longer subscribing suboxone for opioid addiction. I feel bad for the patients. Let the last subscriber turn out the lights.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-81400041537639982692014-07-16T18:53:38.663-07:002014-07-16T18:53:38.663-07:00Bravo to Dr. George Dawson who sued MEDCO to reimb...Bravo to Dr. George Dawson who sued MEDCO to reimburse him for his time doing these idioitc, waste of time PA's and WON!<br /><br />Dr. Dawson, or anyone else who has done this, can you please tell me to whom at these companies do you send your letter of intent informing them of your charges for doing their PA's? Do you have an acutal address for MEDCO, "Express" Scripts, etc?<br /><br />That was a brilliant move. Every practitioner needs to send them a similar letter. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-85687755802119077432014-06-24T09:06:08.665-07:002014-06-24T09:06:08.665-07:00I found this site...as I just had to spend 10 minu...I found this site...as I just had to spend 10 minutes to an inane prior auth for a medicine that is generic and was used to stabilize the patient during her hospitalization. During inpatient reviews, the insurance company knew full well what meds we used and approved them...but then the outpatient pharmacy carveout denied the script...and then a frantic call late last night by the girl's mother. A generic ... I actually chose the twice a day generic rather than the once a day brand name thinking access would have been easier even though compliance is typically better on any med that has less dosing!!!!!Kennoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-52127025293752816212014-06-04T07:41:58.303-07:002014-06-04T07:41:58.303-07:00Suboxone is safer than any other opiate because it...Suboxone is safer than any other opiate because it is a partial agonist and cannot be mixed with other opiates. The requirements for an 'x' license and the DEA audit process are a major barrier in the treatment of chronic substance using patients. Patients who take suboxone have less morbidity and mortality than untreated patients. Other drugs which are much more dangerous than suboxone require no special hurdles to perscribe. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-62140375225145586222014-05-13T07:24:06.503-07:002014-05-13T07:24:06.503-07:00I have just started the process of getting the wai...I have just started the process of getting the waiver to prescribe Suboxone and after reading all of the above I am hesitating. On the one hand I see that there is even more of a need than I thought, at least in some locations. On the other, at this stage in my career, do I want to be subject to this kind of harassment? Is there anything I can do to protect myself, or make this worthwhile, better for patients and physicians/health care providers?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-91009793787748088202013-11-28T09:00:55.961-08:002013-11-28T09:00:55.961-08:00Someone needs to get the dea and samsha out of thi... Someone needs to get the dea and samsha out of this business you said it 100 % correct I am a suboxone patient and of the only two doctors that had license in my county we now have 0 because of this stupid nonsense forcing me to drive two hours and see a doctor who seems scared to even see me. Suboxone Saved my life a seven year heroin addict the first year on suboxone I started a business bought my first home and have since had a baby boy and been on several vacations and off heroin life has been GREAT!!! if I had kept with old ways I would be in prison by now or dead. This is exactly what the D.E.A.is afraid of a magical pill that turns long time junkies into productive members of society OVERNIGHT of course they need to stand in the way of progress its their job security at stake. THIS HAS TO END!!! I have lost freinds to opiate addiction/overdose and if suboxone was more readily easily available this may not have happened.It's hard to get on suboxone took me three times to Doctor and a lot of searching . I realize I may be in the minority here i do know theres a lot of idiots that will trade this drug for other drugs and ruin this for people honestly trying to stay clean. Simple solution make these people pay in cash for the prescription and the doctors visit its the people in the state programs that get these pills given to them that do this. The D.E.A 1 yr school maybe? are driving you doctors with an 8+ yr education into not helping people like me this is SO WRONG ive been stewing over it for a long time now what can we do what can i do as a successful patient? Doctors who read this Thank You for the trouble you go thru I cant imagine, you are making a difference to people like me and Thank You from the bottom of my heart I mean this I would be in Prison again or dead if not for you guys you are in the RIGHT THE DEA IS WRONG ON THIS!!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-919435124853020052013-09-05T20:20:53.934-07:002013-09-05T20:20:53.934-07:00Fantastic!Fantastic!Rachellehttp://thesteammop.info/noreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-378766641089317552013-06-01T21:56:51.960-07:002013-06-01T21:56:51.960-07:00Well, I agree with the author. As a Suboxone prov...Well, I agree with the author. As a Suboxone provider I gave up my DEA suboxone prescribing number. I have been audited TWICE and both times have been horrible. I do not prescribe opiods other than this, I do my urine testing, my PMP reports, my contracts EVERYTHING is in order, and these "agents" still ruin entire schedules at a time, intimidate staff and patients alike and are complete assholes (typical little power trips of ignorant and undereducated government officials). I am a family physician who works in a community center for the underserved, I am not a criminal and will not tolerate to be treated like one. While thousands thugs flood our streets with narcotics everyday without even being questioned. Strange world indeed. But you have a point doc, no drugs=no DEA.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-1404990158184003832013-04-29T21:46:58.801-07:002013-04-29T21:46:58.801-07:00The best I can say is that my moratorium is long o...The best I can say is that my moratorium is long over, and now many of us can accept 100 patients. Sorry it's not helping. I assume you know about NAABT.org. <br />Now, however, the state medical boards make it harder to provide bupe maintenance, for example Vermont: http://behavenet.com/blog/charging-chargers-vermont-medical-board<br />More cause for hope: I am told that the bupe implant, which may get FDA approval this summer, will not count against the limits. moviedochttps://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-12522965526457874612013-04-29T21:38:00.366-07:002013-04-29T21:38:00.366-07:00I just came across this while I have been franticl...I just came across this while I have been franticly looking for a new Suboxone doctor for a couple weeks. I am shocked and saddened to hear that civilians such as yourself have taken such a heroic effort in your carrier to save lives and keep many of us who have unfortunately become dependent on opioid substances and have regained our lives and families through the help of Suboxone, and have been able to contribute back to society (as an elementary school teacher myself). The hardest part about all this is although I understand your frustration and outrage, refusing treatment of anymore patients until you are audited, really hurts the ones needing help the most. As mentioned, I have been seeking treatment without luck because of the long waiting lists. I am sorry that you have to be humiliated in such a manner, but do the ones who need help the most need to be hurt in the process too? I have no clue what you probably go through to help, and appreciate more than you can imagine, just wanted to point out the need for more doctors like yourself out there period without letting the DEA win in the meantime. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-24173946393597601252013-03-01T11:25:08.026-08:002013-03-01T11:25:08.026-08:00Congratulations! This is the best thing, Thank you...Congratulations! This is the best thing, Thank you so much for taking the time to share this exciting information.<br /><a href="http://weedub.com/products/grow-room-plans/" rel="nofollow"><b>More info</b></a>Anonymoushttps://www.blogger.com/profile/15298734367546838271noreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-65574689759413109102012-12-17T11:46:48.506-08:002012-12-17T11:46:48.506-08:00What the DEA is doing is wrong. It makes patients ...What the DEA is doing is wrong. It makes patients like myself sit up at night wondering if my last three years on suboxone (which have had me clean for three years and back in college) are comming to an abrubt end. I never thought I would have to think about the prospect of relapse on Heroin or any other opiod again. Now I have nightmares about relapse since my doctor was frightened out of prescribing. I have a new doc, how long will he help me before they destroy his life and the lives of his patients? I fully support original content of the video above. If anyone feels otherwise I would like to see how much succsess you would have without suboxone if you were strung out on heroin... and you would deserve to experience that yourself if you feel I deserve it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-90009460437257258232012-12-14T17:05:17.770-08:002012-12-14T17:05:17.770-08:00Is anyone going to take this action, send the lett...Is anyone going to take this action, send the letter in and share it with other psychiatrists to see if they wish to do so also?William V. Van Fleet, MDnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-4458510312765721462012-12-14T13:13:04.599-08:002012-12-14T13:13:04.599-08:00I had an appt with the pdoc this morning to check ...I had an appt with the pdoc this morning to check on my progress...another appt scheduled next month to make sure meds are working well. This is what needs to be done as a rule.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-60303077309442293782012-12-13T18:01:03.553-08:002012-12-13T18:01:03.553-08:00(Continued rough draft)
All of the above has noth...(Continued rough draft)<br /><br />All of the above has nothing to do with the general issue as to our public image with regard to integrity. The performance of unnecessary procedures in the service of getting paid more money is, I believe, bound ultimately to have a destructive effect on the image of our profession.<br /><br />There is a second issue of some importance.<br /><br />It should be noted that although we psychiatrist's do indeed prescribed medication, it is just as important a medical judgment to decide that a patient should discontinue medication, or not begin it in the first place. This is especially true because any of our medications have a certain risk for the patient that has to be weighed against the benefits of its use. Since we are physicians, we are indeed held responsible by our profession and by society for making such decisions any time we are treating our patients with psychotherapy.<br /><br />It would be especially troubling to see the introduction of any administrative procedures that would in any way tend to promote the prescribing of medication in order to make more money. A psychotherapist who is understood to have the patient's medical welfare in mind at all times, and is expected to make the judgment as to whether the patient also needs medication, should feel absolutely free to make the judgment in each session that the patient does not need psychotropic medication, and/or does not need any change in such medication.<br /><br />There is nothing inherent in the current coding requirements that would make the prescribing of medication necessary, of course, but I am concerned that the implication that psychotherapy is an "add-on" to a procedure that does not involve psychotherapy may indeed lead to a bias toward the prescribing of medication in order to justify the use of E&M codes. If anything, it should be understood that the provision of a psychotherapy session by a psychiatrist automatically includes the continuing, unceasing assessment of the patient with regard to need for medication. This should be the automatic expectation, the only exception being the explicit understanding between the psychiatrist performing psychotherapy and the patient that the patient's medication decisions would be made by another specific medical provider.<br /><br />Psychologists who are prescribing medication will now code for psychotherapy and, secondarily, for medication management (+98063), and thereby presumably get paid more. I have special concern that this could promote the prescribing of medication that might not be needed. I believe this separate code should be used for any psychologist performing psychotherapy who is authorized to prescribe medication, whether he or she prescribes it or not. I believe this should be made very clear.<br /><br />If an add-on code methodology is necessary for psychotherapy, I recommend that the model being used for psychologists be used also for psychiatrists, and that in both cases the code simply mean that the psychotherapist also is assuming the responsibility for decisions regarding psychotropic medication. There could be separate such codes for psychiatrists and psychologists, to reflect the greater breadth of medical responsibility assumed by psychiatrists. Documentation of such sessions could include a statement regarding the prescribing of medication or the consideration of doing so or the decision not to do so. Although in my opinion such a statement really should be assumed, this documentation would make it explicit. And such documentation would not interfere with the psychotherapeutic relationship.<br /><br />I urgently request that this matter be taken care of immediately. It is quite possible that the new coding requirements may drive some of us out of our professions, because of an unwillingness to have our integrity compromised.<br /><br />Sincerely,William V. Van Fleet, MDhttp://www.homorationalis.comnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-48133124818500674622012-12-13T17:59:50.695-08:002012-12-13T17:59:50.695-08:00For every psychiatrist to consider urgently sendin...For every psychiatrist to consider urgently sending over his/her signature:<br /><br />(Rough draft)<br /><br />To whom it may concern at the AMA and the APA:<br /><br />This letter, though originally not composed by me, represents my viewpoints exactly. I urgently request you take immediate action regarding a problem that threatens the integrity of our profession of psychiatry and the health and lives of our patients, related to changes occurring regarding coding of our procedures.<br /><br />Psychotherapy is a recognized, accepted, and needed medical practice, that has been a part of our training as psychiatrists. We have also been trained to evaluate our patients' needs for medications and other "biological" treatments. We have a responsibility to be aware of our patients' medical status in general, and of the need to refer our patients to their primary care providers and/or to specialists as indicated. Thus, we are expected by our profession and society to maintain all of this concern and awareness throughout the interaction with a psychotherapeutic patient, as an integral part of being a physician.<br /><br />The psychotherapeutic relationship is considered to be especially important in our patient's lives. Anything that distorts that relationship, and introduces into it any element of artificiality or deception, can be quite disastrous for such patients, destroying their ability to communicate genuinely with confidence in our concern for their welfare, and introducing complex transference/countertransference processes detrimental to certain kinds of psychotherapy, thus presenting a health risk to the patient, even perhaps a life-threatening one.<br /><br />For unclear reasons, there have been changes in the coding for psychotherapy, affecting reimbursement in extremely significant ways, that do not appear to be based upon an adequate understanding of the nature of psychotherapy and that can predictably bring about the impairment and possible destruction of some psychotherapeutic relationships, with consequent negative and perhaps even tragic consequences.<br /><br />We psychiatrists who are providing psychotherapy for our patients, often on a weekly basis, in order to be reimbursed for our work will now be required either to code just for psychotherapy, and receive about one half of the amount that we had previously been receiving (perhaps resulting in closure of some practices), or, in order to be paid more appropriately, to code for E&M with the psychotherapy simply being an "add-on" code. Then, in order to document the E&M code, we must report that we have carried out certain procedures. Although the possible selections of procedures are multiple, ultimately they consist of ones that are usually not necessary or even appropriate to be done on a weekly basis.<br /><br />More simply and concretely, the new requirements for documentation for E&M make it most likely that a psychiatrist performing weekly psychotherapy would be expected to take the patient's blood pressure and pulse in every session, even if, for example, the patient was being followed quarterly by a primary care physician who was doing the same. It is exceedingly clear that such a procedure would often be totally unnecessary. And never in the history of the provision of psychotherapy has there ever been any expectation that such a set of procedures, carried out in every session, be a part of that psychotherapy.<br /><br />The introduction of these procedures into each weekly psychotherapy session makes it evident to the patient that the psychotherapist is performing a procedure that is unnecessary, simply in order to get paid more. In fact, if the psychotherapist is to be honest with his patient, that has to be the explanation given to the patient. Justifying this new procedure by giving some false rationale would easily be perceived as dishonesty, and alter the patient’s relationship to the treating psychiatrist, quite possibly profoundly affecting the patient’s perception of the psychotherapist’s integrity and trustworthiness, and reducing confidence in the treatment process.<br /><br />(Continued)William V. Van Fleet, MDhttp://www.homorationalis.comnoreply@blogger.comtag:blogger.com,1999:blog-1627739177988026073.post-87729173049438906012012-12-13T14:38:49.272-08:002012-12-13T14:38:49.272-08:00Anon, I wish there were enough pdocs around so no ...Anon, I wish there were enough pdocs around so no PCPs would try to do our work, but we make mistakes too, and it doesn't matter who prescribes the drug. If it's the right one for you it works, and vv. We all need better science.moviedochttps://www.blogger.com/profile/03617061594621924756noreply@blogger.com