Regulation, Suboxone Clinics & Unintended Consequences Re: Prescription Drug Abuse and the Affordable Care Act
As we all know, prescription drug abuse is a significant problem in Kentucky; so significant that the Kentucky Legislature enacted the toughest and most cumbersome requirements for prescribing controlled substances in the United States. By authorizing the Kentucky Board of Medical Licensure (“KBML”) to promulgate additional standards for prescribing through its regulatory process, Kentucky’s physicians have become the most regulated and policed of any in the country and probably the entire Western Hemisphere. In 2013, the number of Kentucky deaths from overdoses of controlled substances actually declined for the first time in many years. Some have suggested that the decline is a direct result of the stringent prescribing regulations, but this is pure speculation.
A distinct possibility exists that the decline in overdose deaths is driven by Kentucky doctors who have taken on the management of addicted patients by adding recovery services to their practices or establishing separate addiction recovery clinics, often called suboxone clinics (named for the medicine often used to treat substance addiction). Because the FDA limits the number of patients a physician may manage with this medication to 100, it is not economically viable for a single physician to establish a full-time practice that solely provides addiction recovery services. Thus, these clinics have to be a cash operation, and often are a sideline practice. While the risks of managing these troubled patients are tremendous, suboxone clinics provide a great service for those who want to address their problems. Unfortunately, for Kentucky physicians, providing addiction medicine services has just become more complicated.
In keeping with the requirements of the Affordable Care Act, Kentucky’s Department of Medicaid Services has expanded its coverage of physician services for managing substance disorders and established fee schedules. Of course, the individuals who have the most severe drug addictions are those whose lives are out of control and are likely to have lost homes, jobs, and families. These same individuals are likely to qualify for Medicaid, particularly since the Medicaid expansion. Providing recovery addiction services for Medicaid patients, particularly suboxone services, can allow a patient to resume a normal and productive life while undergoing treatment.
Rather than incentivizing physicians to provide these important addiction medicine services, the Department of Medicaid has established a remarkably low fee schedule payment of $21.53 for physicians to treat these substance disorders. Physicians cannot afford to treat these patients at that fee, much less provide the supporting services such as assessment, development of treatment plans, counseling and the monitoring that lead to a successful recovery.