Over the past few months, I have begun to notice a large increase in doctors looking for coverage for pain management clinics in the state of Florida. Doctors that are interested in working in a pain management clinic should be aware of some of the laws that are changing to set a standard for this type of care and how it will affect their medical malpractice insurance. Such laws have been created to stop what Florida is calling an increase in “pill mills,” where doctors may see up to 100 patients per day and prescribing large quantities of medication.
Pain management clinics prescribe medications are various medical drug needs; however the most common is chronic pain. Many states, including Florida, have had significant problems with drug addicts going to pain management clinics to get the drug of their choice. This has caused the state, the medical board, and medical malpractice insurance companies to be very uneasy with pain management clinics. The state of Florida has begun to scrutinize pain management clinics very closely. Across the nation there have been far too many physicians convicted of over prescribing narcotics to other physicians. This is a major crime, in which the doctor loses his license, has all of his assets and accounts frozen and often requires jail time. Due to the higher frequency than normal, medical malpractice insurance companies pay close attention when underwriting pain management clinics and often charge higher premiums to compensate for the risk.
According to The Florida Times Union in Jacksonville (see below), many pain doctors welcome the new laws in hopes it will offer some distinction between them and the rest of the industry. Many doctors think this will root out those who have given their profession a bad name.
Florida Pain Clinic New Requirements:
- Require pain clinics to be owned by doctors, unless the facility is registered with the Agency for Health Care Administration (such as hospices, hospitals or assisted living facilities).
- Limit offices that dispense on-site to providing only three days worth of pills (drugs) to anyone who is paying with cash, check or credit card instead of insurance.
- Prevent pain clinics from advertising prescriptions for specific drugs.
- Failing to register with the state as a pain clinic becomes a felony under the new law, and starting in 2012, doctors entering a pain management practice will have to be qualified in the specialty by board certification or completing a fellowship in pain management or a related field. Doctors will also have to keep careful records documenting that patients were given physical exams the same day prescriptions are written for controlled substances like oxycodine and xanax.
Pain management is a fairly common medical specialty as there is a very large need for it. Doctors who are providing pain management care are required to be residency trained physicians. In fact, most of them have completed additional training by doing a fellowship. Physicians seeking to become pain management doctors complete their residency in anesthesiology and then typically complete a one year fellowship in pain management.
Medical malpractice insurance companies classify pain management in the same class of risk as anesthesiology. Therefore, many anesthesiologists/pain management trained physicians practice both specialties in their practices. It is important that these doctors inform their medical malpractice insurance company that they are performing both specialties. Most underwriting departments will ask what percentage of each specialty they practice and if they are practicing any interventional pain management. Doctors will not need two policies to cover both specialties, as long as the physician malpractice insurance company is aware of the totality of the physicians practice.
The stringent rules for pain clinics certainly help the market with the availability of medical malpractice insurance for pain management clinics and doctors. The tighter the rules and guidelines are for these facilities, the more comfortable medical liability insurance companies will be to write this medical specialty. Hopefully, this will also help to lower the number of drug-dependent abusers over time. More Florida medical malpractice insurance carriers will be willing to write coverage for a pain clinic if they feel the doctors are practicing under the states laws.