There is NO reason, no rationale, no logic behind docs dispensing drugs to workers comp claimants.
Proponents claim it is better care, leading to speedier recovery and lower costs.
We long suspected the opposite is true; that is, claimants getting drugs from docs get more treatment, incur higher medical costs, are out of work longer and run up bigger claim costs than claimants with the exact same injury who don’t get pills from their physicians.
Thanks to CWCI, we know that’s the real impact of doc dispensing.
Now, we know even more – we know that dispensing docs prescribe more opioids for longer times, thereby increasing the risk of addiction and drug diversion and overdoses and death. Thanks to a research paper authored by Johns Hopkins University Medical School and Accident Fund, there’s clear and convincing proof that doc dispensing is a highly risky, very dangerous, and very expensive proposition.
Here is the money quote:
“we found 39% higher medical costs, 27% higher indemnity costs, and 34% higher frequency of lost-time days associated with physician-dispensed versus pharmacy-dispensed medication. We found even more striking differences related to physician-dispensed opioids versus pharmacy dispensed opioids. The effect was nearly doubled and revealed 78% higher medical costs, 57% higher indemnity costs, and 85% higher frequency of lost-time days associated with physician-dispensed versus pharmacy-dispensed medication. [emphasis added]
And yes, the analysis was case-mix adjusted.
It’s not about convenience; Claimants get drugs for free and quickly thanks to PBMs and pharmacies who are only too happy to fill their scripts.
It’s not as if the drugs they dispense – NSAIDs, antibiotics, pain meds, stomach acid treatments – MUST be consumed within nanoseconds or the claimant dies. None of the top 50 doc-dispensed drugs are deemed time-critical.
It’s about docs sucking more money out of employers’ and taxpayers’ wallets. While dispensing more opioids, and keeping patients out of work longer.
Which brings up a question:
Why in hell are regulators and legislators not banning physician dispensing?
You know the answer to your question. The regulators and legislators don’t ban it because the AMA and folks like AHCS spend loads of money lobbying the very legislature that claims to care about injured workers. I’d venture to say the plaintiff bar in WC and the legislators care far more about their personal fortunes than they do about the injured workers they’re supposed to be protecting and advocating.
And that is certainly true for considering alternatives to expensive surgeries in the US that require these pain meds to be prescribed in the first place, if the claimant goes under the knife. It would be nice to know how many individuals get hooked on pain meds when they opt for surgery in other countries, for example, Costa Rica and Mexico, as well as countries in other regions of the world. I bet they don’t have plaintiff lawyers and physicians paying off legislators to look the other way.
There is such a need to stop physician dispensing. Physicians have always given samples to patients to help with costs and start their medication immediately. These samples are not to be sold. But I often wonder how many of the physician dispensed meds are samples that these physicians are dispensing and charging back to the insurance companies. Out of 50 drugs none were time sensitive. There is NO excuse.
It’s quite a self-serving scheme: physician dispenses medications, usually narcotics, NSAIDS, muscle relaxants and topical balms, on the first visit and makes a HUGE (over 1000%) profit off the meds. Also, the office visit code is higher (which yields a higher reimbursement) because of “medication management”. Now the claimant becomes constipated (due to the narcotics), so a stool softener is prescribed and dispensed at the next visit. Physician makes a huge profit off the drug , and this yields a higher level (AND higher reimbursement) office visit. Now the claimant can’t sleep well due to acid reflux (most likely from the NSAIDS), he comes back to the office and gets sleep medication and antacid medication, guess what? Higher office visit code, huge profit from the sleep and antacid medication…same goes for: antidepressants, erectile dysfunction drugs, etc. as the claimant deteriorates from all the drug side-effects. Wait, I forgot to mention the “drug screening tests” that the physician runs in his office (or contracts with a lab) and bills for(I’ve seen drug screening bills run in the $2,000 to $3,000 range)… REPEAT cycle…Talk about job security! And all along, no consideration for the negative effects on the claimant. And for what benefit when there are drugstores in every corner nowadays?
I suspect that this is association, not causation. Those who self-dispense are not a random sample of doctors. They are likely predominated by the bad actors who are acting out of self-interest. Combined perhaps with a skewing of referrals to them, if not outright solicitation of the expensive minority of injured workers and their advocates who drive the major costs in the system.
In other words, by all means abolish office-based dispensing, but don’t assume that another maneuver will not pop up to take its place. It is a symptom, not the cause of a number of systemic problems.
It is a bad idea for physicians to have a financial interest in anything that is ancillary to while associated with the practice of medicine. I do not want to go to a doctor who makes a profit out of prescribing drugs and I do not want to go to a doctor who owns a funeral parlor!