What Differentiates Pain Management Centers from Pill Mills

Author: Sherry Krueger

 

Pill mills have been in the news quite a lot the past few years, and not in a good way. They dole out millions of narcotic prescriptions annually. Often times the line between doing what's best for the patient and doing what's best for the bottom line of the pill mill practice gets very shady at these businesses.

"Comprehensive pain centers are very different from "pill mills". Unfortunately the two practices get associated together in the minds of the public." states David Greene MD, CEO of a pain management center in Phoenix, Arizona and consultant to National Medical Testing Supply (NMTS).  "With the US in the midst of a full onslaught pain medication epidemic, best practice pain centers are regularly being thought of as pill mills when in fact there are considerable differences."

 

Although many patients will purposely seek out pill mills for the obvious reasons, as busy medical professionals we certainly don't want to be referring patients to one or even thought of as one ourelves.  Here are the top 3 reasons pain management centers are different (in a good way) from your standard Pill Mill: 

 

 1. Quality of Doctors

a. Pill Mills frequently utilize physicians who do not have formal pain management training. They are usually neither fellowship trained in pain nor board certified. Due to this, they may not understand the best practices for handling comprehensive pain management for patients. Comprehensive pain management practices, on the other hand, are able to incorporate doctors with specific training who know methods to prevent narcotic tolerance. It can make all the difference in a patient getting off narcotics versus one spiraling out of control with narcotic doses appropriate for a horse.

2. Surveillance Methods

a. Pill Mills are often so busy running a high volume through the practice they often neglect to properly monitor their patients. There are 3 methods that are highly effective as a trio for monitoring, which are frequently utilized in comprehensive pain centers. One is pain agreements, which involve the patient signing that if he or she does not abide by the rules, then he or she may be fired from the practice. This may involve agreeing to pill counts, showing up for appointments, showing up for physical therapy, procedures, etc.

b. Second, monitoring the state pharmacy board is a vital tool in detecting "doctor shopping." Over 30 states have this in place, and the practice can check each patient for where they've been getting their medication. It does take a few minutes, which may be more than what Pill Mills are willing to include on each patient's visit.  

c. Third, drug testing is an important component of patient adherence to treatment. If patients are on Oxycodone, their urine should reflect that when they take a test at the office. Not only that, it looks for illicit drugs as well, so if they are trading their prescribed medication for heroin or cocaine and using those drugs they will show up. Drug testing will also protect the practice from potential legal issues as well. More and more medical boards are highly recommending drug testing, and the DEA has ramped up their efforts in tracking down prescribing doctors. It's a way of monitoring the patient and showing diligence on the part of the practice to detect non-compliance.  

3. Additional Services.

a. Pill Mills are typically a factory type setting, where patients are run through the system in high numbers. If a normal pain doctor sees 40 patients a day, a pill mill may try and hit 100. But Pill Mills do not usually offer any additional services outside of seeing patients such as physical therapy.  

b. Comprehensive pain centers, on the other hand, offer these services. They may include interventional pain management, physical therapy, chiropractic treatment, holistic treatment, or spinal decompression. These treatments may be able to increase a person's functional capacity while decreasing the amount of narcotics needed.

These three main factors differentiate comprehensive pain management centers from Pill Mills. By combining all of them, these pain centers can actually help individuals decrease the amount of narcotics being taken.

It may sound like an overwhelming and daunting task, but in essence these are very simple steps to take.  Most Pain Management doctors are already taking these steps or have at minimum thought they need to implement something similar.  And if you are a really cutting edge doctor you have already realized that adding drug testing to your practice will add a very lucrative revenue stream to the bottom line while setting you apart from a pill mill and just plain doing the right thing.

 

Sherry L Krueger – Executive Director

Healthcare Networks of America

 

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