I love stirring the shit pot, so here is one about the potential for a Suboxone clinic business, an outpatient opioid addiction center.
With the recent opioid addiction (blamed on doctors), it’s an interesting topic to revisit. This article was initially written before our virus-induced health crises. And it’s sad to see the devastation from Fentanyl in the US.
Opioids as a Business
Opioids include opiates and so you can treat damn near any addiction related to the activation of the opioid receptors in the body. If the patient meets the criteria for opioid addiction, you can treat them.
Primary care doctors and non-addiction medicine specialists can treat opioid addiction, unlike the old methadone days. All you need is an 8-hour course to be licensed to do this.
Suboxone is dispensed from your clinic, and the patients must be seen regularly. There are all sorts of regulations that you’ll have to meet to be a bonafide opioid addiction clinic.
The HHS has a division called SAMHSA which regulates the administration of buprenorphine under their MAT (medication-assisted treatment) as an OTP (opioid treatment program).
The Drug Addiction Treatment Act of 2000 (DATA 2000) is what opened this little window for any physician to start a suboxone clinic. Remember how popular they used to be in the mid to late 2000s?
Then, the medical boards started coming down hard on doctors who were giving out suboxone. They would do random chart audits, and doctors who didn’t fall under the strict scrutiny of DATA 2000 would have their lives turned upside down.
The Opioid Epidemic
Then we hit the opioid epidemic years, and now all of a sudden, those “blood-sucking doctors” are in desperate demand and in short supply. It turns out they were actually keeping many patients from turning toward the much more potent fentanyl street drugs.
But now we only have about 6-8% of doctors who are certified to give out Suboxone. And a recent study showed that despite decent Medicaid reimbursement for this condition, 50% of patients couldn’t find a doctor.
We have approximately 30,000 people dying in the US from opioid addiction. And Medicaid is willing to pay, but no doctor wants to sign up for MAT. I’m sure the medical boards had nothing to do with this. And this is where the opportunity arises.
Setting up a Suboxone Clinic
I don’t own a Suboxone clinic. So if you want exact numbers, don’t rely on my research. However, looking at CMS reimbursement rates and the maximum number of patients you can have under MAT, earning $50,000/month is possible. Or a little under $700k/year.
This is assuming you have the maximum number of patients (275) and only get the minimum payment of around $50/week/patient. There are a lot of reimbursement structures you can review and they are somewhat state specific.
Each state treats its Suboxone program differently. In some states, Medicaid pays for 50% of those patients, and in other states it’s an abysmal 7%. But you don’t have to have a purely Medicaid model.
Many states also pay for the medications and the office visit, and the initial treatment. It can add up handsomely.
Telemedicine can be used to maintain follow-up with such patients. It certainly can’t be used for the initial evaluation, but it’s a very effective and cheap way to maintain access demanded by federal regulations.
If you meet at least one of these criteria listed by SAMHSA then you can open your own Suboxone clinic. For most of us it would mean taking an 8-hour course – for which you get CMEs.
You must agree to treat at least 100 patients and can have only 30 patients at a time. Later – after about a year – you can request an increase to the max number of patients, which is around 275.
The Medical Board Stigma
The first logical question is, why the fuck would you want to get on your state medical board’s radar?! Especially for something like opioids! We all know that the medical boards hate the shit out of opioids and marijuana.
The kind of person who goes to enforce rules in a medical board is a hardcore religious or entitled person who thinks that they have the right moral compass to rule medicine.
In fact, this is exactly why it makes sense to have a Suboxone clinic. You know exactly the kind of game you’ll be playing. And as long as you stick to all of the criteria set forth by the federal guidelines, there ain’t shit medical boards can do to you.
In fact, you’ll be lawyered up ahead of time. You’ll submit your own chart audits to your state medical board. If the medical board oversteps its reach, you’ll be miles ahead and ready to take your case before the media.
A big advantage for anyone considering a Suboxone clinic is that the FSMB has a position statement on this topic. Even though states don’t have to accept the Federation of State Medical Board’s stance, they are likely to follow it.
This is helpful because it makes finding an attorney specializing in such matters much more likely.
Should a patient with an opioid addiction be placed on more opioids? That’s the kind of moral judgment I cannot make. I’ve never been addicted to anything so I’m useless to comment on it.
There is a lot of solid research on opioid addiction and the use of suboxone. Is it bullshit? Is it legit? No idea. But the research is there, which legitimizes the process.
Some of you sensitive types reading this might think me heartless to only talk about the money aspect of a Suboxone clinic. The reason is that I’m a physician, the clinical side, the helping side, all that other fluff – that’s already assumed under my medical license.
Or, perhaps not.
My own recent medical board issues revealed that my intention as a physician is completely irrelevant. Only my actions were taken into account.
So if you are opening a Suboxone clinic with the good intention of helping patients, you might be at a higher risk. If you’re doing it because you understand the laws and rules and know how to navigate them, you can make a healthy profit.
A Proper Opioid Addiction Clinic
In my opinion, opioid addiction begins with adverse life experiences which prime the nervous system for addiction. This phenomenon isn’t as much genetic or inherent as it is a byproduct of stress, trauma, and the inability to develop healthy coping.
Access for a person in an opioid crisis is incredibly important. There are windows in which the individual is willing to seek help, and that window is critical.
In previous articles, I discussed having a Psych Urgent Care as a great access source for those with psychiatric or substance abuse crises. This is timely access and can be a lucrative business model for physicians.