I love stirring the shit pot, so here is one about the potential for Suboxone clinics which are outpatient opioid addiction centers. With the recent opioid addiction (blamed on doctors), it’s an interesting topic to revisit.
Opioids include opiates and so you can treat damn near any addiction related to 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 have to be seen regularly. There are all sorts of regulations which you’ll have to meet in order 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 2000’s?
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. Turns out, they were actually keeping a lot of patients from turning towards 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.
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 max number of patients you can have under MAT, it’s possible to earn $50,000/month. Or a little under $700k/year.
This is assuming you have the maximum number of patients (275) and you are only getting 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 their 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 the 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 the access which is 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 CME’s.
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 aint 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. You’ll be miles ahead and ready to take your case before the media if the medical board oversteps their reach.
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 it much more likely to find an attorney who specializes in such matters.
Should a patient with an opioid addiction be placed on more opioids? That’s the kind of moral judgement 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 for 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.