Can you be fined and have action taken against your license for following CMS Opioid guidelines? According to Modern Medicine Network, you can:
“In a recent case, the New Hampshire Board of Medicine investigated a physician who is board certified in pain management and anesthesiology after cutting back a chronic pain patient’s prescription opioid painkillers. The patient had been on a dosage of 80 mg of OxyContin twice daily and 30 mg of oxycodone four times a day for many years. After apparently reviewing the guidelines put out by CMS, which the physician read as allowing doctors to prescribe only up to 90 morphine milligram equivalents a day (MME), the doctor informed the patient he was reducing his dosage to comply with those guidelines. This reduction was less than one-quarter of what the patient had been taking (equivalent of 420 MME).”
The physician was found to have violated ethical standards of professional conduct as a result. The guidelines are only guidelines and physicians should be cautious in following them blindly, but in other areas, it is true that regulatory agencies have treated “guidelines” as mandatory. The key is to have excellent documentation of decision-making for exceeding the guidelines, including obtaining second opinions. The article also recommends the following which is good advice:
Have a clearly defined prescribing policy to follow both within the practice and with the patient. Establish strict documentation requirements and mandate continuing education for physicians in the area of pain management.
Have a plan of action for a patient who is noncompliant despite the physician’s exercise of his or her professional opinion when prescribing. This may mean referral to another pain physician for a second opinion or referral to an addiction specialist. Sometimes, patients do need to be terminated from the practice for noncompliance and/or activity that puts both the patient and the physician at risk. Being able to identify these different types of patient situations, and documenting all decisions appropriately, is key.