“90 Day Rule” Causing Pain Management Costs to Rise

Aimed at better and more effectively regulating the “Pill Mills” we’ve all heard about, the Georgia Pain Management Clinic Act (the “Act”) became effective on July 1, 2013.  The legislation amends O.C.G.A. Chapter 34 of Title 43 and represents a move towards remedying the ongoing prescription pill epidemic in Georgia. While most know that said regulations govern those being treated for pain with Schedule II and Schedule III medications for more than 90 days, most do not know that the Act does not include hospice, nursing home, perioperative or in-patient hospital patients.

More specifically, the Act requires that when a doctor prescribes a Schedule II or Schedule III controlled substance for ninety (90) days or greater to treat chronic pain arising from non-terminal conditions, a physician must have a written treatment agreement with the patient and shall require the patient to have a clinical visit at least once every three (3) months to evaluate the patient’s response to treatment, compliance with the therapeutic regimen, and to review any newly arising condition that may have developed and been masked by the use of Schedule II or III controlled substances.  The regulations do provide for a hardship exemption.

For physicians prescribing Schedule II or III substances for chronic pain for greater than 50% of their annual patient population, documentation demonstrating competence in pain management must be provided to the Georgia Composite Medical Board.  The Act also offers the Georgia Composite Medical Board the ability to license and regulate pain management clinics as well as to establish minimum standards for prescribing controlled substances for pain management.

Fundamentally, this legislation is a step in the right direction for the regulation of the “Pill Mills” that have long plagued our great state.  From a workers’ compensation perspective, this may help to limit the long-term effects of the dreaded pain clinic referral by adding stricter rules to these often-unchecked practices.  Rather than simply allowing such a referral and subsequent treatment to go on indefinitely, the Act has had the indirect effect of creating checks and balances for these practices.  Accordingly, when you have a claimant that has been provided with a pain management referral, it is both important and useful to make sure that the appropriate regulations are being followed.  One such strategy would be to request a copy of the written treatment agreement with the patient and to follow-up with the pain clinic to ensure that the appropriate evaluations are being completed every ninety (90) days.

Of course, an additional effect of this legislation has been the burden that has been placed on physicians prescribing narcotics.  As a result of the costs and resources associated with compliance under the Act, many physicians have chosen to discontinue treatment after the initial ninety (90) days, instead referring patients to pain management clinics.

Having worked in the workers’ compensation arena at all, one would truly need to ignore the obvious in order to not recognize the many issues surrounding Schedule II and III controlled substances in Georgia.  Overall, this legislation is a good thing from a defense perspective, again, because the harsher requirements will hopefully eliminate the more nefarious “Pill Mills” on the fringe, replacing them with more accountable and reputable physicians running practices aimed at healing patients rather than enabling their addictions.