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Proposed patient limit raised to 275. ASAM applauds important action to help close addiction treatment gap.

by ASAM Staff | July 6, 2016

HHS Will Raise DATA 2000 Patient Limit to 275!

ASAM applauds important action to help close addiction treatment gap

FOR IMMEDIATE RELEASE

CHEVY CHASE, MD,  JULY 6th, 2016 - The Obama Administration announced today that it will raise the limit on the number of patients with opioid addiction that certain physicians can treat with buprenorphine to 275. ASAM applauds this long-overdue policy change as an important step to help combat the current epidemic of opioid addiction and overdose deaths and urges the Department of Health and Human Services to evaluate the rule’s impact on treatment access, diversion, health care costs and clinical outcomes to inform future changes to the patient limit. 

“For too long, addiction specialists like me have had to turn patients in need away from treatment that might save their lives, not because we don’t have the expertise or capacity to treat them, but because of an arbitrary federal limit,” said Dr. Jeffrey Goldsmith, President of the American Society of Addiction Medicine (ASAM). “It has been heartbreaking to tell patients and their families that my hands are tied, and to see them continue to suffer from a treatable disease. ASAM physicians are grateful that we won’t have to say that quite as often anymore.”

ASAM advocated for several changes to the proposed rule that was issued in March, and the final rule issued today reflects the concerted advocacy of ASAM members, allied organizations and other stakeholders eager to see the Administration make a meaningful impact on the epidemic. In addition to raising the proposed patient limit from 200 to 275, the final rule revised the qualifications for the higher limit to include board certification in addiction medicine or addiction psychiatry from the American Board of Addiction Medicine (ABAM) or the American Board of Medical Specialties (ABMS) or certifications by the American Osteopathic Academy of Addiction Medicine, ABAM or ASAM. Additionally, the Administration delayed implementation of the proposed reporting requirements to seek additional comment before finalizing them.

“This new rule is a critical part of a comprehensive response to the current public health crisis we are facing. It takes an important step toward closing the well-documented addiction treatment gap, but won’t be a cure-all,” said Dr. Kelly Clark, President-Elect of ASASM. “We look forward to continuing to work with the Administration and Congress to further increase access to treatment by removing arbitrary barriers to care.” ASAM is doing a careful analysis of the rule and will provide a more detailed summary in the next few days.

The final rule will be effective on August 5, 2016. 

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Contact: ASAM’s advocacy team at advocacy@asam.org

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The American Society of Addiction Medicine is a national medical specialty society of more than 3,900 physicians and associated professionals. Its mission is to increase access to and improve the quality of addiction treatment, to educate physicians, and other health care providers and the public, to support research and prevention, to promote the appropriate role of the physician in the care of patients with addictive disorders, and to establish Addiction Medicine as a specialty recognized by professional organizations, governments, physicians, purchasers and consumers of health care services and the general public. ASAM was founded in 1954, and has had a seat in the American Medical Association House of Delegates since 1988.

16 comments

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  1. Cleveland Paris Nov 01, 2018 - 10:10 AM

    Its too easy to fill a practice with a bunch of drug addicts when you're handing out their favorite drug. Since they've lifted the limit and started handing out the X license to nurses, the amount of Suboxone on the streets has exploded. There's a "Suboxone Doctor" on every street corner and its become the currency for drug addicts. Caviler prescribers are handing out 16mg per day scripts and the addicts are selling them on the streets for over a thousand per Rx. Cash Clinics are popping up all over the place. 

    I used to be able to keep these patients engaged in treatment using buprenorphine and now, they just walk out the door and go a block down the street to get a higher dose with no treatment requirements. Sad.

       
  2. April Aug 16, 2017 - 08:23 PM
    Seriously to the guy that thinks its okay to let addicts suffer because we deserve to, go crawl back under the rock you crawled out from under. It is insane to want an addict to suffer just because they made bad choices. I am an addict, and seeing ignorant comments such as that makes me think this world is full of nothing but people like you. I made bad choices but I am trying to turn my life around and Suboxone changed my life. Until you walk a mile in an addict's shoes, you are NOT allowed to judge us.
  3. Vythi Alagappan MD Jul 14, 2016 - 01:42 AM

    The simple fix  is to stop all the drugs  on the street. If the police is corrupt or afraid  for their lives  get the army guys come and  clean up one  town at a time. Within a month you will choke  the supply chain. Most of the addicts will go through horrible with drawl which they deserve as a consequence of their own chosen action. But at the end of that grueling time America will be  a  Drug free society.

    The system is  so rigged.

    The government is shedding crocodile tears.

    Putting more regulations  --PMP, E Rx and  limits  for acute  pain management are all fine. The  doctors are ready to helpteh government and do their job.

    No one  suggests to the government that the  problem is  so easily fixable.

    They don't want the  attorneys,th e judges and  the police  and  the entire prisosn system to lose their , "Business"

    Doctors also don't want to lose money.

    We made money on opiate prescriptions and  now on treating the problem which was  created

    Inefficiency  breeds  Jobs In America.

    Please  wake  up!

    Do the right thing which is  so easy

  4. Bruce S. Samuels, MD FACP Jul 12, 2016 - 08:40 PM
    I am a board certified internist. I got my X number 3/15 in 2-3 weeks I had 30 pts. I went to 100 4/16 I just got my 97 pt yesterday & by the end of the week I should have 100! I applaud the increase to 275, but why do I have to wait until 4/17? I get 1-2 calls a day from new pts that now I will have to turn away! I practice in a semi-rural area outside of New Orleans, La., the drug problem here is unbelievable, the pts. I see can't thank me enough for the way Suboxone has changed their lives for the better. At least the government tried
  5. B. Elliott III, MD Jul 12, 2016 - 08:31 PM

    I too am appalled at the idea of one physician treating 275 addicts!!

    No way good care can result.

    Please teach better assessment & better monitoring.

    Too much take home too soon & too few UDS's done in these " mills"!

  6. Dr. Sourbutt Jul 12, 2016 - 06:44 PM

    Drug policy in the US from the 1914 Harrison Act through the Reagan Administration "War on Drugs" shows government has ALWAYS been behind the curve. DEA ?...watch "Narcos" on Netflix to see how out of touch these bureaucrats are...many 100 wavered docs like myself are willing to step in and help...but it appears we have another turf war

  7. Debra Jul 12, 2016 - 04:35 PM

    I am a psychiatrist.  I have been using buprenorphine to treat patients since it was introduced.  At first I had 30 patients and then when the increase went to 100 I was easily able to increase this due to the high demand for treatment.  There were only 2-3 doctors in the whole state.  Now there are more doctors, yet the demand has continued to increase and now people are dying daily due to overdose with heroin or combinations of other opiates.  There continues to be a wait list in most offices in my area of AL.  My practice now has evolved to seeing nearly 85% of these patients every month.  I am not board certified; putting it off due to $$ and time constraints.  Now at 61 years of age it is not practical to do a fellowship.  Every year I attend both addiction, pain, and psychiatric conferences for continuing education.  Years of experience and continuing education is far greater than "taking a test" to prove appropriate levels of credentialing.  I think this should have been left in the "physician requirements".

    I also agree with many of the above comments.  What is the difference between 100 to 275 patients; especially if that physician has been giving excellent care for years?  Once again I have to say there is NO LIMIT on the amount of patients a pain doctor can see to my knowledge.  Myself and others are trying to help patients with a majority of the problem starting in the "pain clinic".

    I am very disappointed in this ruling and was hoping for something that was REALLY going to help the thousands of people who are trying to do this on their own "off the street" because they cannot find a doctor.

  8. Ken Starr Jul 12, 2016 - 11:37 AM

    I'm good with raising the limit. It needs to be done. I don't currently have even 100 patients so it hasn't been an issue for me. 

    What I don't understand is why specialized training such as Board Certification is required for 275 patients but not 100. If addiction is really a medical disease , how does the number of patients treated change the quality of care. 

    If you do 100 appendectomies a year you don't need to be a board certified surgeon, but if you do 275 of them a year you do....?  That's the guy who does it so much he's less likely to need the certification. 

  9. Jack Friedman,md Jul 12, 2016 - 10:50 AM

    What's this nonsense of limits. Should'nt the treating physician know who to treat and how much he wants to work while still giving good care.

    At first it made sense to limit while the technique was new and experience needed to be accumulated,but now and especially with the boarding IT MAKES NO SENSE.

  10. Peter Rostenberg Jul 12, 2016 - 10:31 AM
    The Final Rule was well thought out and respectful of those of us who offered comments.  I think it will improve/maintain high quality buprenorphine practices. Added responsibilities are appropriate for waivered doctors who seek increased patients. 
  11. jsmd Jul 12, 2016 - 10:06 AM

    As Gary commented, I am in total agreement. I run a private clinic where I supervise 7 other Drs. I am Board certified in Psych and by ASAM. I have no intention of increasing to 275 pts. I ensure that the new and sickest patients get as much care and are seen as often as needed where all pts pay a standard monthly fee that is not much more than the cost of a visit to see the cardiologist. This includes lab testings as well. There is no way I could see those clinic pts and an additional 175 of my own. I dont even really have 100 under my own care most months. To take care of 275 pts you must see about 14 pts every day 5 days a week. Good luck with that. The rule appears to read that a Dr Must meet "One of two requirements". It allows private Drs to continue increase if they are Board Certified or Drs who are not if they work in "an approved practice setting" and then it goes through 5-6 requirements for them including they take 3rd party payers.

    This is what happens when you get in bed with govt. They get to tell you who can pay you for your services? Last time I looked that was called restraint of trade. My brother the periodontist has it right. No govt 3rd party payments in fact none from any 3rd party payers. The day I am forced to do this is the day my clinic closes and the day 600 people loose their doctor who treats their opioid use disorder.

  12. Gary Jul 12, 2016 - 09:15 AM

    This a political "football."  We, that are in the "trenches," know the real truth about what takes to treat opiate dependent individuals.   I am practicing Addiction Medicine in New York.  I only treat with buprenorphine and have no other patients. I see my limit of 100 patients.  It takes me four full days a week to manage my patients.  The increase in patient load is going to increase my exposure,  my responsibility, my work load. It will bind me to more government regulation.  All for what reason?  This new regulation is not going to help the "solo" practitioner at all.  So, exactly who will benefit from this if solo practitioners would have to be out of their minds to meet all the requirements and then have to except Medicaid payment for their efforts.

    The key to making this a successful venture is to decrease the regulations, decrease all the "hoops" that insurers put the physician through to "prior-authorize" their patients every few months, and to increase the re-reimbursement.  One way you can increase re-reimbursement, for instance, is to allow the patient to pay out-of-pocket for their physician visits.  These patients pay anywhere from  $ 20.00 to $80.00  a day on their habit.  They can surely pay for a doctor visit a few times a month.  The patient needs to be a part of the solution!

    I have so much to say, but I'll stop here.  My first patient for the day has arrived.  

  13. David Lesxkowitz D. O. Jul 12, 2016 - 06:23 AM
    hi dr fox I spoke to  (michigan )Medicaid one of the directors and she told me it is ok for non Medicaid providers to Rx they will be filled. This conversation happened in response to their newletter stating otherwise
  14. Dr. M. J. Fox Jul 07, 2016 - 04:00 AM
    This is a political ruling. In my opinion this ruling was passed just to get funding from congress. In real world nothing will change. People who will get approval for increased numbers they will be more under scrutiny. So in short- administration achieved their goal: caring and addressing the epidemic. 
  15. Michael Fox Jul 06, 2016 - 09:40 PM
    get this thing done already.medicade in michigan will not honor rx from non medicade providers and to find one that can accept is impossible.
  16. H L Haus MD Jul 06, 2016 - 08:44 PM

    I called SAMSHA twice today and they said they are not ready to have this in place by 8/5/2016 that they still consider as proposals to increase since the form to increase has not been created.

    I was told  will take 90 days for them to get ready. Also DEA inspectors were not aware of the changes. so no change coming for awhile.

    Finally the use of IT is unclear and how many insurances must be accepted. At $30 a visit from MA most practices can not even break even.

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